Sure he recommends researching vaccines faster, giving people flu vaccines since the flu is more serious than Covid, admitting fewer Covid patients into hospital care, and doing more research so that we're better prepared next time when something actually serious happens. Or if this is serious, doing more research so that the data is the most accurate possible.
I think calling that doing nothing is pretty generous. Since you disagree, what measure that he's proposing did you have in mind?
He seems to recommend the protection of the high-risk slices of populations and campaigns to increase awareness regarding the importance of hygiene. Also figuring out the real incubation period since, he claims, the original patient that was found contagious was already symptomatic, but researchers did not ask.
he seems to advocate individual hygiene and avoiding the public when sick, which also btw seems to be the response that countries like Japan, Taiwan and Singapore have taken, where complete lockdowns or closures have largely been avoided. Together with tracing they seem to have handled the situation just fine.
This is key — these countries were able to avoid lockdown by testing and tracing early, before the case load became unmanageable. In the US, we’ve missed that opportunity
But US still needs to develop that capacity as quickly as it can, because once quarantine brings the virus under approximate control, testing and contact-tracing are what can eliminate it.
South Korea, with one-sixth the population of the US, peaked at 10,000 cases. We haven't passed that per capita case load - and even if we do, lower population density should make it easier to get the virus under control in the US (except in NYC).
On Friday, March 20, The Atlantic said over 100,000 people in the US have been tested.[1] More recently, Mike Pence said 250,000 people have been tested.
We're a few days away from Korea's testing capability, if we haven't already matched it.
I think southeast Asia in general handles pandemics better. The people know how to respond and do so more quickly than Americans. Wearing masks, not going on spring break, etc.
Those are old numbers. Roche alone is sending out 400k test kits per week (over 1000 per million people).[1]
According to [2], more than 290,000 Americans have been tested for the coronavirus (close to 1000 per million people) and in Washington and New York, over 3000 people per million have been tested.
What is South Korea's testing capability (tests per week)? They've had several weeks to get a lead in absolute number of tests performed, but if they've only done 6000 per million people in all that time, we've probably matched them in testing capability.
Taiwan is doing more than public service announcements. Singapore too. Japan closed all schools in Feb. Tracing won’t work without first getting the number manageable.
>I am worried there is a fine line between 'realism' and a backlash against care for the elderly and chronically ill.
I guarantee you that if we don't target our lockdowns on the at-risk population (elderly being the most numerous in that group), whatever backlash there is will be worse when the general population realizes they aren't at any significant personal risk.
> ... when the general population realizes they aren't at any significant personal risk
With 15-20% of confirmed cases needing intensive care and symptoms developing at roughly the same rate, it becomes a perfect storm. So deaths may begin with only the elderly or immune compromised, it likely won't stop there as the younger folks need care they can't get. Perhaps they survive anyway, but an unknown number with permanent lung damage and lower quality of life.
General population may come to any number of realizations. The underlying reality may never become entirely clear to any of us. Y2K probably could have been much worse. Yet the media coverage around the aftermath gave the impression it was no big thing.
My coworkers in China confirm that people are gradually getting back to work, and I have no reason to doubt them.
The procedure seems quite interesting: Instead of lifting quarantine for everyone at once, the return to work is rolled out slowly (some %age of workers return the first day, some more the next day), so the situation can be monitored.
Apple has re-opened Apple stores and factories there, while shutting down Apple stores everywhere else. No matter how you feel about the PRC there's no reason to doubt Tim Cook.
No we typically don't. But in this case we may have. The science is beginning to point to the fact that this virus is not particularly lethal, but it is extremely contagious with an R0 of at least 2. That's where the danger lies -- if this was the plague and more than half of people who got it died our response should be what China did or perhaps significantly stronger than that. But there may be better options that don't doom an entire generation to an economic depression and its manifold consequences (which in and of themselves, in the long run, could kill more people than this disease ever will.)
in the case where the disease itself is not particularly lethal.
The lockdown stuff that has economic consequences is speculated to need to last as long as 18 months! Even two months will cause untold damage that will have knock on effects for years, perhaps decades. We didn't even recover from 2007 before this latest downturn and the effects have rippled through our society touching everything, including suicides.
I think the pandemic is really pulling the mask off in that it neatly sorts out the kind of people who worry about vulnerable people, the elderly and not overwhelming the healthcare system so that more could live on one hand, and the kind of people who worry first and foremost about "the economy", and whatever imaginary deaths a recession could entail based on some abstract sleight-of-hand reasoning.
You're putting words into my mouth. And I really don't appreciate it. In fact, I think that our focus should be directly on the at risk population. I think we should do more to protect them and provide a whole host of interventions and services. I think we can do that without causing a depression; Remember, the effects of economic downturns affect every single aspect of peoples lives including their health. If we do this wrong even more people may die or have significant, long lasting, hardship because of an ill-considered and potentially unnecessary intervention.
Read through my profile to find what I've said to this end, I don't feel like giving you any more of my time after you've not given me the benefit of the doubt and basically called me inhumane.
We don't usually call a disease that can easily evolve to pneumonie "a cold". And your focus on the supposedly low lethality is misplaced. Way more people need a stay in an hospital (sometimes short). This disease has the power to double (or even worse) the mortality rate of industrialized country during months or even years.
That some people are even asymptomatic is not even a particularly good news IMO. It will just spread more because of that...
I am personally 100% on board with halting the economy to fight COVID-19, but your are factually incorrect. The influenza is often called "a cold" and it does cause pneumonia. I have gotten pneumonia most likely from it and so have several people I know.
>We don't usually call a disease that can easily evolve to pneumonie "a cold".
That's not true. Just not true. Colds and influenza regularly proceed to pnemonia or long lasting secondary lower respiratory infections, especially in the elderly but also in the young and healthy.
>Way more people need a stay in an hospital (sometimes short).
No that isn't clear at all. The current understanding is that because the infectivity is so high the proportion of cases that are serious come in many times faster than other respiratory viruses, and on TOP of other respiratory illnesses.
>This disease as the power to double (or even worse) the mortality rate of industrialized country during months or even years.
That's potentially true, but it isn't necessarily true. The excess mortality of this disease -- it is plausible and it can be sensibly argued, may not be that high. That is because it is killing, in general, those who are already ill. In Italy 88% of those who have died had one or more serious commodities such as heart disease, and that is on top of the fact that the median age of death is currently 81 (median case age 63.) An unknown but potentially high proportion of these deaths may have happened in the next two years anyway. So at the end of this the excess mortality rates may not be anywhere close to double amortized over two years, and consequently in two years we might see a drop in general mortality rates as a result (if this illness does end up infecting >50% of the population as some leaders have seen fit to say.
>That some people are even asymptomatic is not even a particularly good news IMO. It will just spread more because of that...
It is good news, definitely. Because it means that we don't need to worry about most people. We need to worry about those at high risk. We may be able to get through this by focusing on isolating, social distancing, and providing at home resource for those at significant risk. Such a strategy, if properly done, could even be used to allow the illness to travel through the otherwise not vulnerable population creating herd immunity which will allow those at risk to come out of quarantine earlier.
To be clear, the evidence seems to be that your outcome is still in the minority of cases. Some unknown but double digit percentage experience no symptoms at all despite testing positive, another large proportion only experience upper respiratory symptoms and never get a lower respiratory infection or pneumonia, finally there are so called "mild" cases which I believe are "a bad flu." What these proportions are exactly is unclear, but it is clear that the vast vast majority people are not at risk of death. The data is unreliable and all over the place, but it's trending in this direction: in otherwise healthy people, this isn't particularly lethal.
I am not a doctor but you should probably get tested.
I cannot get tested. I live in the Netherlands and unless your case is serious enough that you either have very high fever or a great difficulty breathing, the official instructions are to not even call the health line, much less go to a hospital. I have friends in Portugal, Spain and Italy that have similar symptoms to mine and are home and doing the same because those are the official guidelines.
I agree with these guidelines, the phone lines and hospitals should be open for people who are at risk of dying. But that means that the numbers you're looking at are barely the tip of the iceberg for a lot of these european countries.
That's too bad. We really need to ramp up PCR tests as well as begin serological studies (there is one I am ware of, and a product on the way.) Immediately. We will not get this under control if we don't. We need to know how fast it's spreading, where, and so on.
It is clear that in some ways our hands are tied on testing, but a case like yours at this time knowing if you have it or not could affect your course of treatment.
There aren't as many as for bacteria, for a number of reasons including that viruses don't really clearly fall into "alive" or "dead" in the same way. They hijack your cellular machinery to produce more of themselves but they're not much more than a strand of genetic code wrapped in a bundle. It's hard to say they're more alive than any computer virus.
However, we've studied the way in which viruses do this hijacking and are able to disrupt the process, for instance by blocking their mechanism of entering cells, by blocking their mechanism of exiting cells or by disrupting their ability to replicate their genetic information.
There are even some (albeit new) broad-spectrum antiviral medications such as Remdesivir which was explored in COVID-19. It does work, well even, though as the COVID-19 infection is primarily in the lungs it's difficult to establish a sufficient concentration to be hugely effective.
Hydroxycholorquine is interesting [1] both as an anti-inflammatory and immune modulator. The Azithromycin probably does nothing against nCoV-2 but may well help control secondary infection.
>Hydroxycholorquine is interesting [1] both as an anti-inflammatory and immune modulator. The Azithromycin probably does nothing against nCoV-2 but may well help control secondary infection.
I had no clarity as to why azithromycin had improved the outcomes in that study to 100% of those treated with it, when HCQ didn't. That's very interesting.
Maybe you could clarify something else for me. Is there any information about whether these two drugs together could function as a prophylactic, or is this something patients have to be administered at the beginning of symptoms, or is this something that can be done late in the course of the disease?
I was speculating about the role of Azithromycin though it appears another peer post mentioned something similar. The study was only 28 patients, open-label, non-randomized, 6 of which were asymptomatic. I think it's too early to say one way or the other, the N is really small on the study.
It could easily have been that some patients in the study developed bacterial pneumonia secondary to their COVID-19 and the azithromycin treated it. Much too early to say.
> Maybe you could clarify something else for me. Is there any information about whether these two drugs together could function as a prophylactic, or is this something patients have to be administered at the beginning of symptoms, or is this something that can be done late in the course of the disease?
Wish I knew, seems to be something we'll hear more about in the near term given the interest in studying it. From what I read it works best in early stages of disease and not as well later on. While not side-effect free, they're pretty highly targeted.
> For instance, viruses can cause pneumonia directly. But in some cases, if a viral respiratory infection is severe enough, it can damage the lungs and leave them vulnerable to a secondary infection: bacterial pneumonia. This is common with flu, though scientists aren’t exactly sure how often it occurs.
Absolutely. One of the worst consequences that we may have to deal with at the end of this is that public trust will go down. In the beginning our leaders failed to act on the guidance of the scientific and medical communities -- almost two months wasted. And now, our leaders are flailing around implementing policy that is not based on reliable data or scientific evidence. They've both failed to react and then when they did react they are in many ways failing to act prudently.
Take a look at this editorial written by John Ioannidis. Excerpt that is relevant, though the whole thing is a worthwhile read:
>If COVID-19 is not as grave as it is depicted, high evidence standards are equally relevant. Exaggeration and over-reaction may seriously damage the reputation of science, public health, media, and policy makers. It may foster disbelief that will jeopardize the prospects of an appropriately strong response if and when a more major pandemic strikes in the future. [0]
Quick BIO rip from wikipedia:
>Ioannidis studies scientific research itself, especially in clinical medicine and the social sciences. He is one of the most-cited scientists in literature. His 2005 paper "Why Most Published Research Findings Are False" is the most downloaded paper in the Public Library of Science, and has the highest number of Mendeley readers across all science."
>Ioannidis is a Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences. He is director of the Stanford Prevention Research Center, and co-director, along with Steven N. Goodman, of the Meta-Research Innovation Center at Stanford (METRICS). He is also the editor-in-chief of the European Journal of Clinical Investigation. He was chairman at the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine as well as adjunct professor at Tufts University School of Medicine.
Ioannidis had [a similar opinion article][0] published last week.
It's worth reading [the rebuttal that followed][1] (as long as we're doing credentials: "Marc Lipsitch, D.Phil., is professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of Harvard’s Center for Communicable Disease Dynamics."):
It agrees that the basic lack of good information is a failing and also certainly creates risk. But we have seen at least twice now the outcomes of doing nothing or almost nothing:
> First, the number of severe cases — the product of these two unknowns — becomes fearsome in country after country if the infection is allowed to spread.
> So acting before the crisis hits — as was done in some Chinese cities outside Wuhan, and in some of the small towns in Northern Italy — is essential to prevent a health system overload.
There are clearly no truly good choices available right now.
I had read that rebuttal. The odd thing about it is as the author himself wrote, I'm not sure that Ioannidis is advocating inaction. Neither would I. Things must be done. It's that it's completely unclear that the "lockdown" stuff that is going to cause a new depression is actually worth it, or effective. And because lockdown is so vague, I mean not allowing people to go outside under threat of imprisonment and fines, or needing papers to travel somewhere. It may be an extreme overreaction, and I personally believe the cure would be worse than the disease. There are other things we can do.
Here's speculation based on data:
I can't help but see the demographics of those who are dying and come to the conclusion that this is not a threat to the general population in the direct sense. No one aged 0-9 has died worldwide to date. No one in Italy under 30 has died. Of those that have died in Italy, 88% had one or more serious comorbidities; only 12% can be directly attributed to COVID-19. It seems that this is killing people who are already sick or in fragile health; it just so happens that the elderly of course dominate those categories. Consider this: nearly 3,000,000 people die every year in the USA. How many of those who will die this year from COVID-19 will overlap with that 3,000,000? In other words, could it be that the excess mortality rate of COVID-19 when amortized over the next two years isn't actually that high? Does it make any sense to throw ourselves into a depression because of this? Remember, the effects of eceonomic downturns affect every single aspect of peoples lives including their health. If we do this wrong even more people may die or have significant, long lasting, hardship because of an ill-considered and potentially unnecessary intervention.
I read a paper this morning that suggested some things that I believe need more attention:
> For example, we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system,1 which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors. Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.
>This disaster could be averted only by massive deployment of outreach services. Pandemic solutionsare required for the entire population, not only for hospitals. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.2 Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments. This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment. In hospitals, protection of medical personnel should be prioritized. No compromise should be made on protocols; equipment must be available. Measures to prevent infection must be implemented massively, in all locations and including vehicles. We need dedicated Covid-19 hospital pavilions and operators, separated from virus-free areas.[0]
> In the beginning our leaders failed to act on the guidance of the scientific and medical communities -- almost two months wasted.
Some of them still are. Bolsonaro went on TV to downplay the virus and is actively trying to reduce state agency because state governors aren't waiting on the federal government to protect their citizens.
> Morrison objected to claims that the office was “dissolved,” writing in the Post on March 16 that the administration “create[d] the counterproliferation and biodefense directorate, which was the result of consolidating three directorates into one, given the obvious overlap between arms control and nonproliferation, weapons of mass destruction terrorism, and global health and biodefense. It is this reorganization that critics have misconstrued or intentionally misrepresented.”
Why on earth would anyone believe a Trump Appointee on what happened. The administration has proven themselves time and time again to lie through their teeth. And it sure seems to me that Arms Control, Weapons of Mass Destruction don't have that much in common with Global Health. And if it did, where is that agency right now during this crisis?
