Lunchtime Pandemic Reading 14-April-2020
second half of 2021
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.
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A paper leaked from investment firm Morgan Stanley is making the rounds. "We see a slow return to work with US cases peaking in ~50 days. We expect social distancing reductions in June as diagnostic/serology testing are widely available and hospital capacity is extended. Variable levels of social distancing will remain until a vaccine is widely available in Spring 2021."
Source: https://www.dcba-pa.org/UserFiles/files/events/Biotechnology_%20COVID-19_%20A%20Prescription%20To%20Get%20The%20US%20Back%20To%20Work.pdf
Much of the paper contains data that we've been sharing together since late January, so congratulate yourself: you've been ahead of one of the largest investment banks in the world, in terms of being in the know.
For perspective, approximately 0.02% - 2 in 10,000 - have had the disease thus far. That means 9,998 people out of 10,000 have not - a forest full of dry tinder awaiting the next spark. Herd immunity with a disease at R0 of 3-4 (the earlier R0 of 2.4-2.7 is now contested because of probable Chinese underreporting) means that 80% of the population (8,000 out of 10,000) must have had the disease or antibodies from vaccine to achieve herd immunity. 2 versus 8,000 is a BIG gap to close, and to make it manageable, we'll be doing some form of containment until a vaccine is generally available and affordable.
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To give you a sense of vaccine timing, via Stat News: "he French drug giant Sanofi said Tuesday that it plans to use technology from GlaxoSmithKline to accelerate the development of its experimental vaccine against the novel coronavirus, SARS-CoV-2. Sanofi and GSK said in a statement that the vaccine would be ready to begin testing in humans in the second half of 2020 and that they aim to complete all of the work required to file for regulatory approval by the second half of 2021. The new vaccine will combine a vaccine technology that Sanofi currently uses to make a flu vaccine, FluBlok, with GlaxoSmithKline’s adjuvant, an additive that increases the potency of vaccines, making them more likely to be effective and easier to manufacture in large quantities."
Source: https://www.statnews.com/2020/04/14/glaxosmithkline-sanofi-coronavirus-vaccine-collaboration/
Give that some thought. These are two of the largest pharmaceutical companies on the planet. They will have access to, if their vaccines pass all clinical trials, literally billions of dollars from governments around the world. And the soonest they're saying they hope to get regulatory approval is the second half of 2021.
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Supply chain issues continue to plague the food industry. The NY Times warns of additional disruptions: "The spread of the virus through the food and grocery industry is expected to cause disruptions in production and distribution of certain products like pork, industry executives, labor unions and analysts have warned in recent days. The issues follow nearly a month of stockpiling of food and other essentials by panicked shoppers that have tested supply networks as never before. Industry leaders and observers acknowledge the shortages could increase, but they insist it is more of an inconvenience than a major problem. People will have enough to eat; they just may not have the usual variety. The food supply remains robust, they say, with hundreds of millions of pounds of meat in cold storage. There is no evidence that the coronavirus can be transmitted through food or its packaging, according to the Department of Agriculture. Still, the illnesses have the potential to cause shortages lasting weeks for a few products, creating further anxiety for Americans already shaken by how difficult it can be to find high-demand staples like flour and eggs."
Source: https://www.nytimes.com/2020/04/13/business/coronavirus-food-supply.html
Every supply chain has time lags built into it. Expect to see the change in meat in the next couple of weeks. Without hoarding, buy a little in advance. If your supermarket, as many do, has restrictions (limit of X per customer) obey those restrictions, but go ahead and buy the maximum permitted amount of anything that is a favorite of yours. When I shop, I typically buy two of everything essential whether I need it or not, so that if a shortage hits that item, I've got some backup.
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Dr. Emma Hodcroft warns strongly against lifting restrictions. "While the restrictions currently in place are damaging economically & socially, they are *working* - & saving lives. There seems to be a bit of a fantasy that because things 'aren't so bad now,' we can start lifting restrictions & things will just be 'normal' again. I cannot emphasise enough how much this *is not the case*. Restrictions are working - the minute we ease them, the virus will quickly regain ground! There is no short cut way #COVID19 isn't going to continue to cost a lot. But we have a choice in *where* those costs are. The virus isn't less dangerous now: we are stopping it with restrictions. As soon as we relax, the virus *will* return - if we do nothing, it will kill millions & hospitalise millions more. Do we really think the economy will be 'normal' through this?"
Source:
The politicians are eagerly rushing to reopen society. Absent current restrictions, that strategy will kill millions of people. Dr. Fauci, on PBS, said that the lack of transparency from China caused lost time and drastic underestimation of how easily spread COVID19 is. It's not less dangerous now, and removing restrictions will be like throwing matches on the rest of the bone-dry forest.
Source: https://www.aei.org/foreign-and-defense-policy/dr-fauci-china-delayed-our-understanding-of-covid-19s-efficient-transmissibility/
And an additional perspective:
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SARS-CoV-2 appears to be far more asymptomatic than initially thought. According to NEJM:
"Our use of universal SARS-CoV-2 testing in all pregnant patients presenting for delivery revealed that at this point in the pandemic in New York City, most of the patients who were positive for SARS-CoV-2 at delivery were asymptomatic, and more than one of eight asymptomatic patients who were admitted to the labor and delivery unit were positive for SARS-CoV-2. Although this prevalence has limited generalizability to geographic regions with lower rates of infection, it underscores the risk of Covid-19 among asymptomatic obstetrical patients. Moreover, the true prevalence of infection may be underreported because of false negative results of tests to detect SARS-CoV-2."
Source: https://www.nejm.org/doi/full/10.1056/NEJMc2009316
This is a surprising number to many, that 87.6% of coronavirus infections in this broad surveillance were asymptomatic. Those people had no idea they were carrying and spreading the virus.
Masks on, any time you're around other people. This virus is like an iceberg - you only see a tiny bit of it.
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Virtual healthcare has become a necessity, according to The Lancet. "Eric Topol, director of the Scripps Research Translational Institute in La Jolla (CA, USA), praises these efforts, but laments that they have been so long coming. “This is a very big moment for virtual health care. But, of course, there isn't a lot of readiness. There are so many ways to monitor people's health that we aren't doing at any scale, in large part due to interstate regulatory barriers that have meant we are in no way ready for this moment.”
Similar steps to sweep aside regulatory and hegemonic professional barriers are being taken in Canada, according to Sandy Buchman, president of the Canadian Medical Association. “As we confront [COVID-19], we're racing to implement virtual health-care technologies as quickly as we can. The scale and pace of change is unprecedented for Canadian health care.”"
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30818-7/fulltext
The race to virtualization opens new possibilities as well. Right now, significant barriers exist to working with providers outside specific service areas, especially in the United States. As the planet goes virtual for care, it opens the possibility - if we're ready for it - to find the best care possible, wherever we are. I would expect, of course, substantial interference from for-profit entities, but the fact that it exists now at such a broad scale means putting the genie back in the bottle will be quite difficult. Some people, especially in the United States, may find it more cost effective to pay cash out of pocket to a provider in, say, Indonesia, than to pay healthcare premiums in the United States, at least for routine care. The times, they are a'changin.
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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/