Avoiding a Second Wave

It seems like we are soon going to see the end of most Covid 19 restrictions.  Wearing masks, washing hands, avoiding crowds is likely to stay with us and depending on how bad the second wave is might last quite a while.

There is some discussion of whether there will or will not be a second wave.  Considering human nature and our previous experiences, I believe we will have one, but we don't have to.

Some will follow all the proper measures and others won't and since the numbers indicate that most people have no immunity, the cases will rise, maybe not as dramatically but maybe in a more widespread manner.  

Infectious diseases spread steadily and insidiously throughout the population.  Since many people can carry the infection without exhibiting symptoms, it is certainly spreading to certain areas as we speak.  Its biggest targets of opportunity were our urban centers and that wave has mostly happened.  Not completely over but in some retreat.

Our greatest hope would be that many more people were infected than we know and that infection grants immunity.  Since exposure to the disease would have generated antibodies that will activate quickly upon a new exposure, some immunity is almost certain.  Immunity though is about getting sick from the virus.  If you are carrying it but defeating it, you may still spread it.

When it was at its peak it didn't cause symptoms in a lot of infected.  I've seen estimates that up to 80% of infected people had no symptoms.  Generally it had the worst impact upon people with other health issues who often were elderly.

So the infections will spread but the number of victims (people who get sick and die) is uncertain.  It may also be worse in the fall like cold and flu generally is.

Some things are only know when they are known.  Predictions can be useful but they are estimates and estimates can be wrong.  

Its not a political thing, its a virus thing so taking precautions is for everybody.

Safe Openings

We are certainly getting close to reopening the economy and that's a good thing.  The questions that need to be answered are tricky.

Since we know asymptomatic people can spread the virus, the use of masks should be mandatory in any public place.  This is to stop people from spreading the virus and to reduce the risk of inhaling it.

Secondary spread via surface is still not clear so we need to provide large amounts of hand sanitizer so people can take precautions.  I suppose another alternative would be to make sure there are enough disposable gloves available but they present risks of their own on disposal and removal.  Removing the virus from your hands quickly is the best protection.  Not touching you face is also good, but we all do that fairly instinctively.

You have to consider that while individuals might feel its ok for them to engage in risky behavior, that behavior is likely to put others at risk.  Failure to protect yourself and resultant infection means you become an infectious agent, and might not even know it.  No one has the right to endanger others.

Of course if you are taking proper precautions and interact with someone who isn't, you should shun him or her and use sanitizer to protect yourself.  Someone may have the right to carry a weapon but I have the right to avoid being a target.

As infections become rare we need to trace the source of any new infections quickly.  Of course if the incubation period is up to 14 days this tracing might be difficult. Still it would be the only chance at continuing containment.

We might fact a real problem when schools re-open, we always see an uptick in some infectious diseases and of course Covid-19 is likely to be around.  We simply need to be alert and isolate those exhibiting possible symptoms until they can be cleared.

This brings up the need for rapid accurate tests.  Imagine if in the school day started with a quick test and then the pledge of allegiance.  Teachers too.

The virus can be effectively starved to death if it can't infect us.  The faster the better.

Sacrificing Others?

When I see someone like the Lt Gov of Texas say that we need to accept some loss of life to restart the economy, I know he doesn't mean people he cares about.  Its easy to sacrifice nameless people on a chart.

Of course decisions that risk lives do happen a lot especially in wars.  Certainly when first responders rush into a dangerous situation risk is involved. Usually they are trying to minimize additional loss of life or sometimes property loss.

Its also been clear throughout our history that people have been willing to take dangerous jobs in exchange for compensation.  Its much more common to be willing to risk other people's lives.

We obviously should be working to get the economy going and as we learn how to avoid the virus we need to incorporate those behaviors into the way we work.  More testing can identify risk as can other measures like temperature monitoring and oxygen level monitoring.

Antibody testing can help determine who is likely to be immune, although not sure individual immunity protects those who contact you.  You might still be able to spread the virus via the items you wear or personally.

We talk about essential industries and ultimately almost everything becomes essential at some point or we probably wouldn't pay people to do it.

Open up the economy safely with as little risk as possible.  Increase testing and availability of PEP for health care professionals and others.

We also might want to consider how many essential items are dependent on foreign suppliers.

The odds are pretty high that this isn't the last virus we will have to deal with.

Really?

You would like to think that in a time of crisis the objective would be to save people's lives, improve supplies, and work for the best outcomes.

If you simply work with that motivation you may at times take heat or be criticized but you would know you were doing your best.

We are where we are and dredging up how we got here is better left to the future where perhaps an analysis can point out things we can do better next time.

For various reasons related to geography I sometimes get to see up to 5 briefings today on the situation, Federal, State, City and local counties.  Four of them are primarily focused on the latest changes, what we should be doing, what are the ongoing plans and progress made.  Sometimes reporters like to bring up things that might be controversial and generally its not that hard to address, even at times admitting a previous error.

One of the briefings, while at times imparting important information has turned into more of a campaign rally, while complaining about how other are politicizing the situation.

It has further degenerated into petty bickering, silly presentations about how everything they did was perfect and how good his ratings are.  Yes the experts there sometimes get to talk but they are required to, as we say, kiss the ring or perhaps a different part of his anatomy.

This perverted view that the thousands of victims both past and future are less important than his ego is signs of a mental defect.

Its called Narcissism.

Musings

The great majority of people who catch the Covid19 virus actually survive.  In fact there is significant evidence that many people who have it don't have symptoms and may never have any.

Still, some percentage of those who get it get sick and some get very sick.  A few (relatively) die.

I still sometimes wonder if we are being too cautious.

As bad as the 1918-1919 Spanish Flu was, and it killed a great many people (if you look at the numbers as a percentage of the population it would equate, today, to infecting 2 billion people and killing 200 million worldwide) we managed, and in many ways better than now.

Of course, had they followed the practices we are following today the numbers may have been a lot less.  Its also possible that a lot less would have died if we had the technology we have today.

Right now I'm living in one of the hot spots and the local news frequently highlights families that have lost one or more loved ones and the fact that they were unable to say their goodbyes.  I do understand their sadness and pain but the alternative would be for more of them to potentially get sick and maybe die.  Their loved one certainly wouldn't want that.

Dying is the one activity that every one of us will experience and the only one where we can't learn from the experience of others.  No one who has died can write a "Dying for Dummies" book.

We tend to judge it from the survivors view for obvious reasons, but whether a dying person cares is unknown.

We also don't know if its a transition or an end, although many people claim they do know.

We will all find out someday.

Masks Save Lives

How dangerous is it for the average person who goes to work or goes shopping for essentials?

Well obviously it depends and if you can avoid contact between your respiratory system and the virus, probably pretty safe.

It would be a lot safer if we all had suitable masks.  Gloves are not as important since the virus doesn't infect through the skin and hand washing after any potential contact is important.

Why we don't have enough masks available is the real question?

They seem pretty easy to manufacture and there are instructions on how to make them at home, although not the really good ones.

Any mask reduces the chance that the virus will find an entrance to your respiratory system.

The mask also prevents others from spreading the virus.

Its just common sense we should wear them.

Viral Pandemics

I've seen a number of articles detailing what was called the Spanish Flu.  That Pandemic really had nothing to do with Spain, it got its name because the countries engaged in the Great War heavily censored their news so neutral Spain was the only one writing about it.

It was a horrible disease that claimed its victims quickly and killed quickly.  It may have killed as many as 100 million people worldwide and over 600,000 in the United States.

There was no effective treatment except for social isolation and basic sanitation and one treatment recommended at the time (high doses of aspirin) may have been deadly.

Eventually we developed herd immunity and it faded into history.

Since then medical progress has improved although at the time everyone seemed to have masks available to wear in public.  In some cities you were fined for not wearing one.

It may simply be the way these things have to happen.  A highly infectious virus is going to infect many people and it doesn't take much to lose control.  Its certainly possible that if we tested everyone we might already find high infection rates in hotspots.

There are two ways this will end or at least become less threatening.  First once we develop herd immunity, similar to the Spanish Flu.  That will require vast infection rates and unacceptable numbers of deaths.  The other will be the development of an effective vaccine.

Either way we need to be at least as smart as we were in 1918 and use masks and good sanitation to reduce the number of infections.  Wash your hands, don a mask, do what you have to do, remove mask and wash your hands without touching your face.

Other items that might be exposed should be handled carefully although the danger of secondary infection is variable.

If someone in your household in infected exercise extreme caution.

Be Safe.

Lack of Testing Was the Problem

Covid19. a potentially lethal virus has infected tens of thousands of Americans and yet every day the headline is ""US Death Toll From Corona Virus exceeds 1,000".

Since there is no miraculous cure or new treatment, we are pretty much guaranteed that the number will continue to rise for the foreseeable future.

Its sad that people are dying but unfortunately everyday in this country people die from multiple causes.

In fact its close to 8000 people a day.

Many of the deaths were in people who were already high risk for other factors.

The question that is hard to answer is how lethal is this virus really?

Part of the problem is that we are only testing in most countries people who display symptoms and mostly people with fairly serious symptoms.  This has led to mortality rates that are clearly inflated.

Analyzing the data we see that South Korea, which was exposed to the virus early on has managed to control it with much less disruption to its day to day society. Its methods relied on testing and contact isolation, meaning that if someone tested positive, everyone who may have come in contract with him/her was asked to get tested.  This identification led to the best containment of the virus to date but also because of the extended testing a large number of asymptomatic people were identified resulting in a lower fatality rate.

Germany which is at an earlier stage of the outbreak is also demonstrating that widespread testing has led to a much lower fatality rate than other European countries.  Of course since the virus is still very active, things could change, but I believe the data is indicative of an actual fatality rate below 1%.

No onw knows how many untested people have an asymptomatic or mild symptom infection.  Since we don't test them they are still infecting others, some of whom will develop serious symptoms and possibly die.

We have effectively adopted a strategy that assumes everybody is a potential carrier and requires everyone to isolate or social distance themselves.  An investment is test kits could have allowed the economy to continue since could have identified the carriers.

Too late now.

Just Wondering?

One of the things that is just so hard to determine is just how dangerous Covid19 actually is.

In Northern Italy where the death rate is reported as the highest in the world, it is also clear that the number of infected people is greatly undercounted.  Same is true in China.

Without knowing how many people are actually infected it is impossible to get an accurate mortality rate.

It doesn't kill you quickly.  Reading about the Spanish flu you see stories about people getting sick and dying the same day.  Other differences are the people who were most afflicted.

The Covid19 virus is most dangerous in older people or others with weak immune systems.  The Spanish Flu was most dangerous among young people with strong immune systems. In both cases some of the worst damage is actually related to the body's attempt to fight the virus off,   It would seem they should be similar, but apparently not.

Still consider the latest news on flu and COVID-Covid19 from the CDC.

ATLANTA (Gray News) – Flu-like activity is up in the United States this week, but its severity is moderate to low overall, the Centers for Disease Control and Prevention reported Friday.

The CDC estimates that so far this season there have been at least 23,000 deaths from flu, 38 million flu illnesses and 390,000 hospitalizations.  

COVID-19: U.S. at a Glance*

• Total cases: 33,404
• Total deaths: 400

For the first one we effectively have ignored it for the second we have effectively shut down the country.

Now I realize the COVID-19 is on the rise,and we as yet do not have an effective way to combat it.  Still, I wonder if it was in fact necessary to react like we did when possibly it just would have required some simple precautions to protect us.

This Is About You, Not Them

Almost everyone, while probably not infected has been impacted by the Covid19 virus and we are all eager to get the most accurate information.

I've watched a number of the press conferences, if that's the right term, that occur every afternoon now and where we get misinformation from the President sometimes corrected by the experts he allows to talk.

He keeps harping on how perfect his response has been when clearly he is easily contradicted by video showing how wrong he was.

I don't even fault him for getting it wrong, although he was briefed about the virus, but just acting like that wasn't his words and actions is the sign of a mental or personality disorder.

Its like he has never learned to accept responsibility for his actions, similar to how a toddler responds when caught doing something wrong.

I originally didn't think this virus was going to be a big deal and clearly it is.

I don't know if it is going to be as bad as some previous pandemics, the Spanish Flu comes to mind, but we have a lot of cases and clearly our health system is unprepared for it.

Which makes me think about a quote I heard from a health official on some show about the virus.

He says hospitals work on "Just in Time" inventory.

That has become the linchpin of modern management theory and it helps explain many of the shortages that we see.  Excess inventory, defined as anything you stock that can be supplied before you need it is a form of waste.  The theory is a wonderful thing when supply lines are functioning.

Not so great if the supply chain has a problem, which is likely now.

How much backup supply or capacity do you need normally is based on assumptions that things stay normal.

Should we prepare for events like this?  It would cost a lot of money, but because we aren't we will have casualties among our population.

How much value do you put on your life or that of your loved ones?