COVID-19 Resources
Brief excerpts, summaries, opinions, interpretations, and links on selected topics.
Like everyone else, I am in a learning process about the coronavirus.
If you have disagreements, elaborations, questions, or additional thoughts on any issue please contact me.
Brief excerpts, summaries, opinions, interpretations, and links on selected topics.
Like everyone else, I am in a learning process about the coronavirus.
If you have disagreements, elaborations, questions, or additional thoughts on any issue please contact me.
Recent Posts--go to the COVID Blog Page for all posts or click on selected titles below for specific posts
- Guidance: reducing risk of coronavirus transmission, June 28--Pulls together previous information covered in blog posts in a chart to help guide personal reflections and interpersonal conversations on risk.
- The Risks--Know them--Avoid them...by Dr. Erin Bromage, May 18--How do you assess risk in different situations?
- Crushing the Curve, May 14--What data helps inform when to consider expanding our "bubbles?"
- The Bubble Concept, May 12--How long do we need to stay socially isolated? How will we emerge safely?
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Links to key articles and references
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Newsletters to consider
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Posts from March 2020--new posts are now on the Clovid Blog Page
ADDITIONAL RECOMMENDED VIDEOS AND ARTICLES--posted in March
- Dr, Richard Hatchett interview, CEO of the Center for Epidemic Preparedness Innovations
- Three Vignettes on Coronavirus--see the first one on the situation in Italy
- How cancelled events and self-quarantines save lives in one chart
- Coronavirus testing shortages force extreme shift in strategy by local health officials
- Study highlights ease of spread of coronavirus
- Joe Rogan interview of Michael Osterholm, an internationally recognized expert in infectious disease epidemiology
Added March 26
Social distancing, testing, contact tracing--we know what to do now if....
The following three sources make me optimistic that all this sacrifice in social distancing and lockdowns is necessary right now because we (unlike South Korea and Singapore which have had only partial shutdowns) do not have capabilities for widespread testing and contact tracing (explained below). By ramping up these latter capabilities, there are ways to safely come out of our lockdowns relatively safely. Not easy at all but definitely within reach of our science right now if…
…if...we have strong, coordinated, aggressive national leadership. That we don’t have this now is demoralizing to me but I am encouraged and deeply grateful that our healthcare providers, our public officials at the state and local levels, our scientists are all doing the best they can and risking their own lives in the process.
Bill Gates Interview on TED network--what we must do now
Excellent interview—52 minutes. Check out 17:00 and 25:00 for especially informative excerpts.
In brief, he confirms the viewpoints from the following two articles:
• Aggressive social distancing now which may take about 20 weeks.
• Ramp up testing and contact tracing to be able to come out of widespread isolation.
• Develop vaccines and treatments.
“It is irresponsible to suggest that this is a trade-off between the economy and health.”
When can we let up?--strategies to relax lockdowns (STAT news special report)
EXCERPTS
An emerging consensus points to aggressive tracing of contacts of sick people, much broader testing, targeted quarantines, and new online tracking technology as strategies that would facilitate the easing of social distancing measures.
The point of lockdown measures, WHO Director-General Tedros Adhanom Ghebreyesus said during a briefing Wednesday, “is to enable the more precise and targeted measures that are needed to stop transmission and save lives.”
Both Singapore and South Korea used these methods allowing them to make tactical decisions about schools (mostly open in both countries) and public movement, sparing them from shutting down to the extent that the U.S. and many countries in Europe have.
An analysis of how China, Hong Kong, South Korea, and Singapore controlled the coronavirus outbreak also concluded that the strategy with the greatest impact was rapid testing, contact tracing, and quarantining cases and those they might have infected, for two weeks. That was more effective than travel bans, lockdowns, and school closings, Andrew Tatem of England’s University of Southampton and his colleagues found.
More and more modelers are discussing “precision quarantine,” as Momiao Xiong of the University of Texas Health Science Center and colleagues in Shanghai call it, to “slow down and keep people from transmitting the disease.” That could help with both an exit strategy and a next-wave strategy. If policymakers needed any more reasons to prepare for extensive testing and the targeted countermeasures that would allow, it’s this: Covid-19 could well return next fall with a vengeance because of today’s social distancing measures. There will be “a high proportion of susceptible individuals in the population,” Harvard’s Lipsitch and his colleagues explained in their analysis. That could lead “to an intense epidemic … in the late autumn and winter.”
How to safely end social distancing (Vox.com)
EXCERPTS
Know this: Ceaseless social distancing is not the only way to end this outbreak. And President Trump paints a false choice between saving lives and saving the economy. We can find a balance. It’s just that the current orders of social distancing would need to be replaced by a comprehensive, extremely ambitious plan.
Epidemiologists have been telling me about what it would take to end social distancing safely while fighting the spread of Covid-19. It isn’t easy. It will require an immense amount of leadership, coordination, and more sacrifice. It would take a sort of moon-shot-level effort. But the tactics they outline aren’t unfamiliar. They’re textbook epidemiology — they just need to be scaled up to a level never really seen before.
“We really do need a Manhattan Project effort to get this stuff in place in really a two-or three-month period,” Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, says.
It’s worth remembering why we’re in this situation. “The facts remain that we wasted a lot of time in terms of ramping up testing,” Saad Omer, director of the Yale Institute for Global Health, says. Testing in an outbreak provides two functions. One is to diagnose those who are sick. The other is surveillance: to see where the virus may be lurking, especially in cases where symptoms are mild or don’t manifest at all. The US has barely had enough testing capacity to test the sickest, let alone the capacity to do surveillance. Many doctors are telling patients with milder symptoms to just stay home and not get a test.
“Social distancing is basically a sledgehammer,” Konyndyk, who has worked on past outbreaks, like Ebola, says. “You’re just stopping everything and hoping that in the process you will also slow transmission.” What we need to do, he says, is turn that sledgehammer of social distancing into a scalpel: widespread testing and contact tracing.
“The classic epidemiological approach to controlling disease is not to shut down society; it’s to target the people you know to have the disease and understand who they’re spreading it to,” Konyndyk says. “We can’t do that right now because we don’t have enough testing to know who has the disease.”
Not only do we need more testing, we also need testing that can be completed within minutes. Once there’s widespread testing, there needs to be a huge team of public health workers in place to trace the contacts of those who test positive. Everyone who tests positive, or who has come into contact with someone who tests positive, then needs to be put into quarantine or isolation, to not spread the virus any further. This is how authorities routinely beat outbreaks — even of incredibly infectious diseases like measles.
In South Korea, this work was aided by technology. Authorities used GPS data from people’s cellphones to figure out whom they may have been in contact with. The GPS data may prove more reliable than their memory. “We need to take a good look at what South Korea has done, and what people here are willing to accept as far as some of those intrusions of public health into their normal lives, their privacy,”
Konyndyk suggests this effort would take “tens of thousands of people, maybe more.”
So these are the questions our leaders need to be asking now: Who will do this work? Will it be the National Guard? Could we employ and train laid-off workers from the concurrent economic crisis to provide support? “I think there’s lots of options, but starting with the vision and the strategy is kind of where we should begin,” Rivers says.
And even in this aggressive test-and-trace scenario, there could be many disruptions to our lives. It could mean a lot of people still under quarantine orders. Some level of general social distancing might also still need to be put in place. Perhaps, for example, schools could reopen but adults would still be encouraged to telework, and sporting events and other mass gatherings would be canceled. It’s not the case that everything could go back to normal. It’s the case that we could let some things go back to normal. Social distancing is a treatment we’d need to gently taper off.
The ultimate goal, in stopping a pandemic, is a safe and effective vaccine that can prevent people from getting the virus. The good news is that these are already being tested. The bad news is that it could take a year or more to prove they are safe and effective. “Honestly, I think the vaccine in 12 to 18 months is a moonshot,” Smith says.
In the meantime, we might be able to find a treatment sooner. The World Health Organization is currently facilitating a multinational clinical trial, testing medicines — and combinations of medicines — to treat Covid-19. If scientists do discover “drugs that decrease
Social distancing, testing, contact tracing--we know what to do now if....
The following three sources make me optimistic that all this sacrifice in social distancing and lockdowns is necessary right now because we (unlike South Korea and Singapore which have had only partial shutdowns) do not have capabilities for widespread testing and contact tracing (explained below). By ramping up these latter capabilities, there are ways to safely come out of our lockdowns relatively safely. Not easy at all but definitely within reach of our science right now if…
…if...we have strong, coordinated, aggressive national leadership. That we don’t have this now is demoralizing to me but I am encouraged and deeply grateful that our healthcare providers, our public officials at the state and local levels, our scientists are all doing the best they can and risking their own lives in the process.
Bill Gates Interview on TED network--what we must do now
Excellent interview—52 minutes. Check out 17:00 and 25:00 for especially informative excerpts.
In brief, he confirms the viewpoints from the following two articles:
• Aggressive social distancing now which may take about 20 weeks.
• Ramp up testing and contact tracing to be able to come out of widespread isolation.
• Develop vaccines and treatments.
“It is irresponsible to suggest that this is a trade-off between the economy and health.”
When can we let up?--strategies to relax lockdowns (STAT news special report)
EXCERPTS
An emerging consensus points to aggressive tracing of contacts of sick people, much broader testing, targeted quarantines, and new online tracking technology as strategies that would facilitate the easing of social distancing measures.
The point of lockdown measures, WHO Director-General Tedros Adhanom Ghebreyesus said during a briefing Wednesday, “is to enable the more precise and targeted measures that are needed to stop transmission and save lives.”
Both Singapore and South Korea used these methods allowing them to make tactical decisions about schools (mostly open in both countries) and public movement, sparing them from shutting down to the extent that the U.S. and many countries in Europe have.
An analysis of how China, Hong Kong, South Korea, and Singapore controlled the coronavirus outbreak also concluded that the strategy with the greatest impact was rapid testing, contact tracing, and quarantining cases and those they might have infected, for two weeks. That was more effective than travel bans, lockdowns, and school closings, Andrew Tatem of England’s University of Southampton and his colleagues found.
More and more modelers are discussing “precision quarantine,” as Momiao Xiong of the University of Texas Health Science Center and colleagues in Shanghai call it, to “slow down and keep people from transmitting the disease.” That could help with both an exit strategy and a next-wave strategy. If policymakers needed any more reasons to prepare for extensive testing and the targeted countermeasures that would allow, it’s this: Covid-19 could well return next fall with a vengeance because of today’s social distancing measures. There will be “a high proportion of susceptible individuals in the population,” Harvard’s Lipsitch and his colleagues explained in their analysis. That could lead “to an intense epidemic … in the late autumn and winter.”
How to safely end social distancing (Vox.com)
EXCERPTS
Know this: Ceaseless social distancing is not the only way to end this outbreak. And President Trump paints a false choice between saving lives and saving the economy. We can find a balance. It’s just that the current orders of social distancing would need to be replaced by a comprehensive, extremely ambitious plan.
Epidemiologists have been telling me about what it would take to end social distancing safely while fighting the spread of Covid-19. It isn’t easy. It will require an immense amount of leadership, coordination, and more sacrifice. It would take a sort of moon-shot-level effort. But the tactics they outline aren’t unfamiliar. They’re textbook epidemiology — they just need to be scaled up to a level never really seen before.
“We really do need a Manhattan Project effort to get this stuff in place in really a two-or three-month period,” Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, says.
It’s worth remembering why we’re in this situation. “The facts remain that we wasted a lot of time in terms of ramping up testing,” Saad Omer, director of the Yale Institute for Global Health, says. Testing in an outbreak provides two functions. One is to diagnose those who are sick. The other is surveillance: to see where the virus may be lurking, especially in cases where symptoms are mild or don’t manifest at all. The US has barely had enough testing capacity to test the sickest, let alone the capacity to do surveillance. Many doctors are telling patients with milder symptoms to just stay home and not get a test.
“Social distancing is basically a sledgehammer,” Konyndyk, who has worked on past outbreaks, like Ebola, says. “You’re just stopping everything and hoping that in the process you will also slow transmission.” What we need to do, he says, is turn that sledgehammer of social distancing into a scalpel: widespread testing and contact tracing.
“The classic epidemiological approach to controlling disease is not to shut down society; it’s to target the people you know to have the disease and understand who they’re spreading it to,” Konyndyk says. “We can’t do that right now because we don’t have enough testing to know who has the disease.”
Not only do we need more testing, we also need testing that can be completed within minutes. Once there’s widespread testing, there needs to be a huge team of public health workers in place to trace the contacts of those who test positive. Everyone who tests positive, or who has come into contact with someone who tests positive, then needs to be put into quarantine or isolation, to not spread the virus any further. This is how authorities routinely beat outbreaks — even of incredibly infectious diseases like measles.
In South Korea, this work was aided by technology. Authorities used GPS data from people’s cellphones to figure out whom they may have been in contact with. The GPS data may prove more reliable than their memory. “We need to take a good look at what South Korea has done, and what people here are willing to accept as far as some of those intrusions of public health into their normal lives, their privacy,”
Konyndyk suggests this effort would take “tens of thousands of people, maybe more.”
So these are the questions our leaders need to be asking now: Who will do this work? Will it be the National Guard? Could we employ and train laid-off workers from the concurrent economic crisis to provide support? “I think there’s lots of options, but starting with the vision and the strategy is kind of where we should begin,” Rivers says.
And even in this aggressive test-and-trace scenario, there could be many disruptions to our lives. It could mean a lot of people still under quarantine orders. Some level of general social distancing might also still need to be put in place. Perhaps, for example, schools could reopen but adults would still be encouraged to telework, and sporting events and other mass gatherings would be canceled. It’s not the case that everything could go back to normal. It’s the case that we could let some things go back to normal. Social distancing is a treatment we’d need to gently taper off.
The ultimate goal, in stopping a pandemic, is a safe and effective vaccine that can prevent people from getting the virus. The good news is that these are already being tested. The bad news is that it could take a year or more to prove they are safe and effective. “Honestly, I think the vaccine in 12 to 18 months is a moonshot,” Smith says.
In the meantime, we might be able to find a treatment sooner. The World Health Organization is currently facilitating a multinational clinical trial, testing medicines — and combinations of medicines — to treat Covid-19. If scientists do discover “drugs that decrease
Added March 24
From Politico nightly coronavirus update--sign up at politico.com
Good news from Italy: Two weeks after the country's lockdown commenced, Italy's daily death toll fell for the second day in a row, hitting 601, after 651 Sunday and 792 Saturday. The timing of that progress is in line with what health experts predicted in recommending the lockdown.
From Politico nightly coronavirus update--sign up at politico.com
Good news from Italy: Two weeks after the country's lockdown commenced, Italy's daily death toll fell for the second day in a row, hitting 601, after 651 Sunday and 792 Saturday. The timing of that progress is in line with what health experts predicted in recommending the lockdown.
Added March 23
From Propublica
The Coronavirus Testing Paradox
Excerpt
Where you stand depends on where you sit,” Frieden said. “Local context is all important. In New York City, today, you should not get tested if you have mild symptoms.” The reason, he said, is that the health care systems in places like New York, Los Angeles and Seattle are about to be overwhelmed by a wave of people seriously ill from COVID-19. They know it’s coming. Administering each test takes up protective gear, swabs and health care workers’ time, all of which should be reserved for patients with life-threatening conditions. On Monday, for instance, NewYork-Presbyterian Hospital reported that it had more than 600 patients with COVID-19.
Conversely, Frieden and other experts pointed out, the United States will need to pursue a policy of very broad testing if it hopes to slow the spread of the disease and restart parts of the economy anytime soon. Frieden noted that one of the countries most effective in lowering its infection rate, Singapore, had great success in tracing and isolating the contacts of each infected person. That is no longer possible in New York state, which has reported more than 20,000 positive tests and has many times that number of people infected. But he said it remains doable in many other cities and towns.
“In places where you’ve got the cases way down, or there are no cases,” he said, “aggressive testing will be needed.”
From The Hill WHO official warns more steps needed in addition to lockdowns
A World Health Organization (WHO) emergency-preparedness expert said Sunday that public health measures against the coronavirus must extend beyond large-scale lockdowns.
“What we really need to focus on is finding those who are sick, those who have the virus, and isolate them, find their contacts and isolate them,” Mike Ryan said on BBC’s Andrew Marr Show, Reuters reported. “The danger right now with the lockdowns ... if we don’t put in place the strong public health measures now, when those movement restrictions and lockdowns are lifted, the danger is the disease will jump back up,” he added.
Ryan cited measures put in place by South Korea, Singapore and China, combining restrictions with mass testing. “Once we’ve suppressed the transmission, we have to go after the virus. We have to take the fight to the virus,” Ryan said.
“The vaccines will come, but we need to get out and do what we need to do now,” he added, noting that any vaccine would likely not be approved and widely available for at least a year.
Ryan’s comments echo those of former FDA Commissioner Scott Gottlieb, who told CBS’s Margaret Brennan Sunday morning that the U.S., particularly cities like San Francisco and New York, which have almost entirely locked down, should begin developing strategies for transitioning to case-by-case interventions.
Added March 21
From Washington Post update today--see above for link to sign up
QUESTION
“I have seen reports on the fraction of cases that result in death as a function of age. But what is the fraction of severe reaction (e.g. number of cases that require hospitalization) as a function of age?” — Mark Sears, New Mexico
This question gets at an extremely important new finding about which age groups can become seriously ill from covid-19, the disease caused by the coronavirus. (Spoiler: almost all of them.)
Early data from China suggested only elderly people got very sick from the disease. A newly released study suggests this thinking is dangerously false, as The Post reported this week. The Centers for Disease Control and Prevention examined more than 4,000 covid-19 cases in the United States and found that, while 80 percent of deaths were people 65 or older, “the percentage with more moderate or severe disease requiring hospitalization is more evenly distributed between the old and the young.”
The specific numbers Mark is looking for can be found in the CDC report, specifically this paragraph:
Among 508 (12%) patients known to have been hospitalized, 9% were aged ≥85 years, 36% were aged 65—84 years, 17% were aged 55—64 years, 18% were 45—54 years, and 20% were aged 20—44 years. Less than 1% of hospitalizations were among people aged ≤19 years (Figure 2). The percentage of people hospitalized increased with age, from 2%–3% among people aged ≤19 years, to ≥31% among adults aged ≥85 years.
The important point is that many younger Americans do appear to be getting seriously ill from COVID-19. Even those who aren't, such as teenagers, can spread the virus to people who are more at risk.
Added March 19
From Washington Post update--see above for link to sign up
Two days ago, the United States had around 5,700 confirmed cases. Today, that number is over 11,300. This is a massive acceleration, due in part to more testing, but also because the virus is indeed spreading. The death toll in the United States is over 160.
How rigorous do we need to be with social isolation?--warnings from Italy and the CDC
The first article below offers a few thoughts on small things like morning coffee or visits with friends/family from a journalist in Italy who was asked what she would have told herself if she could go back in time to two weeks ago. She saw the situation change over two weeks from knowing people who were sick to knowing people who died. The second article below from the CDC suggests we may be on Italy's pathway.
One thing that worries me about this virus is that, while critical illness and death are much more likely with older patients with chronic illnesses, there are cases in any age group with no illnesses who get seriously ill and die. So minimizing the risks rigorously is, I believe, warranted.
From the article—interview of a journalist who lives in Italy
Warning from Italy
Excerpt
(Interviewer) To me, you’re like this messenger from the future. I wonder, if you had to call yourself up back in time before this happened, before you were in lockdown, what would you tell yourself about what’s to come?
(Journalist) I would say, dear Greta, please stay at home. Please give up stuff like going out for a coffee in the morning or going out with friends, because if you want your life back again, you need to give up some behaviors. The virus will behave in Italy as it behaves in other countries. So we have to give up our freedom a little bit, otherwise one day we’ll be sad because our fathers of our friends will die, because our neighbors will die. And we cannot stop that. The only thing we can do to help the doctors and patients is stay home. It’s saving lives, really.
Another article on why we may be on Italy's pathway from the CDC
Hospitals are bracing for the worst
Excerpt
In estimates leaked to the New York Times, the Centers for Disease Control and Prevention projects that in various COVID-19 scenarios, 2.4 million to 21 million people might need hospitalization, and—it’s hard to take in these numbers—200,000 to 1.7 million might die. The idea with flattening the curve, of course, is to spread out the need for intensive care as much as possible. But given that there are only about 46,500 ICU beds in the U.S.—and maybe resources to double that, in an emergency
Added March 18
From Propublica
The Coronavirus Testing Paradox
Excerpt
Where you stand depends on where you sit,” Frieden said. “Local context is all important. In New York City, today, you should not get tested if you have mild symptoms.” The reason, he said, is that the health care systems in places like New York, Los Angeles and Seattle are about to be overwhelmed by a wave of people seriously ill from COVID-19. They know it’s coming. Administering each test takes up protective gear, swabs and health care workers’ time, all of which should be reserved for patients with life-threatening conditions. On Monday, for instance, NewYork-Presbyterian Hospital reported that it had more than 600 patients with COVID-19.
Conversely, Frieden and other experts pointed out, the United States will need to pursue a policy of very broad testing if it hopes to slow the spread of the disease and restart parts of the economy anytime soon. Frieden noted that one of the countries most effective in lowering its infection rate, Singapore, had great success in tracing and isolating the contacts of each infected person. That is no longer possible in New York state, which has reported more than 20,000 positive tests and has many times that number of people infected. But he said it remains doable in many other cities and towns.
“In places where you’ve got the cases way down, or there are no cases,” he said, “aggressive testing will be needed.”
From The Hill WHO official warns more steps needed in addition to lockdowns
A World Health Organization (WHO) emergency-preparedness expert said Sunday that public health measures against the coronavirus must extend beyond large-scale lockdowns.
“What we really need to focus on is finding those who are sick, those who have the virus, and isolate them, find their contacts and isolate them,” Mike Ryan said on BBC’s Andrew Marr Show, Reuters reported. “The danger right now with the lockdowns ... if we don’t put in place the strong public health measures now, when those movement restrictions and lockdowns are lifted, the danger is the disease will jump back up,” he added.
Ryan cited measures put in place by South Korea, Singapore and China, combining restrictions with mass testing. “Once we’ve suppressed the transmission, we have to go after the virus. We have to take the fight to the virus,” Ryan said.
“The vaccines will come, but we need to get out and do what we need to do now,” he added, noting that any vaccine would likely not be approved and widely available for at least a year.
Ryan’s comments echo those of former FDA Commissioner Scott Gottlieb, who told CBS’s Margaret Brennan Sunday morning that the U.S., particularly cities like San Francisco and New York, which have almost entirely locked down, should begin developing strategies for transitioning to case-by-case interventions.
Added March 21
From Washington Post update today--see above for link to sign up
QUESTION
“I have seen reports on the fraction of cases that result in death as a function of age. But what is the fraction of severe reaction (e.g. number of cases that require hospitalization) as a function of age?” — Mark Sears, New Mexico
This question gets at an extremely important new finding about which age groups can become seriously ill from covid-19, the disease caused by the coronavirus. (Spoiler: almost all of them.)
Early data from China suggested only elderly people got very sick from the disease. A newly released study suggests this thinking is dangerously false, as The Post reported this week. The Centers for Disease Control and Prevention examined more than 4,000 covid-19 cases in the United States and found that, while 80 percent of deaths were people 65 or older, “the percentage with more moderate or severe disease requiring hospitalization is more evenly distributed between the old and the young.”
The specific numbers Mark is looking for can be found in the CDC report, specifically this paragraph:
Among 508 (12%) patients known to have been hospitalized, 9% were aged ≥85 years, 36% were aged 65—84 years, 17% were aged 55—64 years, 18% were 45—54 years, and 20% were aged 20—44 years. Less than 1% of hospitalizations were among people aged ≤19 years (Figure 2). The percentage of people hospitalized increased with age, from 2%–3% among people aged ≤19 years, to ≥31% among adults aged ≥85 years.
The important point is that many younger Americans do appear to be getting seriously ill from COVID-19. Even those who aren't, such as teenagers, can spread the virus to people who are more at risk.
Added March 19
From Washington Post update--see above for link to sign up
Two days ago, the United States had around 5,700 confirmed cases. Today, that number is over 11,300. This is a massive acceleration, due in part to more testing, but also because the virus is indeed spreading. The death toll in the United States is over 160.
How rigorous do we need to be with social isolation?--warnings from Italy and the CDC
The first article below offers a few thoughts on small things like morning coffee or visits with friends/family from a journalist in Italy who was asked what she would have told herself if she could go back in time to two weeks ago. She saw the situation change over two weeks from knowing people who were sick to knowing people who died. The second article below from the CDC suggests we may be on Italy's pathway.
One thing that worries me about this virus is that, while critical illness and death are much more likely with older patients with chronic illnesses, there are cases in any age group with no illnesses who get seriously ill and die. So minimizing the risks rigorously is, I believe, warranted.
From the article—interview of a journalist who lives in Italy
Warning from Italy
Excerpt
(Interviewer) To me, you’re like this messenger from the future. I wonder, if you had to call yourself up back in time before this happened, before you were in lockdown, what would you tell yourself about what’s to come?
(Journalist) I would say, dear Greta, please stay at home. Please give up stuff like going out for a coffee in the morning or going out with friends, because if you want your life back again, you need to give up some behaviors. The virus will behave in Italy as it behaves in other countries. So we have to give up our freedom a little bit, otherwise one day we’ll be sad because our fathers of our friends will die, because our neighbors will die. And we cannot stop that. The only thing we can do to help the doctors and patients is stay home. It’s saving lives, really.
Another article on why we may be on Italy's pathway from the CDC
Hospitals are bracing for the worst
Excerpt
In estimates leaked to the New York Times, the Centers for Disease Control and Prevention projects that in various COVID-19 scenarios, 2.4 million to 21 million people might need hospitalization, and—it’s hard to take in these numbers—200,000 to 1.7 million might die. The idea with flattening the curve, of course, is to spread out the need for intensive care as much as possible. But given that there are only about 46,500 ICU beds in the U.S.—and maybe resources to double that, in an emergency
Added March 18
- Summary of English Modeling Study by the Washington Post--suggesting aggressive measures for 12 - 18 months may be needed to prevent overhwhelm of health care system (For PDF of summary by the authors, click on Study Summary by Authors)
- Why coronavirus is worse than the flu in one simple chart (vox.com)
- Eleven things everyone should know about the coronavirus (vox.com)--a good, thorough review which acknowledges differing viewpoints on certain issues
- What the experts have to say on social distancing (from Johns Hopkins)
- What coronavirus looks like in kids (Washington Post)
- Stealth Transmissions: Research study shows substantial transmission occurs through undocumented (mild, asymptomatic) cases that are not reported. Washington Post refers to this as “stealth transmissions.”
- Statement from King County (Seattle area) executive Dow Constantine “Treat the next two weeks as a period of self-quarantine, to protect yourself and the lives and health of your loved ones and the entire community,”
- CDC Notice on Gatherings
- Why outbreaks like coronavirus spread exponentially and how to "flatten the curve" (Washington Post)
- A COVID-19 coronavirus update from concerned physicians
- Article on Crisis Leadership from the Harvard Kennedy School
Resources added March 15, 2020
Please read this article on coronavirus just circulated on twitter by an executive at the Institute for Healthcare Improvement:
Coronavirus: why you must act now
IN BRIEF
In Washington State we likely have in the thousands of cases not hundreds. This is because we are only catching cases with manifest symptoms.
In the US we are way behind countries who have done a lot of testing and containment. Their death rates will range from 0.5% (South Korea) to 0.9% (the rest of China after they locked down their first city). In countries like the US we are likely to hit rates of 3 – 5%. As you know this sounds small but will overwhelm the healthcare system leading to rationing—e.g. decisions like in Lombardy Italy where they don’t use respirators with people over 65 or younger people with chronic conditions.
Social distancing is crucial to save lives. The worst infections come through surfaces: the virus survives for up to 9 days on different surfaces such as metal, ceramics, and plastics. That means things like doorknobs, tables, or elevator buttons can be terrible infection vectors. The only way to truly reduce that is with social distancing: keeping people home as much as possible, for as long as possible until this recedes.
Look at the graph below on the impact of one day of social distancing.
Coronavirus: why you must act now
IN BRIEF
In Washington State we likely have in the thousands of cases not hundreds. This is because we are only catching cases with manifest symptoms.
In the US we are way behind countries who have done a lot of testing and containment. Their death rates will range from 0.5% (South Korea) to 0.9% (the rest of China after they locked down their first city). In countries like the US we are likely to hit rates of 3 – 5%. As you know this sounds small but will overwhelm the healthcare system leading to rationing—e.g. decisions like in Lombardy Italy where they don’t use respirators with people over 65 or younger people with chronic conditions.
Social distancing is crucial to save lives. The worst infections come through surfaces: the virus survives for up to 9 days on different surfaces such as metal, ceramics, and plastics. That means things like doorknobs, tables, or elevator buttons can be terrible infection vectors. The only way to truly reduce that is with social distancing: keeping people home as much as possible, for as long as possible until this recedes.
Look at the graph below on the impact of one day of social distancing.
What you can do
See: Social Distancing: this is not a snow day
(published by Ariadne Labs which is a research center for healthcare innovations that is part of Harvard)
Also see: The Do's and Don'ts of Social Distancing (published in The Atlantic)
My brief review of the latter article:
The article interviewed three experts. The following is the most conservative opinion which I lean toward.
Cannuscio: I would recommend that people minimize social contact, and that means limiting all social engagements. That includes intimate gatherings among friends. I think the exception is if two households are in strict agreement that they are also going to reduce all outside contact and then those two households socialize together, to support one another. I can see social and mental-health advantages to that kind of approach.
Below are the two more liberal responses. The problem I see with these is that the best we know is that you get infectious even before symptoms. Also, practicing these is very hard and people will have different definitions so asking people in general if they are “social distancing” may not be reliable---e.g. for one person it might mean not being in any gatherings of 250 people or more and commuting and having people over as usual; for another, this could mean staying at home except for groceries and pharmacy.
Watson: I think small gatherings are probably okay as long as nobody has symptoms, respiratory symptoms. As soon as someone seems sick, you should probably not get together.
Ko: We’re in a gray zone now. The public-health imperative is to create social distance; that’s the only way we’re going to stop this. Think about having those get-togethers but practicing good public health: not sitting very close, trying to keep distance. Wash your hands; avoid touching your face. There are places on the board game that people are constantly touching—routinely disinfect [those, as well as] doorknobs, the bathroom faucets, those types of things. There’s no absolute rule about what works, but what we do know is that decreasing the size of those gatherings, increasing the distance, practicing good hygiene will go a long way.
See: Social Distancing: this is not a snow day
(published by Ariadne Labs which is a research center for healthcare innovations that is part of Harvard)
Also see: The Do's and Don'ts of Social Distancing (published in The Atlantic)
My brief review of the latter article:
The article interviewed three experts. The following is the most conservative opinion which I lean toward.
Cannuscio: I would recommend that people minimize social contact, and that means limiting all social engagements. That includes intimate gatherings among friends. I think the exception is if two households are in strict agreement that they are also going to reduce all outside contact and then those two households socialize together, to support one another. I can see social and mental-health advantages to that kind of approach.
Below are the two more liberal responses. The problem I see with these is that the best we know is that you get infectious even before symptoms. Also, practicing these is very hard and people will have different definitions so asking people in general if they are “social distancing” may not be reliable---e.g. for one person it might mean not being in any gatherings of 250 people or more and commuting and having people over as usual; for another, this could mean staying at home except for groceries and pharmacy.
Watson: I think small gatherings are probably okay as long as nobody has symptoms, respiratory symptoms. As soon as someone seems sick, you should probably not get together.
Ko: We’re in a gray zone now. The public-health imperative is to create social distance; that’s the only way we’re going to stop this. Think about having those get-togethers but practicing good public health: not sitting very close, trying to keep distance. Wash your hands; avoid touching your face. There are places on the board game that people are constantly touching—routinely disinfect [those, as well as] doorknobs, the bathroom faucets, those types of things. There’s no absolute rule about what works, but what we do know is that decreasing the size of those gatherings, increasing the distance, practicing good hygiene will go a long way.