Lunchtime Pandemic Reading, 23-Mar-2020
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 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.
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The US Surgeon General was frank with his words this morning. "I want America to understand this week, it's going to get bad. And we really need to come together as a nation, I heard the story that you were just playing young people out on beaches. We see here in DC, that the district set up a camp for people to watch the cherry blossoms. You look on the cam, you see more people walking around the cherry blossoms. And this is how the spread is occurring."
Source:
Former FDA commissioner Scott Gottlieb says, "the scenes out of New York are going to be shocking. The hospitals are going to be at the brink of being overwhelmed in the next 2 weeks. They're going to start getting thousands of admissions; this is infection that started two weeks ago. The time to hospitalization is 9-12 days. Other cities are at extreme risk - New Orleans is at very high risk and they are not taking appropriate measures. Any city that has a mass transit system is at very high risk."
Source:
The time lag is critical. What you're seeing today is an effect of what was happening two weeks ago. We're seeing containment measures taking effect now, but the damage showing up today has already been done. All those "COVIDiots" on Spring Break and other places? They are going to go back to their communities and in two weeks will be responsible for new outbreaks. This is why staying home matters more and more every day. You're not stopping today's infections - you're reducing infections in two weeks - and our hospitals desperately need the break as soon as possible.
Stay away from anyone who has traveled for any reason in the last two weeks.
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Cloth masks work better than nothing. A trial by the NIH of the effectiveness of cloth masks vs. N95 medical masks vs. no mask at all shows that cloth masks, while substantially less effective than N95 masks, were better than nothing, especially for influenze-like illness. Thus, all these community sewing efforts that are happening? They're worth it until proper protective equipment reaches healthcare providers.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/
See figure 2 in the report for the analysis. For those doing this work, thank you - and keep doing it. It's better than no PPE.
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Via the Italian COVID-19 surveillance group, a list of the most common comorbidities that resulted in death in Italy thus far:
- hypertension: 73.8% of patients who died
- diabetes: 33.9%
- schemic heart disease: 30.1%
- atrial fibrillation: 22%
- chronic renal failure: 20.2%
- active cancer in past 5 years: 19.5%
- COPD: 13.7%
- stroke: 11.2%
- dementia: 11.9%
- chronic liver disease: 3.7%
Source: https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_20_marzo_eng.pdf
Note that these are co-occurrences and may not be causal in nature - but if you or someone you know has one or more of these comorbidities, treat it as though it WERE causal and be sure they are kept away from others.
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Via ACS Neuroscience, SARS-CoV-2 may also cause neurological damage. "It is important to mention here that although the cerebral damage may complicate a COVID-19 infection, it appears that it is the widespread dysregulation of homeostasis caused by pulmonary, renal, cardiac, and circulatory damage that proves fatal in COIVD-19 patients. With that being said, a dominant cerebral involvement alone with the potential of causing cerebral edema in COVID-19 can take a lead in causing death long before systemic homeostatic dysregulation sets in."
Source: https://pubs.acs.org/doi/pdf/10.1021/acschemneuro.0c00122
One of the key messages currently lost around communications to the public is that while you probably won't die, there are much higher odds of damage occurring that may become permanent, from 20-30% reduction in lung capacity to this new study on neurological damage.
Lung capacity source: https://www.scmp.com/news/hong-kong/health-environment/article/3074988/coronavirus-some-recovered-patients-may-have
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Via NEJM, SARS-CoV-2 maintains its uneven gender balance in children as well. 60% of children infected were male.
Source: https://www.nejm.org/doi/pdf/10.1056/NEJMc2005073?articleTools=true
Genomics hasn't unraveled why males are more impacted than females, but it's a reoccurring theme. If you have at risk family members, chances are the males will be slightly more at risk.
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Does losing sense of smell indicate a potential COVID-19 infection? The American Academy of Otolaryngology says there's enough anecdotal evidence, even in the absence of a clinical study, to warn its practitioners. "Anecdotal evidence is rapidly accumulating from sites around the world that anosmia and dysgeusia are significant symptoms associated with the COVID-19 pandemic. Anosmia, in particular, has been seen in patients ultimately testing positive for the coronavirus with no other symptoms. We propose that these symptoms be added to the list of screening tools for possible COVID-19 infection. Anosmia, hyposmia, and dysgeusia in the absence of other respiratory disease such as allergic rhinitis, acute rhinosinusitis, or chronic rhinosinusitis should alert physicians to the possibility of COVID-19 infection and warrant serious consideration for self-isolation and testing of these individuals."
Source: https://www.entnet.org/content/coronavirus-disease-2019-resources
If someone you know - or you - loses sense of smell and there's no other obvious reason, consider it a sign that you should self-isolate immediately.
The original UK ENT source: https://www.entuk.org/loss-sense-smell-marker-covid-19-infection
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Credit Suisse warns that economic data will be off the charts. "The result is an economy that has gone from full-speed-ahead in January to a full-on freeze. Economists have had to update their models daily as the pandemic increasingly throttles work, commerce and travel. “Economic data in the near future will be not just bad but unrecognizable,” Credit Suisse said in a note on Friday. On Thursday, the Labor Department reported that initial jobless claims jumped 30 percent the previous week, to 281,000, the highest level since the aftermath of a hurricane in 2017. But even that number looks tiny next to the number of new claims that Goldman Sachs foresees in the next weekly report: 2.25 million. The pain is so severe because the economy is dominated by services, with consumers powering overall demand, a shift from previous generations, when the production of goods counted for a greater share of output. The credit-rating agency Moody’s found that lodging, restaurants and airlines would be among the most affected industries, with sectors like health care, pharmaceuticals, mining and chemicals taking more modest hits. Telecommunications, software and the steel industry would be among the least affected."
Source: https://www.nytimes.com/2020/03/21/business/economy/coronavirus-recession.html
Pay attention to economic indicators in your industry to get a sense of what's happening. Use free services like Google Trends as an early warning system (set it to 30 days view to see daily data) if demand in your industry takes a sudden, precipitous decline.
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On a lighter note, a sports commentator with nothing to do is offering commentary on everyday events, and it's a wonderful chuckle.
Source: https://www.thepoke.co.uk/2020/03/20/this-commentators-got-no-live-sport-left-so-hes-commentating-on-everyday-life-and-its-brilliant/
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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. Stay home. Just stay home.
4. Avoid in-person interaction with anyone at risk, without exception. Video call instead of visit.
5. Get your personal finances in order now. Cut all unnecessary costs.