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.
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Via Trends in Molecular Medicine, a new paper that looks at cross-species jumps of SARS-CoV-2. "It might also be desirable to monitor farm animals and pet cats for infection with 2019-nCoV, since their ACE2 receptor responsible for 2019-nCoV binding differs in only a few amino acids from human ACE2. Surveillance might prevent the virus establishing itself in another animal species that is in close contact to humans."
Source: https://www.sciencedirect.com/science/article/pii/S1471491420300654
Given that coronaviruses jump from species to species already, this isn't a huge surprise. That said, those who work with animals - farmers, pet owners, etc. - should consider watching their pet's health as well as their own. Isolation and #StayHome isn't just good for you, it's good for your pet, too.
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A pre-print paper emphasizes that no clinical trials have been performed on inflammation-reducing interventions for all the stuff you see on social media that claims to help COVID-19 infections and pneumonia. "Since the conventional treatments of COVID-19 patients have not been sufficiently effective and the mortality rates of the patients are high, it is incumbent upon us to test promising unconventional approaches that have a chance of reducing their mortality rates. The reasoning and evidence presented above indicate that the I4R approach maybe effective in reducing the pneumonia incidence and mortality rates in COVID-19 patients. Pilot clinical trials are needed to validate this approach for the patients."
Source: https://osf.io/6zy9u
Read that carefully. We have no clinical evidence that essential oils, aromatherapy, saunas, acupuncture, vitamin D, healing crystals, silver tinctures, etc. is effective in mitigating the impact of COVID-19. That means ANY solution you see being hawked as a cure isn't. Period.
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Via The Lancet, use of ultrasound to diagnose lung problems is suggested in order to minimize risks to healthcare workers. "During such a diffusive outbreak there is still the need to guarantee both the patients' rights to be evaluated according to the highest standards of care and, at the same time, the health-care workers' safety. Therefore, it is important that the minimum number of health-care workers and medical devices be exposed to suspected or confirmed cases of COVID-19. In this regard, in 2016, Copetti highlighted how lung ultrasound could have several advantages compared with the use of the stethoscope, to the extent that it could be replaced. In our opinion, the use of ultrasound is now essential in the safe management of the COVID-19 outbreaks, since it can allow the concomitant execution of clinical examination and lung imaging at the bedside by the same doctor."
Source: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30120-X/fulltext
For anyone who works with or speaks with healthcare professionals doing front-line work, please forward them the link above so they can evaluate it in their own practice. It may help reduce risk.
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The more severe your case of COVID-19, the more powerfully infectious you are, according to a paper in The Lancet. "Mild cases were found to have an early viral clearance, with 90% of these patients repeatedly testing negative on RT-PCR by day 10 post-onset. By contrast, all severe cases still tested positive at or beyond day 10 post-onset. Overall, our data indicate that, similar to SARS in 2002–03,6 patients with severe COVID-19 tend to have a high viral load and a long virus-shedding period. This finding suggests that the viral load of SARS-CoV-2 might be a useful marker for assessing disease severity and prognosis."
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30232-2/fulltext
This is challenging news for healthcare workers, because they will not only be exposed to more cases than the average individual, those cases will inherently be more severe. If you have any personal protective equipment to donate - masks, gloves, goggles, etc. - from industries like construction, welding, nail salons, etc. - please call your local emergency room or clinic and ask if they need donations. If they do, work out the logistics of your donation. If they do not, take a look at GetUsPPE.org to donate.
Source: https://getusppe.org/give/
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How will healthcare facilities prioritize who gets care, once they are overwhelmed? NEJM has recommended guidelines. "These ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients. Priority for limited resources should aim both at saving the most lives and at maximizing improvements in individuals’ post-treatment length of life. Saving more lives and more years of life is a consensus value across expert reports."
Source: https://www.nejm.org/doi/full/10.1056/NEJMsb2005114
The guidelines proposed are difficult to contemplate because the truth is, once services are overwhelmed, people who would survive under normal circumstances will not. These guidelines are difficult but fair, well-reasoned, and the best we can hope to do for those of us not wealthy enough to have fully private care, a personal physician, etc.
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US doctors are talking to their colleagues in China about how they handled the crisis. "A U.S. physician not involved in the Hopkins effort said that more and more of her colleagues are reaching out to those on the front lines in China, South Korea, and Italy for advice, especially as their doubts about guidance from U.S. authorities grow. The U.S. Centers for Disease Control and Prevention originally told physicians, nurses, and others caring for Covid-19 patients to use N95 masks, for instance, but earlier this month changed that to ordinary surgical masks for most needs."
Source: https://www.statnews.com/2020/03/24/covid-19-answers-doctors-turn-to-china/
Despite what an absolute mess the politicians are making of things, I am exceptionally encouraged by how well the scientific and medical communities are collaborating. This is international cooperation and collaboration at never-before-seen levels, and with the same unified goal: put an end to this thing.
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Via the Upjohn Institute, US state unemployment reserves are near all-time lows, which means many states' funds are already close to being depleted. "Reviewing historical data, O’Leary and Kline find that pre-recession reserves should be around 2 percent of total wages or 5 percent of taxable wages. By the end of 2018, after years of economic growth, reserves were at only 1 percent of total wages and less than 4 percent of taxable wages. Simulating effects of mild, moderate and severe recessions for the reserves of 53 U.S. states and territories, the researchers find that the reserve funds of 11, 18 and 21 states, respectively, would be in the red. A severe recession would further generate a system-wide debt of $3.8 billion. O’Leary and Kline propose financing changes to help shore up the unemployment insurance system. One such change would be increasing the federal taxable wage base, which sets the floor for state taxable wage bases, and indexing it to adjust annually for inflation."
Source: https://www.upjohn.org/research-highlights/state-unemployment-insurance-reserves-wont-be-enough-recession
Whatever your employment situation is, shore up your personal finances now. Cut spending. Find alternate sources of income if possible. We are likely to hit the severe recession benchmark (or beyond) and with the current mismanagement of the crisis by the federal government, no meaningful help will be coming any time soon.
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Via the Harvard Business Review, what you're feeling is grief. "HBR: People are feeling any number of things right now. Is it right to call some of what they’re feeling grief? Kessler: Yes, and we’re feeling a number of different griefs. We feel the world has changed, and it has. We know this is temporary, but it doesn’t feel that way and we realize things will be different. Just as going to the airport is forever different from how it was before 9/11, things will change and this is the point at which they changed. The loss of normalcy; the fear of economic toll; the loss of connection. This is hitting us and we’re grieving. Collectively. We are not used to this kind of collective grief in the air. Yes, we’re also feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There’s something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this, but all together this is new. We are grieving on a micro and a macro level."
Source: https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief
An excellent read that puts to words what many of us, myself included, are feeling in a stew of daily emotions. Remember: it's okay to not be okay in this. I wrote more about that here: https://www.christopherspenn.com/2020/03/its-okay-to-not-be-okay-right-now/
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On a lighter note, an amusing series of anecdotes from spouses who are finding their partners are very different people at work, and documenting such. "Laura Norkin, deputy editor at InStyle, took to Twitter to share what she’d discovered about her husband. “A funny thing about quarantining is hearing your partner in full work mode for the first time. Like, I’m married to a ‘let’s circle back’ guy—who knew?”"
Source: https://www.workingmother.com/spouses-share-hilarious-things-theyve-learned-about-their-partner-working-from-home
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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/