Tagged public health

COVID-19 message to my students this evening

Hi all,

I thought that our session yesterday was quite good and loved the chat contributions in the first

Photo by CDC on Unsplash

part of the class. I have thought most though about this comment from Garrett:

00:28:15 Garrett Canterbury: “I think the issue that Trump and other officials, including state and local, are struggling with is that at what point is putting millions of people out of work worth saving X amount of lives. I think the goal should be to move to the South Korean model where there is loads of testing, the economy is mostly re-opened, and the sick and vulnerable are isolating while the healthy are back to work.”

This is to me a vital question. I heard people who should know better say on TV in the past day or two that to weigh the economic consequences of social distancing and lockdown against the lifesaving public health measures many are taking is irrelevant or unethical.

There are things that I think are unethical to debate. This is not one of them. Take a look at this short column a couple of days ago by Tom Friedman, a liberal and no supporter of Trump: https://www.nytimes.com/2020/03/22/opinion/coronavirus-economy.html (Links to an external site.)

What is happening to our economy now, what will happen soon, really really hurts people. It will kill people.

But Garrett is not suggesting we do nothing. He is suggesting the South Korea model, which means social distancing based on testing, with one eye on getting people back to work. Here’s what I have to say about the balance:

  1. We must get the economy going again as soon as we safely can.

  2. The projected one to two million American deaths without strong social distancing would also tank the economy and rip the hearts out of millions of families. The overwhelming of hospitals and deaths of health care workers would do the same.

  3. We have missed the boat on testing at the right stage of the epidemic the way South Korea did, and we have missed the boat on timely mask and ventilator manufacturing BUT…

  4. We are where we are and we have to look forward. We must social distance to flatten the curve or this will destroy our hospitals, killing nurses, doctors, and other first responders.

  5. We have to hugely ramp up the things we haven’t done and still aren’t doing nearly well enough. The first is testing. We need tens of millions of tests, not tens of thousands, to follow the South Korean model as Garrett rightly suggests. We need two kinds of tests: one to find and isolate the currently infected, aggressively testing those they have been in contact with; and another one to identify those (now perhaps in the millions) who have had the virus and have successfully recovered. Those people are almost certainly no danger to anyone and can go back to work, socialize, and help others.

  6. We need manufacturing that is on a war footing. In World War II we did not ask auto makers to please make tanks. We ordered them to make tanks—and planes and helmets and bullets and uniforms. And by the way that project put a lot of people to work and saved the economy, as well as winning the war.

  7. We do not have medicine for COVID-19, but we have medicine for the economy, and it is being applied. The Federal Reserve bank has reduced interest rates to near-zero and is pumping unprecedented trillions into the economy. Even the dithering Congress has agreed to pass a two trillion dollar stimulus package and will do more. We know how to treat the economy when it is sick. Yesterday the Dow had its biggest increase since 1933, and another increase today. People will get paychecks in the mail that will be too small, but will help. Companies will get too much, but will be somewhat rewarded at least for not firing people and giving them paid sick leave.

McKenzie and others yesterday in saying we have the wrong kind of health care system to handle all this right. We also have the wrong kind of economy and a shameful lack of preparation. (See the previously assigned 2005 Scientific American article, “Preparing for the Next Pandemic.”  We didn’t.) But we are where we are. Go to this website to see what will happen to hospitals in your state under varying degrees of social distancing. Click on your state and see the date on which, with inadequate social distancing, your hospitals will be overwhelmed: https://covidactnow.org/ (Links to an external site.)

And please please learn the meaning of the word several of you supplied yesterday: exponential. We have more deaths from auto accidents right now, but they are not increasing exponentially. We have more deaths from seasonal flu, and this is a bad season, but they are not increasing exponentially. Our hospitals take care of patients in danger of dying from those two things every day, every year. They cannot take care of an exponentially increasing number of victims of COVID-19.

Take care of yourselves and protect yourself and others. Flatten the curve.

Dr. K

PS: If you’re curious to see how long I’ve been fighting for a better health care system, go here: https://www.melvinkonner.com/new-york-times-op-ed-page-columns/

Summary I sent my students on Wednesday, with preface/update Saturday

Photo by CDC on Unsplash

Since Wednesday the number of identified cases in the US has gone from 3,500 to 20,000, partly because of increased testing. Testing remains woefully inadequate so the real number of cases must be much higher. The US deaths have passed 200. More young people are sick and dying. Mardi Gras (Feb. 26) made New Orleans a hot spot and Carnival encouraged transmission throughout Latin America. Spring Break on Miami Beach will have a similar effect. US hospitals are begging for supplies, personal protective equipment (PPE), and ventilators (respirators),  and the government in Washington is so far not demanding that factories repurpose to produce these items. Barring drastic action, hospitals will be overwhelmed in two or three weeks, heroic health professionals will be dying at higher rates, and remaining doctors will have to decide who lives and who dies. Don’t become one of those casualties. Protect them, yourself, and those around you.

Use this source for daily future updates, interactive maps, and reliable information in days to come: https://www.nytimes.com

COVID -19 UPDATES

WEDNESDAY March 18, 2020, 8am

Here is what has changed in the past week:

  1. The WHO declared a worldwide pandemic last Wednesday
  2. Italy is probably the worst hit, with hospitals completely overwhelmed; Iran may be worse, but we have no reliable information from there.
  3. France announced a nationwide lockdown two days ago, noting a rise in severe cases in young people around the country.
  4. The U.S. President announced a national emergency & discouraged gatherings of more than 10 people.
  5. Testing became more widespread, but still lags far behind that in other countries.
  6. Testing proved that the virus is being spread by people who have no symptoms, mainly the young; the young may not know it, but they are killing the old.
  7. Stock markets crashed & economies shut down in many countries and U.S. states.

Here is where we are this morning:

  1. Many leading U.S. hospitals are seeing a dramatic rise in cases and expect to be overwhelmed soon.
  2. Many governors are calling for U.S. army and other national aid that isn’t there yet.
  3. Approximately 3,500 cases are identified in the U.S.; experts say there are 10 unidentified cases for every identified one, so the real number is around 35,000.
  4. Despite lockdown in many areas & the closing of restaurants, bars, gyms, theaters, sports events, etc. by law, experts agree social distancing is far less than needed.
  5. Hospitals are running out of supplies needed to protect health care workers.
  6. Ventilators (respirators; breathing machines) cannot be manufactured fast enough to keep up with the need; doctors will have to decide who will get treatment & who will be let go of, just like in a war zone.
  7. Doctors and nurses are getting the virus from their patients and going home; they cannot be replaced, even if machines and supplies can.
  8. The Secretary of the Treasury now warns that U.S. unemployment can go from 3 to 20 percent.
  9. Economists widely agree that we are in or are “sliding into” a recession which cannot be avoided, and which could be worse than the Great Recession of 2008.
  10. No one can tell us how long this will last or how bad it will get.
  11. Epidemics in warm countries seem to disconfirm the hypothesis that summer weather reduces the number of cases.

My advice to you right now:

  1. Stay home and urge anyone in your family who is not performing a vital service (hospital work, food and medicine deliveries, grocery stores, pharmacies) to stay home too.
  2. Maintain contact with friends and family by phone, Skype, etc.
  3. If you must leave your home, stay six feet away from any other person.
  4. If you have traveled anywhere by air, train, or bus, stay away from your grandparents & all older people for at least 14 days. Stay in touch with older people by phone & have food and medicine delivered to them if you can.
  5. Develop, & urge everyone you know to develop, skills for working, preventing isolation & sadness, & being entertained at home. If you must get out, walk in the woods or in a park where you can avoid getting within 6 feet of another person. If you have to walk the dog, use the same precautions.
  6. If you are coughing & sneezing without a fever, stay home & call your doctor. Do not just show up at a medical office or emergency room. Get a test if you can find one.
  7. If you develop a fever and feel very weak, call 911.
  8. If you are in the U.S., check the CDC web page every day:

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-in-us.html (Links to an external site.)

  1. Wherever you are, check your national, state or provincial, and city or local health department websites every day.
  2. Wash your hands for 20 seconds many times a day; avoid touching your face as much as possible; frequently wipe down all surfaces from cell phones to kitchen counters with alcohol wipes; gloves & masks are in short supply, so use them wisely.

(Note: the photo above shows viruses in the coronavirus family, not SARS-COV-2, the causal agent of COVID-19, currently pandemic.)