Today’s must-read is What I Learned When My Husband Got Sick With Coronavirus by NY Times editor Jessica Lustig. If you’re on the fence about whether COVID-19 is worth all this fuss, Lustig’s account of caring for her gravely ill husband in a Brooklyn apartment while trying to keep herself and their daughter from getting sick should help straighten out your thinking.
Now we live in a world in which I have planned with his doctor which emergency room we should head to if T suddenly gets worse, a world in which I am suddenly afraid we won’t have enough of the few things tempering the raging fever and soaking sweats and severe aches wracking him β the Advil and Tylenol that the doctors advise us to layer, one after the other, and that I scroll through websites searching for, seeing “out of stock” again and again. We are living inside the news stories of testing, quarantine, shortages and the disease’s progression. A friend scours the nearby stores and drops off a bunch of bodega packets of Tylenol. Another finds a bottle at a more remote pharmacy and drops it off, a golden prize I treasure against the feverish nights to come.
His doctor calls three days later to say the test is positive. I find T lying on his side, reading an article about the surge in confirmed cases in New York State. He is reading stories of people being hospitalized, people being put on ventilators to breathe, people dying, sick with the same virus that is attacking him from the inside now.
This is a rough read, no doubt about it. I started crying at the part about his father’s sweater.
Like many of you, I’ve been wondering about COVID-19 & food safety. Is it safe to eat takeout prepared by your local restaurant? To answer that and many other questions, Kenji Lopez-Alt has compiled a comprehensive guide to food safety and coronavirus for Serious Eats. Kenji is the most fastidious and exacting food person I know β how could you think otherwise after having read The Food Lab? β so I take his thoughts and research on this very seriously.
Even so, plenty of folks β myself included β have been confused or curious about the safety of allowing restaurants to continue preparing and serving food. Is it actually safe? Should I reheat the food when I get it home? Is it better to support local businesses by ordering food, or am I only putting workers and delivery people at risk? And if I’m cooking my own food, what guidelines should I follow?
To answer these questions, I referenced dozens of articles and scientific reports and enlisted the help of Ben Chapman, a food safety specialist from the North Carolina State University and cohost of Risky or Not and Food Safety Talk.
Let’s get right to the nitty gritty:
Q: Can I get COVID-19 from touching or eating contaminated food?
According to multiple health and safety organizations worldwide, including the CDC, the USDA, and the European Food Safety Authority, there is currently no evidence that COVID-19 has spread through food or food packaging. Previous coronavirus epidemics likewise showed no evidence of having been spread through food or packaging.
Be sure to read on for answers to questions like “Are we going to run out of food?” and “Am I more likely to get COVID-19 from take-out, delivery, or cooking at home?”
Unlike foodborne gastrointestinal (GI) viruses like norovirus and hepatitis A that often make people ill through contaminated food, SARS-CoV-2, which causes COVID-19, is a virus that causes respiratory illness. Foodborne exposure to this virus is not known to be a route of transmission.
In a piece from March 14, Amanda Mull talked with epidemiologist Stephen Morse from Columbia University about food safety:
Even if the person preparing it is sick, he told me via email, “cooked foods are unlikely to be a concern unless they get contaminated after cooking.” He granted that “a salad, if someone sneezes on it, might possibly be some risk,” but as long as the food is handled properly, he said, “there should be very little risk.”
Even if a sick worker sneezed on my food (I know that’s gross), my risk of contracting COVID-19 from it are very low.
First it’s important to realize that this is a respiratory illness as far as we know. The biggest risk is being around sick people who are shedding the virus when they sneeze or cough.
Even if the virus did get onto food, we’re going to put that food in our mouth and swallow it so the virus will end up in our stomach. Our stomachs have a low pH which would likely in activate the virus.
Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.
As the title indicates, Pueyo and his collaborators are suggesting an approach that combines initial aggressive action followed by a longer period of efficient vigilance. First comes the Hammer β we use aggressive measures for weeks, giving our healthcare system time to ramp up & scientists time to research the hell out of this thing and for the world’s testing capability to get up to speed.
And then we Dance.
If you hammer the coronavirus, within a few weeks you’ve controlled it and you’re in much better shape to address it. Now comes the longer-term effort to keep this virus contained until there’s a vaccine.
This is probably the single biggest, most important mistake people make when thinking about this stage: they think it will keep them home for months. This is not the case at all. In fact, it is likely that our lives will go back to close to normal.
But, here’s how the Dance works:
How come South Korea, Singapore, Taiwan and Japan have had cases for a long time, in the case of South Korea thousands of them, and yet they’re not locked down home?
In this video, the South Korea Foreign Minister explains how her country did it. It was pretty simple: efficient testing, efficient tracing, travel bans, efficient isolating and efficient quarantining.
That way, most people aren’t locked down, just those who need to be β the sick, the people who have been with those who have gotten sick, etc. Most people can go back to work, back to fairly normal routines.
I call the months-long period between the Hammer and a vaccine the Dance because it won’t be a period during which measures are always the same harsh ones. Some regions will see outbreaks again, others won’t for long periods of time. Depending on how cases evolve, we will need to tighten up social distancing measures or we will be able to release them. That is the dance of R: a dance of measures between getting our lives back on track and spreading the disease, one of economy vs. healthcare.
We can create a third path. We can decide to meet this challenge head on. It is absolutely within our capacity to do so. We could develop tests that are fast, reliable, and ubiquitous. If we screen everyone, and do so regularly, we can let most people return to a more normal life. We can reopen schools and places where people gather. If we can be assured that the people who congregate aren’t infectious, they can socialize.
We can build health-care facilities that do rapid screening and care for people who are infected, apart from those who are not. This will prevent transmission from one sick person to another in hospitals and other healthcare facilities. We can even commit to housing infected people apart from their healthy family members, to prevent transmission in households.
By manipulating values like R0, incubation time, and hospitalization rate with this this epidemic graphing calculator, you really get a sense of how effective early intervention and aggressive measures can be in curbing infection & saving lives in an exponential crisis like the COVID-19 pandemic.
I don’t know if they specifically had this in mind when making it, but this video from Vox about the importance of hand washing with soap to kill coronavirus is very kid-friendly. From my pals at the excellent The Kid Should See This
Wash your hands for 20 seconds with soap and water. This is the very best way to kill viruses like coronavirus. But why? What’s happening on our hands when we use soap and water? And why do we have to wash with soap for 20 seconds? Why not ten?
The glow-in-the-dark explanation of the 20-second rule was extremely convincing.
Update: Mark Rober did an experiment with a powder that glows under UV and can be transferred from surface to surface (or hand to surface). You can see the germs spreading from person to person and all over that classroom. Yikes.
This morning Kurzgesagt released their video about COVID-19 that they’ve been working on for a week, and it is excellent, particularly the first part where they explain exactly what the SARS-CoV-2 virus does to a human body and why it can be so dangerous. I hadn’t heard that described before, especially in such relatively simple terms.
The virus has not caused too much damage yet, but corona is now going to release a real beast on you: your own immune system. The immune system, while there to protect you, can actually be pretty dangerous to yourself and needs tight regulation. And as immune cells pour into the lungs to fight the virus, corona infects some of them and creates confusion. Cells have neither ears nor eyes β they communicate mostly via tiny information proteins called cytokines β nearly every important immune reaction is controlled by them. Corona causes infected immune cells to overreact and yell bloody murder. In a sense, it puts the immune system into a fighting frenzy and sends way more soldiers than it should, wasting its resources and causing damage.
One of the key shortages in areas overwhelmed by COVID-19 patients (like Italy) is ventilators in hospitals. COVID-19 is a respiratory illness and respirators are essential in treating patients with acute symptoms. In the US and other countries, experts are warning of ventilator shortages and manufacturers say it will be difficult to ramp up production quickly enough to meet demand. So healthcare providers are looking for other solutions.
One potential solution is modifying ventilators to work for more than one person at a time. Based on feasibility research published in 2006, the simple technique uses inexpensive parts that hospitals already have on hand to modify machines to work with 4 patients at a time (with important caveats). One of the authors of that research paper, Dr. Charlene Babcock, explains how to hack the ventilators in this video:
Some notes from the video:
The initial study used test lungs (not actual humans)
You need to make sure the lung size and resistance of all four patients hooked up to a single ventilator are the same. No mixing adults and kids, for instance.
Make sure the ventilator tubes leading to and from the patients are all the same length.
This technique has been used successfully in the field, during the aftermath of the 2017 Las Vegas shooting.
They did not investigate cross-contamination effects, so you have to make sure all the patients connected to one machine are COVID-19 patients in order to mitigate the risk.
In closing, Babcock says:
Now here’s my disclaimer. This is off-label use of the ventilator. The ventilator is made for one person and I’m using it here in a simulation of four patients. I always hope that you would never need to use it in this way, but you can never predict what’s going to happen in a disaster. And if it was me and I had four patients and they all needed intubation and I only had one ventilator, I would simply have a shared discussion meeting with all four families and say “I could pick one to live or we could try to have all four live”. But this is clearly off-label and likely would only be used in dire circumstance, which we may see with COVID-19.
Hand sanitizer, a necessary tool in the fight against the COVID-19 pandemic, has been difficult to come by in stores the past few weeks (or months, depending on your location). Last night, I read in a local email newsletter here in Vermont that Mad River Distillers is producing hand sanitizer and giving it away for free to local residents. They’ve set up two pick-up stations for today β it’s BYOB and limited to 6oz per person. Earlier this week, workers at Barr Hill’s closed distillery made hand sanitizer and distributed it to local food shelves. Green Mountain Distillers and Smuggler’s Notch Distillery have also begun producing hand sanitizer.
Basic recipes include aloe vera for moisturizing; distilleries will also add the botanicals or flavorings from their signature spirits as a twist. Portland, Ore.-based Shine Distillery & Grill isn’t treating its formula like a trade secret. “I have fielded some calls from Seattle and suggested they contact their local distilleries to tell them what we are doing,” says general manager Ryan Ruelos. “Because any distillery can do it.”
The one thing they cannot do, though, is sell their sanitizers: Sales of distilled spirits are strictly regulated by the government and could jeopardize business licenses. Instead, distilleries are giving them away to customers who come through their doors. In some cases, such as at Psychopomp Microdistillery in Bristol, England, donations from customers who take the sanitizer are being given to charity.
Around the world, alcohol is often used in toasts that relate to health: the Irish “slΓ‘inte” (health), the Mexican Spanish “salud” (to health), the Russian “vashe zdorov’ye” (to your health), the Persian “be salamati” (good health), and the Hindi “achchee sehat” (good health). These distillery-produced hand sanitizers are a toast of health from them to us, and I am very grateful for it.
The practice of quarantine began during the 14th century, in an effort to protect coastal cities from plague epidemics. Cautious port authorities required ships arriving in Venice from infected ports to sit at anchor for 40 days before landing β the origin of the word quarantine from the Italian “quaranta giorni”, or 40 days.
One of the first instances of relying on geography and statistical analysis was in mid-19th century London, during a cholera outbreak. In 1854, Dr. John Snow came to the conclusion that cholera was spreading via tainted water and decided to display neighborhood mortality data directly on a map. This method revealed a cluster of cases around a specific pump from which people were drawing their water from.
While the interactions created through trade and urban life play a pivotal role, it is also the virulent nature of particular diseases that indicate the trajectory of a pandemic.
One of my big takeaways from the Tracking Infectiousness section of the piece is: holy shit, look at how contagious measles is! An R0 of 16! (The common flu is about 1.5 and ebola is 2.0.) And people want to keep their children from getting vaccinated for this?!
Note: I feel the need to add a disclaimer to this post. This was a really hard thing to read for me and it might be for you too. It is a single paper from a scientific team dedicated to the study of infectious diseases β it has not been peer reviewed, the available data is changing every day (for things like death rates, transmission rates, and potential immunity), and there might be differing opinions & assumptions by other infectious disease experts that would result in a different analysis. Even so, this seems like a possibility to take seriously and I hope I’m being responsible in sharing it.
The paper is technical in nature but mostly written in plain English so it’s pretty readable, but here is an article that summarizes the paper. It discusses the two main strategies for dealing with this epidemic (mitigation & suppression), the strengths and weaknesses of each one, and how they both may be necessary in some measure to best address the crisis. For instance, here’s a graph showing the effects of three different suppression scenarios for the US compared to critical care bed capacity:
Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread β reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. Each policy has major challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option.
We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package β or something equivalently effective at reducing transmission β will need to be maintained until a vaccine becomes available (potentially 18 months or more) β given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing β triggered by trends in disease surveillance β may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound. Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.
If you missed the scale on the graph (it extends until March 2021) and the bit in there about closures, quarantine, and self-distancing measures needing to remain in place for months and months, the authors repeat that assertion throughout the paper. From the discussion section of the paper:
Overall, our results suggest that population-wide social distancing applied to the population as a whole would have the largest impact; and in combination with other interventions β notably home isolation of cases and school and university closure β has the potential to suppress transmission below the threshold of R=1 required to rapidly reduce case incidence. A minimum policy for effective suppression is therefore population-wide social distancing combined with home isolation of cases and school and university closure.
To avoid a rebound in transmission, these policies will need to be maintained until large stocks of vaccine are available to immunise the population β which could be 18 months or more. Adaptive hospital surveillance-based triggers for switching on and off population-wide social distancing and school closure offer greater robustness to uncertainty than fixed duration interventions and can be adapted for regional use (e.g. at the state level in the US). Given local epidemics are not perfectly synchronised, local policies are also more efficient and can achieve comparable levels of suppression to national policies while being in force for a slightly smaller proportion of the time. However, we estimate that for a national GB policy, social distancing would need to be in force for at least 2/3 of the time (for R0=2.4, see Table 4) until a vaccine was available.
I absolutely do not want to seem alarmist here, but if this analysis is anywhere close to being in the ballpark, it seems at least feasible that this whole thing is going to last far longer than the few weeks that people are thinking about. The concluding sentence:
However, we emphasise that is not at all certain that suppression will succeed long term; no public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time. How populations and societies will respond remains unclear.
Update:Here is a short review of the Imperial College paper by Chen Shen, Nassim Nicholas Taleb, and Yaneer Bar-Yam. The important bit:
However, they make structural mistakes in analyzing outbreak response. They ignore standard Contact Tracing [2] allowing isolation of infected prior to symptoms. They also ignore door-to-door monitoring to identify cases with symptoms [3]. Their conclusions that there will be resurgent outbreaks are wrong. After a few weeks of lockdown almost all infectious people are identified and their contacts are isolated prior to symptoms and cannot infect others [4]. The outbreak can be stopped completely with no resurgence as in China, where new cases were down to one yesterday, after excluding imported international travelers that are quarantined.
If I understand this correctly, Shen et al. are saying that some tactics not taken into account by the Imperial College analysis could be hyper-effective in containing the spread of COVID-19. The big if, particularly in countries like the US and Britain that are acting like failing states is if those measures can be implemented on the scale required. (thx, ryan)
Update: The lead author of the Imperial College paper, Neil Ferguson, has likely contracted COVID-19. From his Twitter acct:
Sigh. Developed a slight dry but persistent cough yesterday and self isolated even though I felt fine. Then developed high fever at 4am today.
Ferguson says he’s still at his desk, working away.
Update: The pair of articles I linked to in this post are excellent and you should read them after reading the Imperial College paper.
Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.
The authors, who are medical doctors, then deduce a set of concrete recommendations for how to manage these impossible choices, including this: “It may become necessary to establish an age limit for access to intensive care.”
Those who are too old to have a high likelihood of recovery, or who have too low a number of “life-years” left even if they should survive, would be left to die. This sounds cruel, but the alternative, the document argues, is no better. “In case of a total saturation of resources, maintaining the criterion of ‘first come, first served’ would amount to a decision to exclude late-arriving patients from access to intensive care.”
In addition to age, doctors and nurses are also advised to take a patient’s overall state of health into account: “The presence of comorbidities needs to be carefully evaluated.” This is in part because early studies of the virus seem to suggest that patients with serious preexisting health conditions are significantly more likely to die. But it is also because patients in a worse state of overall health could require a greater share of scarce resources to survive: “What might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients.”
Mounk continues:
My academic training is in political and moral philosophy. I have spent countless hours in fancy seminar rooms discussing abstract moral dilemmas like the so-called trolley problem. If a train is barreling toward five innocent people who are tied to the tracks, and I could divert it by pulling the lever, but at the cost of killing an innocent bystander, should I do it?
Part of the point of all those discussions was, supposedly, to help professionals make difficult moral choices in real-world circumstances. If you are an overworked nurse battling a novel disease under the most desperate circumstances, and you simply cannot treat everyone, however hard you try, whose life should you save?
Despite those years of theory, I must admit that I have no moral judgment to make about the extraordinary document published by those brave Italian doctors. I have not the first clue whether they are recommending the right or the wrong thing.
I have been rewatching The Good Place with my kids (they love it), and all of the moral philosophy stuff underpinning the show has taken on a greater meaning over the last week or two.
Over the past week or so, echoing public health officials & epidemiologists, I’ve been trying to illustrate the often counterintuitive concept of exponential growth that you see in an epidemic and how flattening the curve can help keep people healthy and alive. But I think people have a hard time grasping what that means, personally, to them. Like, what’s one person in the face of a pandemic?
Well, epidemiologist Britta Jewell had a similar thought and came up with this brilliantly simple graph, one of the best I’ve seen in illustrating the power of exponential growth and how we as individuals can affect change:
Jewell explains a bit more about what we’re looking at:
The graph illustrates the results of a thought experiment. It assumes constant 30 percent growth throughout the next month in an epidemic like the one in the U.S. right now, and compares the results of stopping one infection today β by actions such as shifting to online classes, canceling of large events and imposing travel restrictions β versus taking the same action one week from today.
The difference is stark. If you act today, you will have averted four times as many infections in the next month: roughly 2,400 averted infections, versus just 600 if you wait one week. That’s the power of averting just one infection, and obviously we would like to avert more than one.
So that’s 1800 infections averted from the actions of just one person. Assuming a somewhat conservative death rate of 1% for COVID-19, that’s 18 deaths averted. Think about that before you head out to the bar tonight or convene your book group as usual. Your actions have a lot of power in this moment; take care in how you wield it.
Coronavirus, social distancing, exponential growth, flatten the curve, pandemic, immunocompromised β those are just some of the concepts related to COVID-19 we have had to come up to speed on over the last few weeks. We should add the “paradox of preparation” to that list.
The paradox of preparation refers to how preventative measures can intuitively seem like a waste of time both before and after the fact. Most of us don’t stop brushing our teeth because the dentist didn’t find any cavities at our most recent checkup, but with larger events that have effects more difficult to gauge (like COVID-19, climate change, and Y2K), it can be hard to spur people to action. From Chris Hayes:
A doctor I spoke to today called this the “paradox of preparation” and it’s the key dynamic in all this. The only way to get ahead of the curve is to take actions that *at the time* seem like overreactions, eg: Japan closing all schools for a month with very few confirmed cases.
The thing is if shutdowns and social distancing work perfectly and are extremely effective it will seem in retrospect like they were totally unnecessary overreactions.
You won’t ever know if what you did personally helped. That’s the nature of public health. When the best way to save lives is to prevent a disease rather than treat it, success often looks like an overreaction.
Preparation, prevention, regulations, and safeguards prevent catastrophes all the time, but we seldom think or hear about it because “world continues to function” is not interesting news. We have to rely on statistical analysis and the expert opinions of planners and officials in order to evaluate both crucial next steps and the effectiveness of preparatory measures after the fact, and that can be challenging for us to pay attention to. So we tend to forget that preparation & prevention is necessary and discount it the next time around.
The good news is that while unchecked epidemics grow exponentially, another thing that can also spreads exponentially is behavioral norms. The basic expert advice on how we can slow the spread of COVID-19 in our communities is pretty unambiguous β wash your hands, don’t touch your face, maintain social distance, self-quarantine, etc. β and so is the huge potentialimpact of those precautions on the number of people who will get infected and die. To help overcome the paradox of preparation, let’s continue to spread the word about what the experts are urging us to do. Because if we don’t, there might be a lot fewer of us around in a month or two.
This means that any effective actions taken against coronavirus in the few days before the epidemic curve shoots upward in any country will always look unreasonable and disproportionate.
By the time those actions look reasonable and appropriate, they will be too late.
The idea that an extreme reaction, such as closing schools and canceling events, might prove to be an overreaction that would look silly or wasteful later outweighs any other concern. It can also feel imprudent; just staying home isn’t so easy for workers who depend on weekly paychecks, and closing is a hard decision for local companies running on thin margins. But experts are saying that Americans can’t really over-prepare right now. Overreaction is good!
It’s hard to square that directive with the associations we’ve built up around overreactions. Ultimately, overreaction is a matter of knowledge-an epistemological problem. Unlike viruses or even zombies, the concept lives inside your skull rather than out in the world. The sooner we can understand how that knowledge works, and retool our action in relation to its limits, the better we’ll be able to handle the unfolding crisis.
Few people have trouble understanding the purpose of public education or public housing: they are tangible programs that, at least in theory, are designed to improve our lives. Public-health accomplishments, however, are measured in an entirely different way: success is defined by what is prevented, not by what is produced. This creates an odd psychological dynamic.
When public-health programs are successful, they are invisible, and what is invisible is almost always taken for granted. Nobody cheers when they remain untouched by a disease that they hardly knew existed. That makes it easy for shortsighted politicians to deny long-term realities. And that is what they almost always do.
From Stanford professor of neurobiology and bioengineering Michael Lin, this is an excellent 31-page PDF presentation (Slideshare) on what we know about COVID-19 so far and how to deal with it, with extensive references to the latest research (as of 3/15). I’m going to include a few of the most interesting and important slides right here, but do read the whole thing β it is very informative.
And here are a few other quotes I pulled out:
Compare to Spanish flu of 1917-1918: Cumulative infection rate 27%, IFR 2%. Spanish flu might have higher IFR than COVID-19, but medical care was much worse then (no ventilators, no drugs). In reality COVID-19 is likely the more severe disease. In any case, Spanish flu was devastating.
Large meetings that bring people from around the country are obviously a big risk. Large numbers of people who might breath the same air and touch the same things (e.g. at Biogen meeting, attendants used the same serving utensils at a buffet, and 70 got infected)
If you are young, the worry is more about transmitting virus to older people than about yourself.
Death rates will lag infection rates by 3-4 weeks (2 weeks from diagnosis but that’s 1 week from infection time on average with current testing practices)
Social distancing has been recommended by epidemiologists and public health officials as a way to slow the spread of COVID-19, flatten the curve, and save lives. Avoiding rock concerts and sporting events is easy, but what about going to the grocery store or visiting with a friend? The Atlantic’s Kaitlyn Tiffany talked to a number of public health experts about The Dos and Don’ts of ‘Social Distancing’.
Q: Should I be avoiding bars and restaurants?
Cannuscio: People should avoid gathering in public places. People should be at home as much as possible. The measures that have worked to get transmission under control or at least to bend the curve, in China and South Korea, have been extreme measures to increase social distancing.
Q: Should I stop visiting elderly relatives?
Cannuscio: I think if we are fortunate enough to live near our elders and we get into the mode of seriously isolating our own families, then one person should be designated to go and visit. If we’re not in a situation where we can truly limit our own social contact, then we will be putting that elder at risk by going to visit.
In my estimation, the answers that Carolyn Cannuscio, of Penn’s Center for Public Health Initiatives, gives are the ones to follow. Dr. Asaf Bitton’s advice is even stricter:
2. No kid playdates, parties, sleepovers, or families/friends visiting each other’s houses and apartments.
This sounds extreme because it is. We are trying to create distance between family units and between individuals. It may be particularly uncomfortable for families with small children, kids with differential abilities or challenges, and for kids who simply love to play with their friends. But even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent. The symptoms of coronavirus take four to five days to manifest themselves. Someone who comes over looking well can transmit the virus. Sharing food is particularly risky β I definitely do not recommend that people do so outside of their family.
Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
Interviews with laboratory directors and public-health experts reveal a Fyre-Festival-like cascade of problems that have led to a dearth of tests at a time when America desperately needs them. The issues began with onerous requirements for the labs that make the tests, continued because of arcane hurdles that prevented researchers from getting the right supplies, and extended to a White House that seemed to lack cohesion in the pandemic’s early days. Getting out lots of tests for a new disease is a major logistical and scientific challenge, but it can be pulled off with the help of highly efficient, effective government leadership. In this case, such leadership didn’t appear to exist.
The US has bungled the situation so badly that a pair of Chinese foundations announced this morning that they were donating 500,000 testing kits and 1 million masks to the US. Last month in my Asian travelogue, I wrote that my main observation after spending three weeks in Asia was: “America is a rich country that feels like a poor country”. That we have to rely on foreign aid in situations like this is a good example of what I was referring to.
The number one recommendation on the list of protective measures for COVID-19 from both WHO and the CDC is to regularly wash your hands. The CDC in particular recommends hand-washing over using hand sanitizer.
The soap takes care of the virus much like it takes care of the oil in the water. “It’s almost like a crowbar; it starts to pull all the things apart,” Thordarson says.
One side of the soap molecule (the one that’s attracted to fat and repelled by water) buries its way into the virus’s fat and protein shell. Fortunately, the chemical bonds holding the virus together aren’t very strong, so this intrusion is enough to break the virus’s coat. “You pull the virus apart, you make it soluble in water, and it disintegrates,” he says.
Then the harmless shards of virus get flushed down the drain. (And even if it the soap doesn’t destroy every virus, you’ll still rid them from your hands with soap and water, as well as any grease they may be clinging to.)
And why do you need to wash for 20 seconds? Because that gives soap time to do its work.
First off, your skin is wrinkly, and it takes time for soap to penetrate into all the tiny folds and demolish the viruses that lurk within. Then the soap needs a few moments to do its chemical work. “You do need a bit of time for all the soap to interact back and forth with the virus particle,” he says. Twenty seconds should do the trick just fine.
See also Why Soap Works from the NY Times, which explains why soap & water is better than hand sanitizer in these cases:
On the whole, hand sanitizers are not as reliable as soap. Sanitizers with at least 60 percent ethanol do act similarly, defeating bacteria and viruses by destabilizing their lipid membranes. But they cannot easily remove microorganisms from the skin. There are also viruses that do not depend on lipid membranes to infect cells, as well as bacteria that protect their delicate membranes with sturdy shields of protein and sugar. Examples include bacteria that can cause meningitis, pneumonia, diarrhea and skin infections, as well as the hepatitis A virus, poliovirus, rhinoviruses and adenoviruses (frequent causes of the common cold).
Many stores have long since sold out of hand sanitizer in the US and washing your hands is a better move anyway, but if you’d like to have some sanitizer on hand for when you can’t get to a sink, the World Health Organization has you covered. The WHO recipe is for making 10-liter batchs, so Popular Science helpfully scaled it down to a more reasonable size:
1 cup 99% isopropyl alcohol
1 tablespoon 3% hydrogen peroxide
1 teaspoon 98% glycerin/glycerol
1/4 cup, 1 tablespoon, and 1 teaspoon sterile distilled or boiled cold water
To the alcohol, add the hydrogen peroxide & glycerin and stir or shake if you’re mixing in a container with a lid. Then add the water.
For COVID-19 prevention, the CDC recommends a hand sanitizer that contains at least 60% alcohol; this recipe will end up being about 75% alcohol. The Popular Science piece also includes another recipe for a hand sanitizing gel that’s much closer to store-bought gels that involves mixing isopropyl alcohol, aloe vera gel, and tea tree oil. They also note that vodka does not contain enough alcohol to meet the CDC’s recommendation, especially when mixed with the other ingredients.
In recent years, many media outlets have joined publications like the WSJ and NY Times in erecting paywalls around their online offerings, giving visitors access to a few articles a month before asking them to pay for unlimited access. Due to the continuing worldwide COVID-19/coronavirus crisis and in order to make information about the pandemic more accessible to the public, several publications have dropped their paywalls for at least some of their coronavirus coverage (thanks to everyone who responded to my tweet about this).
“These articles were always written to be shared with as many people as possible,” Reddit user “shrine,” an organizer of the archive, said in a call. “From every angle that you look at it, [paywalled research] is an immoral situation, and it’s an ongoing tragedy.”
Kudos to those media organizations for doing the right thing β this information can save people’s lives. Let’s hope others (*cough* Washington Post) will soon follow suit. And if you find the coverage helpful, subscribe to these outlets!
Update: Added the NY Times to the list above. I am also hearing that many European papers are not dropping their paywalls in the face of the crisis.
Update: Added several media outlets to the list, including Washington Post and Chicago Tribune. At this point, it seems to be standard practice now (at least in the US & Canada) so this will be the final update. (thx, @maschweisguth)
In a media briefing that’s still ongoing as I’m writing this, Dr. Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization, has officially characterized the COVID-19 outbreak as a pandemic. A pandemic is defined as:
An influenza pandemic is a global epidemic caused by a new influenza virus to which there is little or no pre-existing immunity in the human population. Influenza pandemics are impossible to predict; and they may be mild, or cause severe disease or death. Severe disease may occur in certain risk groups, which may correspond to those at risk of severe disease due to seasonal influenza.
WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.
We have therefore made the assessment that COVID-19 can be characterized as a pandemic.
Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.
Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.
Progress on fighting COVID-19 can be made everywhere when the right steps are taken:
If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.
Even those countries with community transmission or large clusters can turn the tide on this virus.
Several countries have demonstrated that this virus can be suppressed and controlled.
The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same — it’s whether they will.
But WHO also acknowledges how disruptive the pandemic can be:
We are grateful for the measures being taken in Iran, Italy and the Republic of Korea to slow the virus and control their epidemics.
We know that these measures are taking a heavy toll on societies and economies, just as they did in China.
All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights.
And in closing he deflects attention from the word “pandemic”:
Let me give you some other words that matter much more, and that are much more actionable.
Prevention.
Preparedness.
Public health.
Political leadership.
And most of all, people.
We’re in this together, to do the right things with calm and protect the citizens of the world. It’s doable.
These three facts imply a simple conclusion. The coronavirus could spread with frightening rapidity, overburdening our health-care system and claiming lives, until we adopt serious forms of social distancing.
This suggests that anyone in a position of power or authority, instead of downplaying the dangers of the coronavirus, should ask people to stay away from public places, cancel big gatherings, and restrict most forms of nonessential travel.
Given that most forms of social distancing will be useless if sick people cannot get treated-or afford to stay away from work when they are sick-the federal government should also take some additional steps to improve public health. It should take on the costs of medical treatment for the coronavirus, grant paid sick leave to stricken workers, promise not to deport undocumented immigrants who seek medical help, and invest in a rapid expansion of ICU facilities.
From 3blue1brown’s Grant Sanderson, this is an excellent quick explanation of exponential growth and how we should think about it in relation to epidemics like COVID-19. Depending on how rusty your high school math is, you might need to rewind a couple of times to fully grasp the explanation, but you should persevere and watch the whole thing.
The most important bit is at the end, right around the 7:45 mark, when he talks about how limiting person-to-person exposure and decreasing the probability of exposures becoming infections can have a huge effect on the total number of people infected because the growth is exponential. If large numbers of people start doing things like limiting travel, cancelling large gatherings, social distancing, and washing their hands frequently, the total number of infections could fall by several orders of magnitude, making the exponential work for us, not against us. Small efforts have huge results. If, as in the video, you’re talking about 100 million infected in two months (at the current transmission rate) vs. 400,000 (at the lowered rate) and if the death rate of COVID-19 is between 1-3%, you’re looking at 1-3 million dead vs. 4-12,000 dead.
So let’s start flattening that exponential curve. South Korea and China both seem to have done it, so there’s no reason the rest of the world can’t through aggressive action. (thx, david)
Update: Vox has a nice explainer on what epidemiologists refer to as “flattening the curve”.
Yet the speed at which the outbreak plays out matters hugely for its consequences. What epidemiologists fear most is the health care system becoming overwhelmed by a sudden explosion of illness that requires more people to be hospitalized than it can handle. In that scenario, more people will die because there won’t be enough hospital beds or ventilators to keep them alive.
A disastrous inundation of hospitals can likely be averted with protective measures we’re now seeing more of β closing schools, canceling mass gatherings, working from home, self-quarantine, avoiding crowds - to keep the virus from spreading fast.
Epidemiologists call this strategy of preventing a huge spike in cases “flattening the curve”.
A few days ago, Dr. Daniele Macchini, a physician in Bergamo, Italy, made a long post on Facebook (also reprinted here) about how the outbreak of COVID-19 (coronavirus) is overwhelming the hospitals there and pleads with the rest of the world to take the virus seriously. The original post is in Italian and Google Translate does pretty well with it. Dr. Silva Stringhini translated the important bits of Dr. Macchini’s post in this Twitter thread and is somewhat easier to read:
After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.
“I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder.
“I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly ‘emptied’, elective activities were interrupted, intensive care were freed up to create as many beds as possible.
“All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.
“I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I’ve seen what’s happening. Well, the situation now is dramatic to say the least.
“The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.
“The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.
Dr. Macchini urges: “Let’s stop saying it’s a bad flu.” But this is the part that stopped me in my tracks and got me to write this post:
So have patience, too, that you cannot go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate.
His overall message is that we shouldn’t panic, but that we should take COVID-19 seriously. The goal here is to keep the most vulnerable of us as safe as possible and work to slow the spread of the virus so it doesn’t overwhelm our healthcare system. So let’s do that β the elderly and those most at risk are counting on us.
At Metropolitan State College of Denver, Milkman was instrumental in developing the idea that people were getting addicted to changes in brain chemistry. Kids who were “active confronters” were after a rush β they’d get it by stealing hubcaps and radios and later cars, or through stimulant drugs. Alcohol also alters brain chemistry, of course. It’s a sedative but it sedates the brain’s control first, which can remove inhibitions and, in limited doses, reduce anxiety.
“People can get addicted to drink, cars, money, sex, calories, cocaine β whatever,” says Milkman. “The idea of behavioural addiction became our trademark.”
This idea spawned another: “Why not orchestrate a social movement around natural highs: around people getting high on their own brain chemistry β because it seems obvious to me that people want to change their consciousness β without the deleterious effects of drugs?”
BTW, this is a somewhat controversial view but it has always made sense to me for those with mild addictions or depression. Speaking strictly for myself, I’ve found that when healthier alternatives are available to me (spending time with family & friends, exercise, exploring, reading a good book), I spend a lot less time mindlessly doing things that give me the same sort of brain buzz but which I don’t consider positive or worthwhile (drinking alcohol, watching TV, eating poorly, and especially reloading Instagram over and over again like a lab rat slapping that lever to get more cocaine).
But back to Iceland. By giving teens access to more healthy activities, getting parents more involved in their children’s lives, implementing curfews, and administering annual surveys, the country has made great strides over the past two decades:
Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.
The way the country has achieved this turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense. “This is the most remarkably intense and profound study of stress in the lives of teenagers that I have ever seen,” says Milkman. “I’m just so impressed by how well it is working.”
Young did a follow-up last year about the expansion of the program into other areas of the world.
Even though larger animals like elephants and blue whales have up to 100 billion more cells than humans in their bodies β and therefore many more chances for harmful mutations to develop β they are much more immune to cancer. This is called Peto’s paradox the subject of Kurzgesagt’s latest video. Scientists aren’t sure why this happens, but one hypothesis is that in order to have grown so large, the evolutionary process that resulted in these animals provided built-in defenses against cancer that other animals didn’t need. Further reading on the topic is available here.
Running through the middle of the chart, the seven vertical panels test for acuity of vision with characters in the Roman alphabet (for English, German, and other European readers) and also in Japanese, Chinese, Russian, and Hebrew. A panel in the center replaces the alphabetic characters with symbols for children and adults who were illiterate or who could not read any of the other writing systems offered. Directly above the center panel is a version of the radiant dial that tests for astigmatism. On either side of that are lines that test the muscular strength of the eyes. Finally, across the bottom, boxes test for color vision, a feature intended especially (according to one advertisement) for those working on railroads and steamboats.
Mayerle was a German optometrist working in San Francisco when he made the chart, designing it for use in a city with a diverse population. My pals at 20x200 are offering limited-edition prints of Mayerle’s chart in a variety of sizes.
This is the most metal shit ever: the doctors removing violinist Dagmar Turner’s brain tumor woke her up during the procedure to play the violin to make sure that she didn’t lose any parts of her brain vital to her playing.
After explaining concerns she had over losing the ability to play the violin, Prof Ashkan and the neurosurgical team at King’s devised a plan. Prior to Dagmar’s operation they spent two hours carefully mapping her brain to identify areas that were active when she played the violin and those responsible for controlling language and movement. They also discussed with Dagmar the idea of waking her mid-procedure so she could play. This would ensure the surgeons did not damage any crucial areas of the brain that controlled Dagmar’s delicate hand movements specifically when playing the instrument. With her agreement, a team of surgeons, anaesthetists and therapists went on to meticulously plan the procedure.
During the operation Prof Ashkan and the team performed a craniotomy (an opening in the skull) and Dagmar was brought round from the anaesthetic. She played violin while her tumour was removed, while closely monitored by the anaesthetists and a therapist.
This site is making N95 respirator masks that work with facial recognition software, so that, for example, you can unlock your phone while still wearing a mask.
After uploading your face, we use computational mapping to convert your facial features into an image printed onto the surface of N95 surgical masks without distortion.
Our printer uses inks made of natural dyes. It’s non-toxic and doesn’t affect breathability.
You can use your mask for everyday life as a barrier for airborne particle droplets.
It is unclear whether these will actually ship or not β “Q: Is this a joke? A: Yes. No. We’re not sure.” β but they’re definitely not planning to make them while there are mask shortages related to COVID-19. And it appears the masks will work with iPhones…you just add a new face (while wearing the mask) to your phone’s face database.
With news of more than 70,000 confirmed cases and 1700 deaths from the COVID-19 virus, the importance of handwashing is once again front and center. Using data from a 1978 study on the hygiene of health professionals, this is a map of the most missed areas when washing hands.
This more recent paper contains a short review of various studies of missed areas, most of which conclude that people often forget to wash their fingertips:
In 2008, the WHO designed a handwashing leaflet, making reference to Taylor, who indicated that the fingertips, interdigital areas, thumbs, and wrists are the most commonly missed areas in handwashing. Pan et al. also found that the tips of the nails and the fingertips had the largest amount of residual florescent stains left after handwashing among healthcare workers in Taiwan. The commonly missed areas among medical students in the study conducted by Vanyolos et al. was the first metacarpal, the proximal part of the palm (lateral), the distal phalanges, and the nail beds. In healthcare workers in Ε kodovΓ‘ et al.’s study, the thumbs and fingertips were the most commonly missed areas. In this study, the most frequently missed area was also the fingertips. However, the medial aspect and back of the hand were the second and third most missed areas, respectively. Moreover, the interdigital area and the front and back of the fingers were the least missed areas, which is in contrast to Taylor’s study.
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