Lunchtime COVID19 Reading, 16-Mar-2020
Lunchtime COVID19/SARSCoV2 (coronavirus) reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crisis and preparations for it. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laiety. ALWAYS prioritize advice from qualified healthcare experts over some person on Facebook.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
You are welcome to share this.
--
The University of Basel has an excellent simulator that allows you to chart both the healthcare system impact and duration of the pandemic in your nation, or with custom data. Using the US, with 994,000 hospital beds and 50,000 ICU beds, and a fast these are the outcomes.
Weak mitigation (what's happening now): Peak in early June. ~100M infections, 1.76M casualties.
Moderate mitigation (widespread social distancing, business closures, restricted travel): Peak in mid to late June. ~100M infections. 1.27M casualties.
Strong mitigation (complete societal shutdown, Wuhan style): Peak December. ~35M infections. 171,000 casualties.
Source: https://neherlab.org/covid19/
Right now, we are at weak mitigation. The sooner we move to moderate mitigation, the better - every day counts. Most non-authoritarian governments cannot implement strong mitigation.
--
Dr. Anthony Fauci on lockdowns: "I think Americans should be prepared that they're going to have to hunker down significantly more than we as a country are doing."
Source:
Transcript: https://otter.ai/s/uy-NQVJgT4W_jyZSvEfM-g
America is at weak mitigation. Do your part, encourage others to do the same, and acknowledge - and plan for - a scenario where we stay at weak mitigation, with the consequences that entails. Protect your vulnerable loved ones as best as you can.
--
Dr. Scott Gottlieb on the healthcare system's surge capacity: "In Wuhan, they hospitalized about 20,000 people; 10,000 were in serious or critical condition and 2,000 were intubated. To give you a basis of comparison, New York State, the entire state has 50,000 hospital beds and about 3,000 critical care beds. And about 20,000 of those beds are in New York City. So if we have a WuHan style outbreak in New York City that's going to overwhelm the system. So they need to be building surge capacity right now, in anticipation of that possibility. Right now if you look at some of the good research out of Fred Hutch by Trevor Bedford and others, they're they're saying that there's probably 10 to 40,000 cases right now distributed across the US, I think the risk that we have in the US is we're a much more mobile population, China was able to confine their app epidemic largely to WuHan."
Source:
Transcript: https://otter.ai/s/TQKf2UB_SJK_OHFYJKNwxg
Preventing the healthcare situation from escalating is the primary objective right now. The reason countries like Italy have had so many fatalities is not because they have bad healthcare, but because they are overwhelmed and people who could be treated normally are not able to be treated.
--
Should schools be closed? Dr. Nicholas Christakis says yes, and they work. "There have been a number of studies that have looked at reactive closures. These analyses, including a paper in Nature in 2006 using math models [of an influenza pandemic], typically find that such reactive school closures for a moderately transmissible pathogen reduces the cumulative infection rate by about 25% and delay the peak of the epidemic [in that region] by about 2 weeks. When you postpone the peak, you also typically flatten the epidemic and space out your cases. This has value. It means that the incidence on any given day is lower, so we don’t overburden our health care system."
Source: https://www.sciencemag.org/news/2020/03/does-closing-schools-slow-spread-novel-coronavirus
School closures work. Even a 25% reduction in transmissibility is a wonderful thing - so if schools in your region aren't closed yet, expect that to happen.
--
There is no evidence that ibuprofen and other NSAIDs make COVID19 worse, according to Dr. Marc Lipsitch.
Source:
As JHU outlined in Event 201, misinformation is just as much of a problem during this pandemic as the actual disease. That graphic floating around telling you to gargle salt water, etc. because the virus likes dry environments? It's excremento de toro, as the Spanish would say. Your nose and throat are ALWAYS wet to a varying degree. Yes, drink water just because it's healthy, but it's not going to impact your vulnerability to the virus one way or another. Same for claims of pretty much every kind. This is a novel - new - disease. No one has immunity, and the only thing you can sensibly do is keep yourself as healthy as possible.
--
Critical care cases in Italy spiked to 16% in its outbreak, compared to 5% in China according to the Journal of the American Medical Association. "There was an immediate sharp increase in ICU admissions from day 1 to day 14. The increase was steady and consistent. Publicly available data indicate that ICU admissions (n = 556) represented 16% of all patients (n = 3420) who tested positive for COVID-19. As of March 7, the current total number of patients with COVID-19 occupying an ICU bed (n = 359) represents 16% of currently hospitalized patients with COVID-19 (n = 2217). All patients who appeared to have severe illness were admitted for hypoxic respiratory failure to the COVID-19 dedicated ICUs."
Source: https://jamanetwork.com/journals/jama/fullarticle/2763188
One note from an article on Statnews is that albuterol (ventolin) and epinephrine are in short supply. If you rely on either, be sure your prescription is filled. If we hit 16% critical care cases, there will be none to be had.
Source: https://www.statnews.com/2020/03/14/coronavirus-hospital-workers-present-sharply-different-pictures-of-preparedness/
--
Dr. Florian Krammer says immunity seems suggested after we have the disease. "Good news. Rhesus macaques seem to be immune to re-challenge with SARS-CoV-2. This suggests that we are also immune once we clear the infection (serology in humans points in same direction). Not sure how long immunity lasts but likely for months or years."
Source:
This is excellent news. There's been rampant speculation that we wouldn't be immune to COVID19, and this suggests we will be.
--
Dr. Francois Balloux demonstrates the importance of keeping livelihoods as we save lives: "Health and the economy are closely linked. The correlation between per-capita GDP and health (life expectancy) is essentially perfect. If the covid-19 pandemic leads to a global economy collapse, many more lives will be lost than covid-19 would ever be able to claim."
Source:
Lives and livelihoods are entangled. We have to balance both.
--
The biggest spreaders of COVID19 in South Korea? People age 20-29. While they were not hardest hit, they were the biggest vectors of infection because they did not adhere to social distancing.
Source: http://ncov.mohw.go.kr/upload/viewer/skin/doc.html?fn=1584234233260_20200315100353.pdf&rs=/upload/viewer/result/202003/ (in Korean)
Stay home. Stay home. Stay home. And communicate that to anyone who believes that just because they're young and healthy, they don't have to obey social distancing.
--
A reminder of the simple daily habits we should all be taking.
1. Wash/sanitize your hands often. Have a bottle of hand sanitizer on your belt, bag, purse, whatever and use it when out and about in public every 15 minutes whether you need it or not.
2. Wash/sanitize before touching any part of your face for any reason.
3. Avoid large crowds. Period. Any group over 25. Stay home as much as practical.
4. Avoid in-person interaction with anyone at risk, without exception. Video call instead of visit.