Monthly Archives: March 2020

While I was involved in hospital infection prevention programs, I often made the argument that all respiratory diseases have both a droplet and airborne component. My rationale was that some of the droplets expelled could easily be small enough to dedicate in the air and leave virus particles suspended in the air, especially in spaces that are naturally dry or through environmental controls.

Expert commentary providing support for this position was provided on the CIDRAP site.

Most importantly though, please don’t purchase either type. These are really going to be desperately needed in healthcare when things really take off mid month.

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I have often told people that they should try to figure out how to stock up on life-saving prescriptions because of supply chain problems that would result during a pandemic. About 80% of the pharmaceuticals in the US are manufactured overseas, first in China as raw ingredients, from where they are shipped to India for final manufacturing. A large portion is shipped into the US in the cargo holds of passenger flights.

Think about all of the pieces of that process that could break down. We have already seen massive amounts of flights cancelled or grounded both domestically and internationally. What do you think governments will do with raw products when they think they may need them in their own countries?

Once again though, you don’t have to take my word for it. The Center for Infectious Disease Research and Policy at the University of Minnesota has also addressed this problem.

I had written back on March 14th that something kept gnawing at me about the case fatality rate in China. It didn’t make sense that it had continued to climb while the incidence of disease appeared to fall. I had thrown out one possible hypothesis, but hoped it wasn’t the one that I didn’t write about that I found much more concerning. Here’s how the data looks today.

Ont thing that seems really suspicious to me is that the CFR got really smooth over the last two weeks. Data just doesn’t behave in that way. That got me wondering even more about how transparent the data from China has been.

Now I suspect that it may have been good up until the middle of February, but after that is anyone’s guess. I also have commented previously that perhaps the CFR was lower because of under-reported mild or asymptomatic cases. Now it looks like the CFR may be higher because of the failure to report deaths as given by this article from Radio Free Asia.

Yikes. This may even be worse than I expected.

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I have reached the point of avoiding going anywhere I may have contact with the public. I’m still trying to figure out the best way to do that, but today was my first round with getting groceries delivered.

Today’s purchases were mostly for my mother, who I have instructed strictly to stay at home. I will be handling her food and other needs for her. I’m going to describe my process today.

When the delivery arrived, I placed the bags placed in the trunk of my car other than the bag that had the two items for me. My oldest son and I drove over to my mothers house and I had him stay just inside her front door while I brought the bags to the front steps and set them there. I had my mother bring some clean bags she had in the house near the door.

We had brought over disinfectant wipes. I had my son take dry goods out of the bag and wipe them down with the wipe. Those were then placed in the clean bags inside the house. We did the best we could with bags of produce and other refrigerated items as well as the frozen items and put refrigerated in one bag and frozen in another.

Essentially, we now had dry goods, perishable goods, and frozen contained in clean bags. I instructed my mother to put each bag in the appropriate space but if she could wait 3-5 days from getting anything out of any of those bags that would be best and then doing normal washing protocols for produce after that time.

I’m sure the neighbors were wondering why we were going to such lengths. I guess this is a good time to add that I worked in the operating room for years and also in hospital infection prevention for another large portion of my career, so I used some of my expertise in those areas to try to make things as safe as possible for her.

I don’t know how I found a link to this video about 2 hours after our grocery safety exercise. The serendipity was uncanny. He does a great job at explaining what needs to be done, probably better than I could with the written word. Heed his advice.

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I thought it would be interesting to compare the cumulative fatalist curves by country. I’ve only included countries with at least 10 deaths and my estimate of a sufficient number of days of experience to be worth comparing.

Once again, we see a very interesting East versus West pattern in trends, which isn’t surprising since that correlates well with what I had previously represented with case counts. Clearly we need to take a more Eastern model of mitigation if we want to get this under control.

The other thing I want to point out is how much steeper the outset of fatalities is in the US. We definitely don’t want to see this curve as a function of exponential growth.

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A friend of mine sent me this video on Facebook. I was completely fascinated. I figured if I did a little bit of searching, I could find it online to link to here.

I have mentioned before how poorly I think we are going to do in the West in comparison to the East, both on March 5th, as well as on March 11th., so I’m not going to rehash all that here.

From an epidemiology perspective, I drool over a big data set like the Chinese have along with all of the GIS information contained inside. I know I could find many insights. However, because of the culture I grew up in, I also chafe at what this would mean. Somewhere, there must be a sweet spot in the middle, I simply do not know what it is.

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I’m simply copying a message from a medical app I use. Please heed this warning.

Hi everyone,

My name is @FedericodelCastillo. I am a general surgeon from one of the most important hospitals in Madrid and in Spain.

I have a message to all the healthcare workers and to all that may be reading this: Do not underestimate the impact of the coronavirus in your health, your patients, your family and your health system. People are dying in hundreds and hundreds per day in a city like Madrid, where we have one of the best health systems of the entire world. We, healthcare workers, are dying with them.

Keep safe, keep your families and communities safe and be ready for the impact of this pandemia in your lives.

Thank you,

Dr. Federico del Castillo-Diez, MD, FEBS/MIS.

I’m not sure that I can say anything better than how this is described in this article. We should have done more much earlier. This is the kind of price we have to pay.

An ounce of prevention is worth a pound of cure.

Hospitals consider universal do-not-resuscitate orders for coronavirus patients

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This is just the tip of the iceberg. In about a week, this will look like a drop in the bucket. This is the same thing that will play out across the country. We did too little, too late, and minimized the threat when it first broke free from China.

https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html

I can’t say this enough.

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