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 top emergency room doctor at a Manhattan hospital that treated many coronavirus patients died by suicide on Sunday, her father and the police said. Dr. Breen, 49, did not have a history of mental illness, her father said. But he said that when he last spoke with her, she seemed detached, and he could tell something was wrong. She had described to him an onslaught of patients who were dying before they could even be taken out of ambulances."
Source: https://www.nytimes.com/2020/04/27/nyregion/new-york-city-doctor-suicide-coronavirus.html
In a war, medical personnel are exposed to horrific, mentally destructive scenarios. This pandemic is no different, except we're not treating it like a war. We should be on wartime footing, and we're thinking of it like a terrible vacation gone awry instead.
In a war and after a war, every soldier, but especially the medical corps, needs counseling and therapy to recover from the horrors of war. This is what is needed for all our healthcare workers right now and in the years to come. Please contact your elected representatives, wherever you live, and encourage them to fully fund mental health services. It's going to be essential to minimize post-trauma stress for everyone.
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"Shopper Lexie Mayewski is having a hard time finding frozen french fries in Washington, D.C.-area supermarkets in the wake of coronavirus-fueled stockpiling. On the other side of the country, Washington state farmer Mike Pink is weighing whether to plow under 30,000 tons of potatoes worth millions of dollars that would have been turned into french fries for fast-food chains like McDonald’s Corp, Wendy’s Co and Chick-fil-A. Their incongruent experiences underscore how America’s highly specialized and inflexible retail and foodservice supply chains are contributing to food shortages and waste in the wake of demand disruptions from the COVID-19 pandemic that has killed almost 50,000 people in the United States."
Source: https://www.reuters.com/article/us-health-coronavirus-french-fries-analy-idUSKCN2261AU
Inflexible is the key word here. Our supply chains are both inflexible and brittle; a disruption is hard to accommodate and has cascading effects on other parts of the chain. Beyond the economic hardships, this also means that it will potentially be months before many of the common shortages are fully remedied; be flexible in what you buy.
And if you live near farms that sell staples you can use and cook with, consider approaching the farmers directly and asking to buy at near-retail prices. They could probably use the business. While you couldn't haul home 50 tons of potatoes, you could certainly buy a few.
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The Lancet has an excellent piece on contact tracing. "The Singapore Government has been heralded for its success at controlling their COVID-19 outbreak early in March. Part of this success was put down to a Bluetooth-operated contact-tracing app, TraceTogether, that logs all proximity contacts made between phones over a 21-day period. According to Singapore's GovTech official website, TraceTogether uses Bluetooth technology to exchange connections with nearby devices that have the app. The app only has the ability to show connections between devices, and not their locations. Furthermore, the logs stay in the user's phone. Should the Ministry of Health need the logs for contact tracing, they will seek the user's consent to share the logs with them."
Source: https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30103-5/fulltext
The reality is that no country can fully lift lockdowns without testing, tracing, and treating. Massive testing, supported with contact tracing, is how we'll keep this fire put out and allow some measures of pre-pandemic life to return. Without these measures, ongoing lockdowns or massive deaths and overwhelmed healthcare systems are the two primary options.
The good news is, we know test, trace, and treat works. The bad news is, we need massive, rapid investment in it to make it work.
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The Lancet reminds us there is still no conclusive proof of immunity, either. "The linchpin for a strategy to move out of lockdown seemingly rests on increased testing and contact tracing, possible return-to-work permits based on immune status, repurposed or new therapeutics, and, finally, vaccination. This approach is broadly sensible, yet immunology is a complex branch of molecular medicine and policy makers need to be alerted to important aspects of immunology in relation to COVID-19. There is no certainty as to the immunological correlates of antiviral protection or the proportion of the population who must attain them, making it impossible to identify a point when this level of immunity has been reached. Caution is needed because total measurable antibody is not precisely the same as protective, virus-neutralising antibody. Furthermore, studies in COVID-19 show that 10–20% of symptomatically infected people have little or no detectable antibody."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30985-5/fulltext
Remember, no proof means no proof. It doesn't mean it will or won't work - it means we don't know.
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How will we finally determine COVID-19's impact? By looking at aggregate death rates. This chart is outstanding:
Source:
What we see is the massive deviation from the 5 year average. That difference will help us understand just how bad things got in the pandemic, when we look back in the years to come. This data analysis will also be helpful for detecting outbreaks where testing was inefficient, like in the United States - the raw death counts will show substantial skewing.
Here's another excellent visualization of the same:
Source: https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html
We see the official COVID-19 death count in NYC is 17,000; the actual excess death count is 20,800, meaning that we potentially missed 3,000 severe, life-threatening cases. Check with your local government's mortality data to see how far off the norm mortality is in your location. That will give you a sense of just how bad the pandemic might be.
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The devil is in the symptoms. NEJM on transmission of COVID-19 in a skilled nursing facility: "Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility."
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2008457
What this means is that we cannot rely on screening anyone for symptoms. The idea that workplaces could identify symptomatic employees and send them home will not work, because this disease is stealthy as heck. Only rapid, widespread, medical testing will work. Someone standing around with an infrared thermometer checking out people will not catch much of anything.
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A reminder of the simple daily habits we should all be taking.
1. Wash/sanitize your hands 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 a mask when out of your home.
3. Stay home as much as possible.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/
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Common misinformation debunked!
There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
There is no evidence SARS-CoV-2 was engineered.
Source: https://www.washingtonpost.com/world/2020/01/29/experts-debunk-fringe-theory-linking-chinas-coronavirus-weapons-research/
Source: https://www.nature.com/articles/s41591-020-0820-9