Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crisis and how to manage it. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. 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.
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I hope the photos of mass graves being dug in New York City is what finally convinces people to take this thing seriously.
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Excellent pandemic workaround suggestions from NEJM: "Medical students in their third and fourth years who are no longer in clinical rotations can help expand the workforce by performing various medical tasks to free up clinicians for Covid-19 care. They can, for example, triage and assess patients, collect and analyze data needed for institutional decision making, and perform administrative tasks. Hospitals have suspended students’ access to their facilities in order to preserve scarce supplies and focus on their care delivery mission. But because students need clinical skill development and clinical hours to satisfy graduation requirements, it’s important to find ways to adapt these restrictions to avert a bottleneck in the educational pipeline. Tens of thousands of U.S. students in the final semester of their education program could help create surge capacity and sustain the workforce if the pandemic is prolonged."
Source: https://www.nejm.org/doi/full/10.1056/NEJMp2006376
Surge capacity is something the tech world has long understood, but hospitals and healthcare have a much longer time to surge staffing. Anyone can become an Uber driver in a short period of time; anyone can become a medical doctor, but it takes much, much longer. NEJM's arguing for common sense measures to get people who are qualified for at least some tasks into the workforce to help out, until the surge ends.
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A roundup of measures authorities can take for dealing with the pandemic. "Third, stay-at-home restrictions are unlikely to be a one-shot deal. Disease prevalence will spike and abate. There is emerging consensus that a graduated approach to restrictive measures will be needed — one that permits a return to some social and economic activity while avoiding undue stress on medical resources and allowing population immunity to build gradually. Such an approach is a far cry from quarantine law’s more binary paradigm of lockdown followed by an all clear signal."
Source: https://www.nejm.org/doi/full/10.1056/NEJMp2007637
The binary approach is what governments and politicians are advocating for, an obvious "OK, we're done, go party!" and that's wishful thinking until 80% of the planetary population is immune to the disease. A vaccine is the only long term approach that will work for this disease, so expect the "new normal" to evolve over months and years. There's no going back to the world that existed prior to 2020 without that vaccine.
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The Lancet urges that we not de-identify study data based on gender. "SARS-CoV-2 does not discriminate, but without careful consideration, the global response to the COVID-19 pandemic might. Demographic data from small studies are already informing political decisions and clinical research strategies. Women and men are affected by COVID-19, but biology and gender norms are shaping the disease burden. The success of the global response—the ability of both women and men to survive and recover from the pandemic's effects—will depend on the quality of evidence informing the response and the extent to which data represent sex and gender differences. Women carry a different kind of burden from COVID-19. Inequities disproportionately affect their wellbeing and economic resilience during lockdowns. Households are under strain, but child care, elderly care, and housework typically fall on women. Concerns over increased domestic violence are growing. With health services overstretched and charities under-resourced, women's sexual and reproductive health services, as well as prenatal and postnatal care, are disrupted."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30823-0/fulltext
A pandemic - every crisis, really - amplifies what's already there. Good becomes great. Bad becomes worse. Inequalities widen. The most important thing we can do as people dealing with data is to ensure we're doing our best - and holding our leaders accountable to do their best - to avoid bias and reinforcing existing structural inequalities.
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The Lancet also urges that palliative care not be an oversight or add-on to pandemic care: "WHO has issued guidance on how to maintain essential health services during the pandemic, highlighting immunisation, maternal care, emergency care, and chronic diseases among others, but there was no mention of palliative care. This was an oversight. Indeed, palliative care ought to be an explicit part of national and international response plans for COVID-19. Practical steps can be taken: ensure access to drugs (such as opioids) and protective equipment, consider a greater use of telemedicine and video, discuss advance care plans, provide better training and preparation across the health workforce, and embrace the role of lay carers and the wider community."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30822-9/fulltext
Palliative care - meaning the care you receive before dying - is an undiscussed part of medicine because so many of us are uncomfortable with it, with discussing our own demise or the demise of our loved ones. Unfortunately, that also means that when the inevitable happens, we're ill prepared for it and may suffer more than is necessary. Healthcare providers can do what they can, but we should also all be prepared to specify what is and isn't acceptable for ourselves in treatment, from do not resuscitate orders to the use of painkillers, and even, depending on the laws in your jurisdiction, whether you can opt for assisted suicide.
At the very least, make sure your own affairs are in order, whether you need it or not, whether you're low or high risk. In the end, you can spare your loved ones from suffering if you've got a plan in place. Get all that taken care of, if you haven't already.
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STAT News reports that ventilators may be unnecessary in some cases and urges more investigation. "What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen. That is making critical care physicians suspect that blood levels of oxygen, which for decades have driven decisions about breathing support for patients with pneumonia and acute respiratory distress, might be misleading them about how to care for those with Covid-19. In particular, more and more are concerned about the use of intubation and mechanical ventilators. They argue that more patients could receive simpler, noninvasive respiratory support, such as the breathing masks used in sleep apnea, at least to start with and maybe for the duration of the illness."
Source: https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/
There's still so much we don't know, but if you use devices like CPAP and other breathing technology, make sure you have an appropriate amount of parts and supplies. Be sure that such device usage is noted in your medical records, in case you are hospitalized.
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South Korea is investigating an unusual phenomenon of people who recovered testing positive again. "About 51 patients classed as having been cured in South Korea have tested positive again, the CDC said in a briefing on Monday. Rather than being infected again, the virus may have been reactivated in these people, given they tested positive again shortly after being released from quarantine, said Jeong Eun-kyeong, director-general of the Korean CDC. “While we are putting more weight on reactivation as the possible cause, we are conducting a comprehensive study on this,” Jeong said. “There have been many cases when a patient during treatment will test negative one day and positive another.”"
Source: https://www.bloomberg.com/news/articles/2020-04-09/coronavirus-may-reactivate-in-cured-patients-korean-cdc-says
I've seen this story shared a lot. The important part to emphasize is that we DO NOT KNOW why this is happening, and thus we cannot draw any conclusions from it until we have clinical data, evidence, to make decisions. Don't let it panic you.
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Is there any good news in this? Yes. Dozens of clinical trials are already underway. You can see a list of them here:
https://clinicaltrials.gov/ct2/results?cond=COVID&term=&cntry=US&state=&city=&dist=
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A reminder of the simple daily habits we should all be taking.
1. Wash/sanitize your hands often, and every time you are in or out of your home for any reason. Consider also spraying the bottoms of your shoes with a general disinfectant (alcohol/bleach/peroxide) when you return home.
2. Wear gloves and appropriate protective equipment if you have it when out of your home in any enclosed airspace (stores, etc.).
3. Stay home. Just stay home.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/