Sunday, March 15, 2020

2019 Novel Coronavirus (CoVID-19): Part IX

2019 Novel Coronavirus (2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019), COVID-2019 Pandemic:

DON’T PANIC, be concerned, but don’t panic. It just makes everything worse.

March 15, 2020 update Part 9
Paul Herscu ND, MPH
Herscu Laboratory

This is the ninth piece of writing on the current epidemic. Please read Part 1, Part 2, Part 3, Part 4, Part 5  Part 6 Part 7 and Part 8 for context and also, please read my other writing on this site for a larger context on the overall topic of public health and epidemics

How the 2019 Novel Coronavirus (2019-nCoV; COVID-2019) ENDS:

Well, at this point from what we know:

Current Statistics
Regarding the current numbers in the USA, we have in less than a week confirmed cases went from 1,832 to 3,400 and, sadly, from 41 to 63 deaths. Personally, I believe at this point, the number most likely went from 7,000-8,000 to 12,000-14,000 infected. Until there are better tests available and widespread testing of everyone, we will not have accurate numbers. As an estimate of incidence, I suggested that the numbers might double each week. As you can see from official numbers that is what is being reported. My suggestion, is for approximating incidence rate, you could take the number who have died and multiply it by 200. That might be a closer approximation to the actual numbers in the USA for the coming period of time. We will know more when widespread testing is more available.

As you know I have been for years closely following the research and writing about how copper surfaces are a much better, safer alternative to stainless steel or other metal surfaces for germ prevention. Another study was just published out comparing surfaces and reflected how copper was much safer in regards to Covid-2019. It would behoove hospitals to change to this surface material as soon as is possible.

Modes of Transmission: Aerosolized Particles vs. Droplet
I mentioned that we do not want to do anything that inadvertently causes this virus to aerosolize. This can occur in the emergency department as by positive pressure ventilation delivering medicines. But I still believe that the transmission is mostly Contact form, meaning person to person, or large droplets, or on surfaces (see more on this in update #8 as well as my prior writing on epidemics.)  

Ending Wave 1, which is the main point of this update:
We went for a brisk walk in the woods and my daughter thought I should write this one, in case some of you may have the capacity to impact public policy. I want to write on how this first wave will end, as it surely will. There are only a few ways, and writing them down gives us specific pivot points to act upon. Here goes.

1.     The virus changes to be less lethal. This happens by itself or we encourage such evolution in the laboratory, and disseminate the less lethal one.
2.     A drug is developed or repurposed that treats the infection, and the wave ends. If that does occur we must be aware that this virus may well recur next fall/winter.
3.     A vaccine is developed, though this is likely to take place after the first wave is over, so this eventuality is not especially impactful on this first wave.
4.     The virus is so heat-sensitive that when summer comes, the first wave ends, but then returns in the fall/winter. So again, not a long-term solution in and of itself.
5.     We continue as we are, have somewhere around 50-60 million infected, develop enough herd immunity that the first wave ends, but again not a long term solution since wave two is sure to follow. This also means that the health care system is overwrought, the economy takes a huge hit and it takes a long time for the economy to recover.
6.     We follow the current public health protocols which ratchet up as the epidemic widens and deepens. This one is a moving target, as we tighten the hygiene, social distancing and isolation, closures, etc. In the short and long term, this is also a sort of lost proposition. At first we only test those that are sick with fever, then those with a cough, then eventually those exposed to someone confirmed, etc. Even though we know that some carry the virus without some of these symptoms. And that some pass this along while very much asymptomatic. As you recall, I have been harping on this since this epidemic began. Anyway, this version tightens and tightens on everyone, eventually, shutting down society, for a period of time. The wave is over and we rebuild. This is the one we are on track for at this time. This is the one that we are in the middle of. But it does not make much sense to me. At all. I would like to offer the one that makes most sense. Always has, at least for the first wave.
7.     To be as clear as possible, this next one is still strikes me as the very best way to end this wave without having to wait for any new science. Everyone gets tested. If you are going to interact with society in general, get tested. On the front end this is expensive, but it would stop the epidemic in a month or so. Period. In fact, it would have been over already. This is easy to model out. Let’s do this in a small version as an example. The town I live in has 50,000 people. If we are all in a lockdown to one extent or another, then we suffer equally. This does not make sense and it is not sustainable for the long run. What if we all get tested. Perhaps only 5 people are positive. You isolate them and the other 49,995 are free to go about their lives, in a cautious way, but life is more typical. Let’s say instead 5,000 are positive, you isolate them and the 45,000 are free to go about life. And then you keep testing every week. Isolating the ones that are newly positive. In a very, very short time, this wave ends. Perhaps a month or so. This is both cheaper, quicker, less intrusive to society, and really everyone wins. The idea of only testing symptomatic people or those that may have had contact, remains an error in judgment and does not match what we know about transmitting the virus from asymptomatic folks. No matter what the cost is to this strategy, unless there is new science that creates an intervention, this is a solid solution. This will become a more obvious solution, in one form or another, if the numbers keep growing as expected.

One way or another this wave will end. It only matters how impactful this virus is to us. And I still say this is not a medical question but a political public health question. Let’s make the right decision now. Some of you can impact public policy. Push for this strategy.

In health to you and your loved ones,
Paul Herscu ND, MPH