We spend a lot of time on this forum having discussions and making arguments about how to be good citizens and good neighbors. The COVID-19 virus gives us all another chance to demonstrate our commitment to one another and the broader community. This has nothing to do with the right-left spectrum of politics or party affiliation. It’s an undisputed matter of public health, as follows:
It is reasonable to assume that the virus will spread locally and worldwide. A key objective is to slow down the rate of spread, so that our health institutions and providers are not overwhelmed.
Nick Kristoff, from the NY Times, put it this way: “Public health experts have emphasized that flattening the COVID19 curve is very important to avoid overwhelming the health care system. Even if the same number of people end up infected, it helps greatly if the infections are spread over eight months rather than eight weeks.”
Leana Wen, former public health commissioner in Baltimore, added: “This is it exactly. Delay is important. We can all take steps to prevent transmission. This protects us as individuals and buys time for us as a society.“
Former FDA Commissioner Scott Gottlieb said, “The goal is to reduce the number of cases at the peak of the epidemic. This extends the length of the epidemic, but can push the total number of cases at any one time below the point where the healthcare system gets exhausted, improving outcomes for patients.“
Drew Harris at Jefferson University was more dramatic in a comment: “Important to remember that Covid-19 epidemic control measures may only delay cases, not prevent. However, this helps limit surge and gives hospitals time to prepare and manage. It’s the difference between finding an ICU bed & ventilator or being treated in the parking lot tent.”
The point? Employing personal hygiene is not just a personal choice. Sensible behavior is our contribution to the community at large. Other suggestions are on the CDC website.
Universal precautions, universally. And don’t wear a mask unless you’re already sick. They don’t prevent one from getting it!
Thanks to Paul Levy for initiating this thread. No one should panic. Just exercise good judgement when you leave your home, and keep those most at risk completely out of harm’s way.
Years ago when my wife was undergoing chemotherapy, we had to be very cautious about any viruses. Through some modest lifestyle changes and a great deal of diligence, we were able to keep her from even getting a cold for more than 3 years. It is possible to significantly reduce your exposure to viruses.
In this current situation people should be prepared to hunker down for a couple of weeks. Many will have to work from home, and schools will likely be closed. Use your common sense. Don’t lose your cool. We can all get through this to see better days.
Please don’t panic buy! Besides the fact that masks are mainly effective when worn by a sick person to prevent passing along their illness, not as prevention from catching one, the current panic buying and hoarding is causing shortages for the people we most need to protect – our healthcare workers. When they don’t have access to protective gear, they are more likely to get sick at a time when we most need them all healthy and able to work.
In addition, I’m hearing stories of people with true medical needs being unable to get things like alcohol swabs to use when giving themselves injections or rubber gloves for changing a loved one’s post-surgical dressing at home.
So take sensible precautions, and feel free to buy a little extra at the store so you can gradually stock up to the point that you can manage 2 weeks of self-quarantine at home if necessary, but don’t buy 2 month’s worth of TP and cleaning supplies at a time!
@Paul,
This is probably the most important thread I have seen in a very long time, and I am really glad that you created it. Mike and Meredith are spot on right. There is absolutely no need to go crazy and stock up on a month’s worth of water (no evidence that our water supply will be endangered) or masks (which are only recommended if YOU are sick – they do not prevent illness. Sensible hygiene rules apply – wash your hands for 20 seconds (sing Happy Birthday twice or count to 20 Mississippi), avoid touching your eyes, nose and mouth. If you are showing signs of illness – stay HOME. (Warning – tedious history to follow…) When I was in high school I had a classmate who won an award for 4 years of perfect attendance. I was in a car pool with her and – to my great chagrin – she came to school sick no matter what. While she was able to soldier on through her illness I ended up home- very sick –because I was exposed to whatever crud she was spewing. And she was sick A LOT. If the prize for perfect attendance is you make other people sick, it isn’t worth it.
From the limited data I have seen, it appears that older people with certain pre-existing conditions, namely uncontrolled diabetes, coronary disease and lung disease, are at the greatest risk of severe and/or fatal complications. Perhaps a good time to check in with your primary health care provider if you have or are at risk for any of these conditions or need help getting them under control. Be attuned to yourself – if you are running a fever stay home.
Personally, I suspect that this illness will become, if it is not already, a pandemic and that it will circulate around the globe until there is herd immunity. In the meantime, sensible and reasonable precautions are in order so that our public health system does not become overwhelmed by critical cases.
Stay healthy y’all.
Sometimes it takes an event far outside of our experience to provide us with clarity, breaking us out of common patterns of actions or thought.
That clarity may be the simple act of handwashing as much as we were always told to. Dispensing with the socially ubiquitous shaking of hands. Realizing that that meeting, that trip, or even the regular commute to work or school isn’t the necessity is seemed just a month ago.
Perhaps we will gain insight and empathy into bigger social questions as well. One perspective I recently read: when facing a serious disease with no treatment, your healthcare is only as good as the worst healthcare of the people you come into contact with. Because of our inability to provide good healthcare for all in this country, the emergency department remains the only recourse for too many people who need routine care. That is exactly what we want to avoid if our goal is not to overburden our hospitals.
Similarly, how can we expect people to stay home when they are sick, when many people don’t have paid sick leave and have no financial cushion? Service industries are filled with low wage full- or part-time workers with minimal benefits. The health choices these people will make will affect everyone that serve as well as their own friends, families, and loved ones.
I read today the government is considering bailing out the travel industry because of the huge impact COVID-19 is likely to have. That will help the millions of people directly or indirectly employed by airlines and hotels. On the other hand, the working poor and unemployed get disproportionally stepped on every time there’s an economic downturn. They don’t get bailouts.
Only this time, if we don’t act, everyone’s health may suffer. It was always true that we benefit as a society when we lift everyone up. This time, though, the risks of not doing so are much higher.
We really are in this together.
Unfortunately, there is no evidence that our leadership at any level of government is capable of addressing these fundamentally relevant social issues.
“Don’t panic buy”. Hahaha. That statement is obviously true – yet obviously false. There is no line that can be drawn between ‘panic buying’ and ‘sensibly stocking up because there is a looming shortage’. Panic buying is the term used by everyone who hasn’t yet started trying to get whatever the item is. All supermarkets here (in Melbourne, Australia) are empty of toilet paper!?
The MA Division of Insurance has stepped up and “yesterday issued guidance to the state’s health insurers on Covid-19 that calls on them to offer diagnostic tests to people with possible symptoms at no cost – and to waive any co-payments or other patient fees for treatment. The memo also calls for insurers to waive out-of-network fees for patients who seek emergency care at a hospital or health center not part of their insurance networks and to waive fees for counseling and, when they become available, vaccinations.”
Re: handwashing – it’s not just the 20 seconds that’s important, but also being sure to get between your fingers and the backs of your hands. Best advice I’ve seen – wash your hands as if you’ve just sliced and pile of jalapenos and need to take out your contact lens.
To make the point Paul is making a bit more starkly, here is an extrapolation of the current exponential growth in international cases:
http://newtonwatch.org/wp-content/uploads/2020/03/23EB1C90-4B54-4DC3-B2FB-7BFFE49A5D88.png
This is a plot of readily available data on Wikipedia.
International cases are doubling every 3.7 days and increasing 10x every 12 days. This leads to a lot of cases very quickly. Epidemiologists may have models that predict this may slow naturally for various reasons, but its not happening yet. Hot spots will continue to emerge across the world and across the country.
If the world doesn’t bend this curve and spread out cases, we have an extreme problem with lack of intensive care beds in coming months. Actually, even if it is bent significantly, the number of intensive care beds we have available is likely still rounding error vs. the need.
It is likely the President is correct that the death rate is much less than 3.5%, but even if it is say 0.5%, the serious cases are 5x the deaths, and coming at once, will swamp the health care system. Unless US proactively rather than reactively slows this, we have a big problem.
Jack Prior says, “It is likely the President is correct that the death rate is…”
Acknowledging the importance of not politicizing this public health crisis, I tread lightly:
As individuals we’re all better heeding facts, interpretations, and advice coming from public health experts.
And politicians best serve the public by disseminating the best advice from exactly the same experts, and otherwise focusing on well-informed policy issues. That’s true at any level of government.
Paul – This is the clearest explanation of the importance of containment, and one I had not heard before. Thank you.
Following up on my previous comment, I also agree completely with Jack’s points.
Thanks for the thread, Paul.
@ Mike your too gentle words regarding health advice from politicians and in particular the president are just that, too gentle. The Idiot in Chief has politicized and lied about the out break from the beginning. His paramount concern is his own political well being, he ducks and dodges , hem and haws while his country is looking for leadership. I’m embarrassed by him. Look to the WHO ,the CDC and other public health policy experts for the latest Covid-19 information. Look to our president for an example of narcissistic, delusion behavior.
Thanks for the post, Paul. I basically agree with everything said above, except I will definitely stick with what experts say rather than anyone’s hunch.
Warning to posters – I just wrote a long thoughtful post only to get the message “comment is spam” and no way to retrieve it! Turns out that below the edge of my screen, underneath “submit comment” is a new field requesting the current year (I assume to prevent posting by bots). Caveat poster.
@Meredith: Thanks for the heads up. We will get “our guy” to look into it.
Trying again. Currently, the most reliable data we are getting is from S. Korea, which has done surveillance testing of tens of thousands of people in the community (even offering drive-through testing!) This has given us the most reliable numbers yet on how widespread it is in one country, the range of severity, and an infected fatality rate (IFR) of 0.8%. The numbers we are getting from other countries are case fatality rates (CFR), which are much higher because they only include patients who come to medical attention.
Sadly, reports from inside China and people knowledgeable about the country make it clear that we have to be skeptical about any reports of slowing of spread or fatality rates there. Fatality rates in most other countries are looking artificially high because they also only include people who have come to medical attention. The rates in Seattle are sadly especially high because of the outbreak in a nursing home full of high risk people, which is what we have to work hardest to prevent. It’s looking likely that the fatality rate is higher than our usual seasonal influenza but lower than the worst numbers currently reported.
Speaking as a statistician/methodologist working in clinical trials – my expertise for this post lies in evaluating data quality, sources of bias, etc.
Great comments by all above. From a doctor friend today — wash hands, wash hands, wash hands… It is important to remember that putting your hands on your dirty phone or particularly in your dirty pockets cancels out hand washing. Elbow bumps instead of handshakes make sense until you combine that with sneezing into your elbow. Remember that eating a sandwich with dirty hands is worst than touching your face. A sick person is shedding trillions of virus particles. Only one has to successfully get a toehold in your body.
I just want to reemphasize how rapidly this situation is going south. It is 20% worse each and every day. It is progressing much faster than in China due to lack of lock downs. By my calculation it could kill 50,000 people by the end of the month and 11 million by the end of next month globally, with 50 million in serious condition.
When the government says the risk is low today, it is technically accurate, but it is the same as saying the risk is low at the moment when a tsunami drains the beach before the wave comes. The wave is coming.
This is not a problem that will be solved anymore with travel restrictions. There may be more infections in US now than in greater China outside Wuhan. In particular, I would guess the majority of elderly killed will be likely infected by a family member, hence the importance of keeping yourself and your kids healthy, even if the risk to you and them is low.
The federal government hasn’t shown any ability to use the time that China bought the world with lock downs, and likely won’t in coming weeks. The state only has so many resources. I think our city leaders reading this blog need to start thinking about what the city can do proactively and reactively if there are no alternatives and we are left on our own. Do we close schools proactively rather than reactively? Seattle has chosen not to because schools deliver important services to kids in need beyond education, but there are trade-offs.
Should city be planning to offer quarantine centers so that mildly infected patients can avoid infecting their families and other residents? Could city procure beds or cots for that purpose to use in school gyms — perhaps from residents? Can we organize food delivery services for elderly that need to avoid public exposure? Can schools and the city immediately focus on hand washing education and other hygiene practices?
Please keep blog posts on this topic coming. Nothing matters more in next several weeks.
@ Jack
” By my calculation it could kill 50,000 people by the end of the month and 11 million by the end of next month globally, with 50 million in serious condition. ”
It’s commendable to share your own calculations with V14. However, I would suggest to anyone who has read them to then visit the CDC or the WHO or the Red Cross to see a more reasoned appraisal of the situation. You should be careful of what you share.
Hi Peter — Here is what CDC.GOV says below. They added this paragraph quietly a few weeks ago. It is just leaving out the actual numbers behind the warning.
https://www.cdc.gov/coronavirus/2019-ncov/summary.html
“What May Happen
More cases of COVID-19 are likely to be identified in the coming days, including more cases in the United States. It’s also likely that sustained person-to-person spread will continue to occur, including throughout communities in the United States. It’s likely that at some point, widespread transmission of COVID-19 in the United States will occur.
Widespread transmission of COVID-19 would translate into large numbers of people needing medical care at the same time. Schools, childcare centers, and workplaces, may experience more absenteeism. Mass gatherings may be sparsely attended or postponed. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and sectors of the transportation industry may also be affected. Healthcare providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Nonpharmaceutical interventions would be the most important response strategy.“
You can do this at home. Open Excel, punch in the data from the last column of the “international cases” table, add a x axis column for days since Jan 13th, plot it, add an exponential trend line to last 17 points, and project forward.
https://en.wikipedia.org/wiki/Template:2019–20_coronavirus_outbreak_data/International_medical_cases
Thank you for this post Paul!
FYI, Johns Hopkins has this excellent graphic on the worldwide progress of the disease: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6