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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Dr. Scott Gottlieb on current projections for cases and outcomes. "It's too early to lift these measures - it's going to be a difficult April; we're going to get through this, April is going to be a hard month, but come May, we'll be coming out of this. And we'll be able to contemplate starting to lift some of these measures as we see the epidemic curve come down. Remember, this isn't going to be a simultaneous reduction across the country, New York is going to come down before the rest of the country does. And it may appear that the overall number of cases around the nation are coming down because New York represents such a big part of that. But in fact, New York could be coming down the other parts of the country going up so we need to look at this on a regional basis."
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I suspect, since everyone's parroting the HealthData model, that the May estimate is still too optimistic. We have MANY cities and states in the US where outbreaks are just ramping up. To assume that your city is on the same scale as NYC is folly; everything about this virus is about time, when outbreaks began.
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Two different groups of public health experts laid out roadmaps for the eventual end of the pandemic in America. STAT News summarizes: "Both road maps are predicated on the United States sharply ramping up testing for the disease and hospitals acquiring sufficient supplies at a time of extraordinary global demand and growing shortages — both of personal protective equipment to shield health workers from infection and ventilators to help the gravely ill to survive. Emanuel, who outlined his road map in an opinion piece in the New York Times, estimated that if spread of the virus isn’t slowed, almost one-third of Americans will be infected by early May. If Covid-19’s fatality rate is 1%, that level of transmission would lead to 1 million deaths, he noted. (There is much debate and no consensus on the fatality rate, though 1% is nearer the lower range of current estimates.)"
Source: https://www.statnews.com/2020/03/29/two-new-road-maps-lay-out-possible-paths-to-end-coronavirus-lockdowns/
The lockdowns might be able to ease up around June, based on the first group's estimates - as long as mitigation efforts step up and remain strong.
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Germany is doing something really smart - issuing certificates to those who have had the disease that they are immune to it and thus can re-enter the workforce. "German researchers plan to introduce coronavirus ‘immunity certificates’ to facilitate a proper transition into post-lockdown life, as Chancellor Angela Merkel’s handling of the crisis has led to a boost in the polls. The antibodies will indicate that the test participants have had the virus, have healed and are thereby ready to re-enter society and the workforce. The researchers plan to test 100,000 members of the public at a time, issuing documentation to those who have overcome the virus."
Source: https://www.telegraph.co.uk/news/2020/03/29/germany-will-issue-coronavirus-antibody-certificates-allow-quarantined/
Other countries would do well to copy this immediately. Action to take: contact your elected representatives and ask them to lobby for this. The sooner every nation starts doing this, the better - especially for healthcare workers and front line workers in food and essential services.
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Everything old is new again. The Journal of the American Medical Association documents the treatment of ill patients with blood plasma containing antibodies of people who recovered from COVID-19. "In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials."
Source: https://jamanetwork.com/journals/jama/fullarticle/2763983
This was a technique used in the 1918 influenza pandemic. Perhaps a part of receiving the certificate of clearance could be a plasma donation as well, to help others fight off the illness who are not as healthy.
Study something old to learn something new.
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Everyone should be wearing masks of some kind in public. Even home-made cloth masks are better than nothing. A Medium piece walks through the rationale. "The viral replication in the nasopharygeal mucosa may also explain positive tests in the prodromal stage and transmission by healthy carriers, and perhaps the anosmia seen in early stages of COVID19. But this biology also means: avoiding large droplets, which cannot enter the lung anyway but land in the upper respiratory tracts, could be the most effective means to prevent infection. Therefore, surgical masks, perhaps even your ski-mask, bandanas or scarf, may afford more protection than portrayed by governmental official in their initial (understandable but unfortunate) recommendation against wearing of masks by the public in general."
Source: https://medium.com/@Cancerwarrior/covid-19-why-we-should-all-wear-masks-there-is-new-scientific-rationale-280e08ceee71
An excellent read, and validated by Dr. Gottlieb as well on the morning talk show circuit. Because the virus infects via the nose and mouth, keeping particles out - even with makeshift masks - is good. Dr. Gottlieb also said (see video at the top of the email) that masks help when someone has no symptoms but is contagious.
To paraphrase Bill Nye, masks on! If you're out of your home, put your mask on.
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The SARS-CoV-2 virus is sufficiently different enough that it may have been circulating in some form for quite some time in humans before it finally mutated into the form we know today. "“Then, as a result of gradual evolutionary changes over years or perhaps decades, the virus eventually gained the ability to spread from human to human and cause serious, often life-threatening disease,” he said in an article published on the institute’s website on Thursday. But the new strain, or SARS-Cov-2, had a mutation in its genes known as a polybasic cleavage site that was unseen in any coronaviruses found in bats or pangolins, according to Andersen and his colleagues. The study had significantly reduced, if not ruled out, the possibility of a laboratory origin, Collins said. “In fact, any bioengineer trying to design a coronavirus that threatened human health probably would never have chosen this particular conformation for a spike protein,” he said."
Source: https://www.scmp.com/news/china/science/article/3077442/coronavirus-pathogen-could-have-been-spreading-humans-decades
Further confirmatory evidence to debunk all the conspiracy theories that this is somehow a bioweapon that escaped a lab, etc. Based on this, it seems likely that not only is it natural, but it's older than we think. It's just the most recent mutation that finally made it into the pandemic it is now.
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Long-term care facilities are at exceptional risk from COVID-19 according to a new study in NEJM. "Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County."
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2005412
We absolutely must keep the virus away from long-term care facilities by any means until a vaccine is available. A 33% fatality rate is astonishingly high.
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Be cautious with the new Health Data model being used to forecast outcomes. Unlike other models used previously, it doesn't use the generally-accepted SEIR epidemic model for disease, and thus may be producing overly optimistic conclusions.
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One of the reasons I've used NeherLab's model in discussions is that it's based on the time-tested SEIR model underneath. It gives much less rosy outcomes in its simulations, so it's definitely not the politicians' first choice for sounding good, but thus far, the models fit the data.
Example: https://bit.ly/2UNRvus
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On a lighter, positive note, love in a pandemic as two Mass General Hospital staff members got married at the hospital.
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Love finds a way.
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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/