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.
--
More excellent commentary on the lack of proof that ibuprofen and COVID19 conflict by Kai Kupferschmidt from Science Magazine and WHO: "Really brief update on the situation regarding #covid19 and ibuprofen, since there are now news circulating that @WHO is warning against using ibuprofen. I just got off the phone with them, and to say they are warning against using ibuprofen is at best stretching the truth."
Source:
Trust, but verify is the mantra. I'm in a couple of different Facebook Groups related to COVID19 and it's astonishing how fast bad information spreads. Verify with trusted medical professionals and experts. Here's the thing about a lot of medical information: it's complex and information-dense. If a piece of news has no nuance, no extensive discussion, no shades of grey, it's probably at least partially untrue. Dig deep.
--
Via the Imperial College of London, social distancing may need to flex, but will be needed for up to 18 months (until the arrival of a vaccine): "We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound."
Source: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/
This may be going on for quite some time. Dr. Anthony Fauci said that we may have therapeutics - drugs that can help lessen the impact of COVID19 - in as little as 3-6 months, but a vaccine is 12-18 months away. We will need to keep social distancing until these pharmaceutical countermeasures are available.
Source:
(19 minute mark)
--
The University of Pennsylvania has an excellent model for any hospital to use that takes local cases of COVID19 and helps hospitals plan for if/when their capacity could be overwhelmed:
Source: https://www.statnews.com/2020/03/16/coronavirus-model-shows-hospitals-what-to-expect/
Model: http://penn-chime.phl.io/
Social distancing is the only way to help our hospitals avoid being overwhelmed. Share this with anyone you know working in hospital administration so that they can run it for themselves - it'll tell them how long they have to build extra capacity and procure extra equipment, as well as institute triage procedures.
--
On the social science front, how telling people they didn't need masks backfired as a communications strategy, via the NY Times. "As the pandemic rages on, there will be many difficult messages for the public. Unfortunately, the top-down conversation around masks has become a case study in how not to communicate with the public, especially now that the traditional gatekeepers like media and health authorities have much less control. The message became counterproductive and may have encouraged even more hoarding because it seemed as though authorities were shaping the message around managing the scarcity rather than confronting the reality of the situation."
Source: https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html
I agree that the communications were jumbled from the start. That said, we also knew this would be a problem months ago. The first post I made about this was in January, and many of you did the right then and prepared when the supply chain was functioning normally.
What should you be preparing for now? The aftermath, particularly the economic consequences.
--
Stat News advocates for accelerating medical students into the field for an "all hands on deck" situation.
Source: https://www.statnews.com/2020/03/14/medical-students-can-help-combat-covid-19/
A continuing point of frustration for me is how poorly we adapt other lessons. In Italy, we saw the Lombardy region activate retired doctors and field graduate nurses from nursing school to help out. This shouldn't be a question of "should we do it", but rather, "how fast can we apply the lessons of others" in order to meet the challenge head on. The same is true for social distancing. We saw that what China did worked, what Singapore did, what Korea did. We ignored those lessons.
--
The Lancet reports that over 500 samples of SARS-CoV-2, there's not much drift/mutation: "Based on more than 500 genetic sequences submitted to GISAID (the Global Initiative on Sharing All Influenza Data), the virus has not drifted to significant strain difference and changes in sequence are minimal. There is no evidence to link sequence information with transmissibility or virulence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),1 the virus that causes COVID-19."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30673-5/fulltext
This is excellent news, and also an important piece of information to hold onto with the various conspiracy theories proclaiming that SARS-CoV-2 is somehow monstrously mutating and we'll never develop immunity, etc. Untrue. The lack of drift thus far means that as researchers build therapeutics and vaccines, they have a good chance of working without much adaptation, if any.
--
A new paper from MRC conflicts with the WHO investigation of undocumented cases of COVID19. "We estimate 86% of all infections were undocumented (95% CI: [82%–90%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%–62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging."
Source: https://science.sciencemag.org/content/early/2020/03/13/science.abb3221
That's a stunningly high number - 86% of all infections were undocumented. On the one hand, it means the fatality rate is probably lower than has been documented thus far, and that's a good thing. On the other hand, it means that social distancing measures will need to be much more aggressive - especially in nations where testing isn't up to scratch.
--
Vice reports that Amazon is struggling to maintain its supply chain. "Amazon and the global supply chain are faltering under the pressure of the coronavirus pandemic. The world's largest retailer announced Tuesday morning that it is suspending all shipments of non-essential products to its warehouses, a move that may help people ordering things like toilet paper and food but will singlehandedly destroy thousands of independent businesses that have come to rely on Amazon’s monolithic platform. 'We are seeing increased online shopping, and as a result some products such as household staples and medical supplies are out of stock,” Amazon wrote in a letter to sellers who use its “Fulfilled by Amazon” service. “With this in mind, we are temporarily prioritizing household staples, medical supplies, and other high-demand products coming into our fulfillment centers so that we can more quickly receive, restock, and deliver these products to customers.'"
Source: https://www.vice.com/en_us/article/7kzqv9/amazons-supply-chain-is-breaking-and-independent-businesses-are-screwed
I don't blame Amazon for prioritizing the staples. The pandemic will have impacts on every business and every person, without exception. The best we can do is prepare and endure. For the near future, plan on shortages for things that aren't essential and change your habits accordingly. Get creative. Most of all, figure out how you can do it yourself. This is a time for us to be innovative, from learning how to bake our own bread and cook delicious meals to home handiwork and more. I am hopeful that when we emerge from this on the other side, we will all have picked up some new, useful skills.
--
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.