Tag: covid-19

Unlocking coronavirus – Moving beyond testing

Much of the focus in recent US debate regarding the response to the covid-19 coronavirus has been on expanding our testing and tracing efforts. Other countries have used this model more or less successfully. Quickly identify sick people, find out everyone they came into contact with, and get them all into quarantine to head off the spread.

But I’ve all but given up on testing as a strategy for many countries, especially the US. I think the focus has to be mostly on increasing medical system capacity – more equipment, more supplies, more quickly-trained personnel who can perform some tasks (and get paid a lot to do them).

Coronavirus Disease 2019 (COVID-19) - United States Department of ...
US Department of State, https://www.state.gov/coronavirus/

We cannot stay closed for the many months and possibly years required to identify safe and effective treatments and/or vaccines. Social distancing of some kind will still be necessary, of course. The peaks should still be shaved off the caseload. And of course, some people who are especially vulnerable should take extra precautions.

But bottom line, it’s about keeping the death rate from SARS-Cov-2 as low as possible. With proper medical care, it seems likely that we can keep the fatality rate down where it seems to be settling in globally – 1% of cases. That is still ten times deadlier than the flu, so there’s no reason to relax. But it is not the first SARS (10%), MERS (30%+), or Ebola (50%). And most cases still seem to be mild, maybe to the point of people not feeling any symptoms at all.

As the expert in this NPR interview points out, we should definitely have testing for the people on the front lines – medical personnel, people working in the manufacturing and delivery of essential products and services (from food to transport to energy to water), security workers of all kinds (firefighters, police, military), etc.

But, at least in the US, I’m convinced we simply won’t ever pull it together to have widespread enough testing – either for covid-19 directly or serological to look for antibodies (and therefore potentially immune people). Better to put our resources into what we already know how to do – provide medical services.

A Rush Job to “Re-Open” the Economy

It appears from his USA TODAY op-ed that Sen. Ron Johnson of Wisconsin is comfortable with doubling down on his previous statements that addressing the covid-19 pandemic in the US is not worth the economic damage caused by the various lockdowns being put in place.

https://www.usatoday.com/story/opinion/todaysdebate/2020/03/29/coronavirus-put-things-into-perspective-ron-johnson-editorials-debates/2937302001/

It’s easy to dismiss him as yet another conservative ghoul. (Sorry, but just about every take that’s either directly or indirectly okay with higher death rates comes from Republicans and/or libertarians).

However, I happen to agree that a balance will eventually have to be struck between coronavirus mitigation and economic activity.

(And to be honest, I don’t mind a stark reminder of our mortality, though he has a particularly brutal way of saying it. “Death is an unavoidable part of life.” Is he a religious man?)

BUT.

We have no effective, widespread testing regime in place in the US, either to detect live cases or to identify people who have recovered. This second group of tests – blood, or serological, tests – can identify people who could be immune and might be able to work safely with sick patients. They can also donate their serum for the virus-killing antibodies it contains, which can be used in research and possibly treatments.

We have not adequately ramped up our medical resources. He makes yet another bogus comparison to known dangers, like the seasonal flu, which our health systems are geared up to address. One of the biggest dangers from this “novel” (as in new) coronavirus, as it was originally called, has been that it appears to be ridiculously infectious – in part, because no human has encountered it before – which creates an enormous number of cases all at once. Current data show about 15% of all cases require hospitalization – often for weeks – which our system is simply not scaled up to handle. Also, while case and mortality data continue to come in, it does appear that covid-19 is some multiple more deadly than the seasonal flu. Even Pres. Trump has now said that 100- to 200-thousand US deaths would be a “very good” outcome, compared to a potential two million deaths.

We have no effective tracing and isolation regime in place. Johnson throws a bone to the need for the current set of social distancing/lockdown orders in place in many states. (“Social distancing should continue until this outbreak is under control.” However, the only way to refine social distancing, and therefore re-start portions of the economy, is to set up a way to identify the sick people, find out who they had close contact with, and get them all out of the public. Otherwise, it just becomes the Wild West for the virus all over again.

In short, how about we fix the public health problem FIRST, then get busy worrying about which parts of the economy to return to normal? I’d take these calls much more seriously then.

Three other things to address.

First, there’s been a lot of focus on whether Trump believes or doesn’t believe in extending these lockdowns. (This isn’t addressed specifically by Johnson.) But why? Trump has no authority to do that. (Or maybe limited? Where are those strict constitutionalist conservative scholars when you need them?) These lockdowns are imposed by the states. Count ourselves lucky that, under our federal system, governors who realized the true extent of the danger were empowered to act without the blessing of the central government. (Unlike China.) The Trump administration’s recommendations are just that – recommendations.

Second, Johnson does say that he wants to flip our policy from identifying “essential” economic activity to instead identifying “non-essential” economic activity. Look, the fact is that a lot of the mass social activities that have been targeted by the lockdown orders are non-essential. Commuting to offices might prove to have been a luxury, or maybe just plain silly. Also with eating out, live entertainment, travel, etc. Our economy existed before these were mass products and services and, while I miss them, too, life does goes on. (A worldview the senator would seem to be comfortable with.) The problem is, instead, how to employ people in this new world. Some are already re-deploying to delivery services and logistics. How about we incentivize and/or aid transitions into medical care, medical support, in-home visits, etc.? We need people in light manufacturing (of masks, etc.) This transition is painful, so let’s find ever more ways to smooth it. And of course, make it absolutely safe for people to perform these roles.

Finally, along that line, should the good senator not be comfortable with addressing any of these public health considerations first, then he should be first in line to volunteer at a restaurant serving out-of-work folks or in a hospital or elderly care setting. Put yourself, Sen. Johnson, on the front lines of the coronavirus economy. Otherwise, kiss off.

Singapore covid-19 covonavirus life update for 19 March 2020

Occasionally on Facebook, I’ve written open letters mainly for family and friends back in the US about how the covid-19 coronavirus outbreak is progressing in Singapore. Here’s the latest.

Hi, everyone. Since I started giving periodic updates out of Singapore, I figured I’d post another. And what a week it’s been. 

Where to start? I suppose with the numbers. After having pretty good control of the covid-19 coronavirus for a while now, the number of new cases increased dramatically just this week. The highest jump came just yesterday – 47 more cases – bringing the total since January to 313. (Just below two thirds of those are still hospitalized, while the rest have been discharged. Fifteen are in critical care.) 

Globally speaking, these are still excellent numbers. And why we saw a jump matters a lot. Most of the cases have been imported from the rest of the world. Many Singaporeans and foreigners who live here are rushing in. The caseload in Europe and elsewhere is surging; business travelers are finally getting the message and cutting trips short; a local school holiday during which some people traveled is ending; cases from Singapore’s neighbors, Indonesia and Malaysia, have landed here; and students whose colleges have closed are returning. Sadly, a friend of mine is one of these cases, having picked up covid-19 in the UK. He and his spouse are doing well as of right now. (Sadly, the work colleague of another friend has died.)

This surge of confirmed and potential cases has led to a lot of dramatic changes. Singapore is now requiring all travelers to serve a two-week stay-at-home period to see if they develop symptoms. Travelers from some countries, like China and places in Europe, aren’t allowed to come or pass through here at all. While not a full lockdown from the outside world, it inches closer. Meanwhile, aggressive testing and tracing of people who might have been exposed continues. People serving stay-at-home notices and quarantines are carefully monitored (with penalties for disobeying.) Temperature checks and filling out travel declaration forms (with penalties for lying) are commonplace.

Besides the clamping down on outside travelers, the other big news of the week was Malaysia finally getting serious about the virus. (Singapore is an island just off the southern tip of Malaysia.) After a growing number of cases, Malaysia decided to block its citizens from leaving the country, presumably to prevent them from coming back infected. For Singapore, this potentially dealt a huge blow to its labor force and, most disturbing, its food supply. 

Between 250k and 300k people travel from Malaysia *each day* to work (and study) in Singapore. Losing these workers could deal a huge blow to a lot of industries. Ahead of the deadline, many Malaysians rushed to get into Singapore, and many Singaporean employers rushed to find places to house them – not always successfully. There are stories of Malaysian workers sleeping in exposed conditions at this time. (Not so bad from a weather perspective – it’s warm here all year long – but the risk of mosquito-borne diseases, like dengue fever, is always high.) These workers are essentially separated from their homes until the end of the month.

As I mentioned, the food supply was also at risk. Many fresh vegetables and meats in Singapore come from Malaysia. (Singapore is basically a city-island. While it tries to grow some food for emergencies, most of it is imported.) Soon after Malaysia’s announcement that it was closing its borders, we had another run on the groceries. We had long lines and many empty shelves (including – yet again – toilet paper. 🙄) The government quickly moved to reassure Singaporeans that there was enough supply by saying it had emergency stocks spread around the island, that it was finding alternative supplier countries for things like eggs, and that it would negotiate some sort of understanding with Malaysia. (Singapore and Malaysia have historically not liked one another, so that’s always tricky.) Meanwhile, one grocery instituted buying limits on some items, and the grocery delivery services are stretched to near breaking. But by yesterday afternoon and today, some shelves were being restocked. This might be resolving itself, but the supply of food and other necessities remains a huge worry.

At this point, a natural question might be, why not leave? After all, we’re foreigners here. Unlike Singaporeans, supposedly we have the option of exit. Well, first off, logistically that’s not so easy. Flights are getting canceled left and right and at short notice. And what do you do with all of your stuff? Just leave it? It’s not like an army is invading. Second, what kind of reception is waiting back in the US? Countries are closing off and turning more xenophobic by the day and might not even welcome back their own citizens. At the very least a mandatory quarantine of some kind seems highly likely. Finally, and maybe most importantly, this is our home. No one becomes a refugee until there’s truly no choice left.

Meanwhile, life goes on, with plenty of disruptions but fewer than elsewhere. 

Most importantly, the medical system seems to be handling the caseload. 
As for education, local schools have been on break, but the government has announced they will re-open on schedule next week. That said, things haven’t been so calm at the kids’ school. While not explicitly stated, after a parent returned from Europe and tested positive, the school clearly began exploring its options should school be forced to close. (Another parent returning from the US has also since tested positive.) So, as a controlled dry run, in-person school was canceled from Wednesday through Friday this week, and Thursday and Friday are being spent doing distance learning. So far, so good. The kids are sitting at computers all day. Pretty good training for a life of office work, I guess. Next week is spring break. (Absolutely no one is traveling. Or at least they shouldn’t be.) And with any luck, just like the Singaporean schools, they’ll be back in class and with their friends soon enough.

People are still going to work in many cases, but not always. Just today, my wife’s US employer announced that everyone worldwide who can work from home should do so until the end of the month. This mirrors what I’m seeing in many other parts of the world. Since I already mostly work from home, all four of us will be here tomorrow, staring at our own screens

Finally, most social activities are canceled – certainly big events, but many smaller ones, as well. That said, we do not have the blanket closure of all restaurants and venues. Fewer people seem to be going out. (With no tourists, crowds in many places are way down.) Usually people are in small groups and spaced out (even if I did see one packed bar the other evening with a live band playing). But all of this is voluntary, with most people seeming to follow the recommendations of health experts. I know I’ve completely eliminated handshakes and even fist bumps from my social gestures. I’ve definitely given up licking flat surfaces… 😉

To wrap up, I’ve tried to present this fairly calmly, but if I take a moment to reflect on the last week, I start seething. The spike in cases that we’ve seen has largely been caused by stupidity and/or denial. Some countries have been ridiculously slow to respond. For example, in Malaysia, a giant religious event was allowed to go forward, and many people became infected, some of whom landed back here. (Another similar event wisely just got canceled in Indonesia.) Some people have taken business or personal trips, when – to my mind – it was clear that they shouldn’t have. Or if the trip was truly necessary, it was certainly clear that you should separate yourself and those close to you voluntarily when you get back. (I feel the infections at our school fall into this category.) There have been big private parties in the community, and as I said, some people still go to crowded venues. In my more charitable moments I try to remember that this is a fast-moving situation. Maybe people feel they were acting reasonably at the time. But nah, the writing has been on the wall long enough. Some people are just being outrageously irresponsible. And we’ll all potentially going to pay the price.

So that’s the view from sunny Singapore – for now. While it’s been nice to see many people praising the country for its response to covid-19, it’s important to remember that it’s a constant battle to keep ahead of the coronavirus, and there are other forms of instability that can come out of nowhere.

Meanwhile, keep flattening that curve by practicing appropriate social distancing and give our modern medical system time to get the drop on this bug. Stay safe, remember to be nice to one another, and 🤛🙏👋 or even 🖖, but certainly do not 🤝. 

🌎🌍🌏

Coronavirus – Keep Calm and Wash Your Hands

So I stayed off social media for a couple of days because it was very difficult to watch the US begin to go through a collective freakout over the coronavirus. Watching a people being forced to confront their (inevitable) mortality is not a pretty sight. And of course, none of this is helped by our current polarized political and media environment.

I hate to feed the polarization beast and talk politics in what should be a medical and apolitical conversation, but it seems unavoidable. On the one hand, we have a president who engaged in his own freakout over how this might affect him and his election chances rather than the American people, going so far as to call the coronavirus a hoax. It is not, just to be clear. If ever there was a kind of crisis when we needed a public-spirited, non-divisive stable genius in charge, a disease outbreak is it. Additionally, we have people in charge at the federal level who deny science; look to religion for answers in medical matters; and constantly dismiss expertise. I don’t like to say it, but I don’t think answers will be found at the federal level. States and medical personnel are going to have to take the lead.

Also, the media need to do better. There’s the insatiable bias toward conflict built into much TV news (which I guess works because people reward it with their eyeballs). But I’ve also already seen enough “doomsday pepper” clickbait articles to know there’s a lot of irresponsible journalism out there right now.

Yes, there are circumstances in which a particular global outbreak could definitely bring down society – say, if Ebola with its average 50% death rate went global. Then there truly would be a complete strangling of the real economy. Production and supply chains for food, medicine, and essentials would break down as factories and fields and transportation networks were starved for workers. Municipal water supplies could be threatened as regular workers became unavailable and whatever chemicals and equipment are needed would be in short supply. And of course, people would be overwhelmed just surviving and burying their loved ones.

But this coronavirus is not that disease. Yes, covid-19, as it’s now called by the WHO, is incredibly infectious. Personally, I’m resolved to the fact that it’s likely to soon be widespread worldwide. But most people’s symptoms (around 80%) are mild. There are more serious cases, but the best data we have right now shows that the death rate remains around two to three percent. That death rate is far higher than the flu (at about .1%), of course, and it’s altogether tragic, like any disease outbreak (or war or famine, for that matter). But it is manageable from a societal perspective. With this disease profile, a recession seems likely (which will be painful in its own right), but the economy will eventually grind back to life.

What cannot happen, under any circumstances, is a panic. Any panic will cause more problems than the disease itself. If you’re overly worried about shortages of essentials and go on a hoarding spree, you’ll cause the very shortages you were worried about. We are all being tested now, whether we can keep our wits about us, while remaining appropriately vigilant.

What is appropriately vigilant? There are both individual and societal components. Healthy individuals need to wash their hands, avoid touching their faces, and avoid crowded spaces and sick people. People who feel sick or could have been exposed need to seek medical care, wear a mask if going out for any reason, and respect quarantine orders. Among the needed societal measures are those quarantines, as well as continued monitoring and testing and making sure hospitals and medical personnel are well supplied.

The goal here is to avoid any given hospital system getting overwhelmed. That’s when it really gets ugly. This is what we see in Wuhan, China – the epicenter of the outbreak and where tens of thousands of people have gotten sick. That situation is unusual compared to other countries so far, but it carries critical lessons for the US. Wuhan’s crisis was exacerbated by a political system that saw coverup, denial, and self-interest as more important than public health. I’m talking about the closed, propagandistic system of communist China, of course, but I am seeing far too many parallels in the early response by the Trump administration and Fox News. To any Trump supporters and Republicans, you must demand better. Sure, Democrats and the media will go too far the other way, but trust me, you want the benefits of an open society that questions and critiques more than you want an authoritarian society that sweeps under the rug.

To wrap up, my basic messages are these: Don’t panic. Stay vigilant. Support medical personnel and researchers. Help your fellow citizens get needed care.

Sure, circumstances could change. After all, before the WHO named this thing covid-19, it was referred to as the novel coronavirus – novel, as in “new”. We’re learning more every day. But I’m confident, based on what we know so far, we can get through this – calmly and together.