Changing Things for a While to Slow Down Coronavirus and Maybe Keep our Health System Afloat: Post 2
3/15/2020 (The Ides of March)
Sit-Rep (Situation report - FEMA talk):
Over the weekend the calls for significant social distancing and closures of public spaces plus restaurants/bars/events have grown. France, Spain, and Italy have closed these public spaces and are keeping people indoors. Schools in most US states are closed, but Americans continue to crowd into airports, lines at big box stores and gun stores are hours long, and many are flaunting public health recommendations. So stopping the spread of this virus for which we have no vaccine and no treatment will likely not be achieved in the US. It's a pandemic, and we are an epicenter.
Numbers:
The cloud-based operating system DOMO offers this Coronavirus
tracker which shows at least 2200 confirmed cases of COVID-19 in the US so far, so at least that many tests have been done. Of these 2200, 47 are casualties (they died from the viral infection). March 10 was first day the confirmed case numbers spiked. About 4000 new cases are confirmed each day across the globe.
The Washington Post built this simulator to show how the virus spreads and how the epidemiology curves are built.
The US messed up testing big-time. We didn't start testing soon enough, and trump prevented the CDC from using the World Health Organization test, so the CDC and private labs in the US have had to build one from scratch. The CDC test had to be re-done because the first draft wasn't accurate. And, Jared Kushner's family owns OSCAR, a health care tech start-up that is now "directing people to testing sites" and providing telemedicine. So the delay in testing and failure to bring the (accurate and cheap) WHO test into the US seems linked to trump not wanting there to be reported cases, plus a wish for a way to tap into profits from the pandemic.
Money:
Lay-offs are happening in travel, entertainment, restaurant, and other industries, and people are already needing food assistance. Donate to your local food bank and homeless and domestic violence shelters - they already need help and the need will grow.
The journal Family Practice Management offered these guidelines for medical practices for billing and coding for testing and treatment. Calls for ambulatory care practices (such as dermatology, ophthalmology, and medical subspecialties that have elective appointments) to close are getting louder, with resistance on patient and providers sides both.
Health care:
But other practices are changing their approaches to try to decrease virus transmission, while hospitals grapple with limited resources. There is not enough personal protective equipment (PPE - gloves, masks, suits, etc) nor ventilators to care for everyone who is likely to need it. One Seattle hospital was down to a 4 day supply of gloves yesterday, and getting more shipped there seems unlikely. Oregon received 10% of the supplies it ordered from the federal government. So we may be looking at rationing of care.
We could look to previous planning for pandemic influenza, realizing this is worse because WE HAVE NOT TREATMENT NOR VACCINE:
Altered Standards of Care for Health Care Providers in Pandemic Influenza. Indiana Health Law Review Vol. 6 No. 1 (2009)
Public Health Newswire's piece Beyond Containment on what comes next can help health care leaders grapple with the new reality.
What you should do:
Stay home.
Don't go to restaurants, bars, concerts, plays, malls, big box stores, grocery stores, pharmacies, playdates, birthday parties, dinner parties, weddings, funerals, church.
Go outside to exercise. Don't go to the gym or yoga class. Jogging/walking/cycling are great - just stay 10 feet away from other people, and when you get home, shower with soap.
Wash your hands often - 20 seconds of rubbing the soap in.
Insist on working from home - we must stay off public transportation and out of office buildings. Restaurants and groceries should change their approach to take-out and pick-up or delivery.
And we should all reach out to people who are elderly to be sure they have their needs met in their homes so they don't go out into public spaces where their risk of getting infected are increasing every day.
Only health care workers and people who work in infrastructure and emergency management should be out and about.
Food for though:
We can think about alternative hypotheses about how the pandemic started -
https://www.thinkglobalhealth.org/article/coronavirus-unknown-source-unrecognized-spread-and-pandemic-potential (authors posit alternative explanations for the start of the pandemic - one author is my Georgetown medical student Krissy Kent!)
and how it will proceed (Japan is reporting a case of a person who had recovered and now has another case of COVID-19. So, this changes how we think of timing and how the pandemic will play out over time.).
And, we can WUTANG:
Sit-Rep (Situation report - FEMA talk):
Over the weekend the calls for significant social distancing and closures of public spaces plus restaurants/bars/events have grown. France, Spain, and Italy have closed these public spaces and are keeping people indoors. Schools in most US states are closed, but Americans continue to crowd into airports, lines at big box stores and gun stores are hours long, and many are flaunting public health recommendations. So stopping the spread of this virus for which we have no vaccine and no treatment will likely not be achieved in the US. It's a pandemic, and we are an epicenter.
Numbers:
The cloud-based operating system DOMO offers this Coronavirus
tracker which shows at least 2200 confirmed cases of COVID-19 in the US so far, so at least that many tests have been done. Of these 2200, 47 are casualties (they died from the viral infection). March 10 was first day the confirmed case numbers spiked. About 4000 new cases are confirmed each day across the globe.
The Washington Post built this simulator to show how the virus spreads and how the epidemiology curves are built.
The US messed up testing big-time. We didn't start testing soon enough, and trump prevented the CDC from using the World Health Organization test, so the CDC and private labs in the US have had to build one from scratch. The CDC test had to be re-done because the first draft wasn't accurate. And, Jared Kushner's family owns OSCAR, a health care tech start-up that is now "directing people to testing sites" and providing telemedicine. So the delay in testing and failure to bring the (accurate and cheap) WHO test into the US seems linked to trump not wanting there to be reported cases, plus a wish for a way to tap into profits from the pandemic.
Money:
Lay-offs are happening in travel, entertainment, restaurant, and other industries, and people are already needing food assistance. Donate to your local food bank and homeless and domestic violence shelters - they already need help and the need will grow.
The journal Family Practice Management offered these guidelines for medical practices for billing and coding for testing and treatment. Calls for ambulatory care practices (such as dermatology, ophthalmology, and medical subspecialties that have elective appointments) to close are getting louder, with resistance on patient and providers sides both.
Health care:
But other practices are changing their approaches to try to decrease virus transmission, while hospitals grapple with limited resources. There is not enough personal protective equipment (PPE - gloves, masks, suits, etc) nor ventilators to care for everyone who is likely to need it. One Seattle hospital was down to a 4 day supply of gloves yesterday, and getting more shipped there seems unlikely. Oregon received 10% of the supplies it ordered from the federal government. So we may be looking at rationing of care.
We could look to previous planning for pandemic influenza, realizing this is worse because WE HAVE NOT TREATMENT NOR VACCINE:
Altered Standards of Care for Health Care Providers in Pandemic Influenza. Indiana Health Law Review Vol. 6 No. 1 (2009)
Public Health Newswire's piece Beyond Containment on what comes next can help health care leaders grapple with the new reality.
What you should do:
Stay home.
Don't go to restaurants, bars, concerts, plays, malls, big box stores, grocery stores, pharmacies, playdates, birthday parties, dinner parties, weddings, funerals, church.
Go outside to exercise. Don't go to the gym or yoga class. Jogging/walking/cycling are great - just stay 10 feet away from other people, and when you get home, shower with soap.
Wash your hands often - 20 seconds of rubbing the soap in.
Insist on working from home - we must stay off public transportation and out of office buildings. Restaurants and groceries should change their approach to take-out and pick-up or delivery.
And we should all reach out to people who are elderly to be sure they have their needs met in their homes so they don't go out into public spaces where their risk of getting infected are increasing every day.
Only health care workers and people who work in infrastructure and emergency management should be out and about.
Food for though:
We can think about alternative hypotheses about how the pandemic started -
https://www.thinkglobalhealth.org/article/coronavirus-unknown-source-unrecognized-spread-and-pandemic-potential (authors posit alternative explanations for the start of the pandemic - one author is my Georgetown medical student Krissy Kent!)
and how it will proceed (Japan is reporting a case of a person who had recovered and now has another case of COVID-19. So, this changes how we think of timing and how the pandemic will play out over time.).
And, we can WUTANG:
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