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.
Copper
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
