Tag Archives: Behavior

A COVID-19 Exercise: What Next?

As we transition from the first phase of COVID-19 into what comes next, I’ve been thinking a lot about what comes next. No, I don’t mean recovery-wise, I mean what do we do next to make sure we are prepared when the next pandemic threat knocks at our nation’s door?

Over the next few weeks, I’m going to do some reading and studying and maybe even ask for your opinions on the subject of “what’s next?” One thing that is 100%, minted in gold, true is we CANNOT respond to the next pandemic disease threat like we responded to this one. As a nation, we got caught with our pants down. We failed to realize the looming threat. We failed to imagine it could happen to us. We failed to respond rapidly and with intent and the virus spread like a wildfire.

We tried to throw cow poo to cover over the problem while telling everyone it was chocolate. The best nation on the planet with the finest people, a great health system, and all the data we needed fell flat on its face. It will take years to recover from the loss in life, health, security, economics, and trust in our elected officials. Years.

The blame falls on everyone. We should have done better. Period.

We can do better. We need to do better. We should demand better from our leaders. We have the plans, the data, the institutions. What we lack is a cooperative system that has a green light to track, analyze, and respond to international, national, state, county, city, and neighborhood threats. This type of system has been bouncing around in my head for weeks. Sound impossible? Maybe. But think about a system you rely on daily and that you really don’t give a second thought to its complexity.

The weather report.

Meteorology relies on data collection, analysis, and modeling to predict what will likely occur in an hour, a day, a week, months, etc. Maybe the weatherman gets a rain shower wrong every now and then but they rarely miss the big threats, like hurricanes, tornadoes, and blizzards.

In public health and infectious disease, we have data, we have analytical tools, and we have computer models. What we need is to make the infectious disease reporting system and response as rapid and as commonplace as our weather service.

I envision a system that can give officials rapid, accurate, point-specific information to help them make decisions about how to best implement responses, resources, and social contact initiatives.

Can we do it? Absolutely!

As they said on the Six Million Dollar Man, “We have the technology.”

It’s a question of do we, as a nation, have the resolve to do it.

Lives are at stake. We cannot accept the loss of 50,000+ Americans to a pandemic again. Never, under any circumstance or political environment or world events.

We need better leadership. We need to use our resources. We need to understand and react.

Nae king! Nae quin! Nae laird! Nae master! We willna’ be fooled again! ― Terry Pratchett, The Wee Free Men.

AWIPS-3-head-workstation

 

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A COVID-19 Exercise: Theoretical effect on local hospitals

Note: This post is the product of my brain working quite a bit on the COVID-19 pandemic issue. It is not meant as any kind of official public health or medical advice. I’m a molecular microbiologist. I’m not a doctor or public health official. There are people A LOT smarter than me supplying official information. There are also many buffoons spewing idiocies out there. In difficult times, knowledge is power. Do the work. Find the truth. Ignore the myths. The most valuable tool we have right now is the same powerful tool we have at our disposal every single day of our lives. Our brain.

On 4-9-2020, the Kansas Department of Health and Environment (KDHE), through their excellent COVID-19 Resource Center web page, reported 1106 confirmed COVID-19 positives with 263 requiring hospitalization (a 23.8% rate). These numbers got me thinking about how my small Kansas town and our excellent local hospital might be affected by the coronavirus. 

I did some calculations on what might be in store for our local medical resources if the coronavirus becomes community transferred in our fair city. Information on our local hospital’s website says they are a 25-bed facility. In an emergency, I imagine they can swing another 5-10 beds but I don’t know for sure.

Doubling times are important in a contagious infection scenario. They mean it takes X number of days for the number of infected individuals to be doubled. The latest I heard last week was that COVID-19 was running at a doubling time of four days, so I included that in the table as well as an eight-day doubling timeline. The whole goal of social distancing and flattening the curve strategies are to extend the doubling time as far as possible. By stretching out the timeline of infections, as you can see in the table, a community can keep the number of infections and patients needing medical services within the limitations of the local medical system.

The public health issues rise exponentially once the illnesses overburden the system. It is vital to stay under these critical numbers and to stay within the limitations of our medical systems. As you can see in the table below, for our community hospital, in theory, the key period will be how fast we go from around 50 total positives (~10 patients hospitalized) to 250 positives (~50 patients hospitalized). If we don’t alter the doubling time of 4 days, our medical system will go from adequate to overwhelmed in about ten days. Ten days!

Bottom line. Stay home. Do what the local and state authorities advise. Be safe. Be kind. Help each other out.

# of COVID-19 Positive Cases Local Hospitalization (at a 20% rate) Days @ Doubling Time = 4 days Days @ Doubling Time = 8 days
1 <=1 0 0
2 <=1 4 8
4 1 8 16
8 1.6 12 24
16 3.2 16 32
32 6.4 20 40
64 12.8 24 48
128 25.6 28 56
256 51.2 32 64
512 102.4 36 72
1024 204.8 40 80
2048 409.6 44 88
4096 819.2 48 96
8192 1638.4 52 104
16384 3276.8 56 112

Here are a few things I’ve posted elsewhere about COVD-19:

Novel Coronavirus 2019: Scientist Roundtable

April 6, 2020 Facebook post about antivirals.

What are antivirals? They’re medications that reduce the virus making more of itself. They do their job in a variety of ways from affecting the genes being made into functional proteins to the proteins not being able to be put together properly to make new virus. They don’t completely kill the virus. They are effective because they can reduce symptoms or shorten the length of infection.

What antiviral drugs aren’t are miracle cures. You don’t inject an antiviral and expect to be protected or to stand up and walk out of ICU in a few hours. They may have serious side effects that may cause more harm than health so the balance has to be weighed between the doctor and the patient. That’s why antivirals and vaccines and all other drugs undergo extensive testing to give the doctor and patient the best information to make the best decisions.

Antiviral drugs are important in new outbreaks. In pandemics, like we’re in now, reducing and shortening hospital stays is vital. But, we have to remember one of the first tenets of medicine as we move to use existing antivirals in novel scenarios, “First, do no harm”.

The best way to stop pandemics? Prevent pandemics. That, my friends, is something I’ve been thinking a lot about and will write about soon. It’s time to elevate infectious disease defense to the level of national defense.

Have a good day! Stay safe. Be nice. Help each other out.

March 31, 2020 Facebook post on Social Distancing

Unacast has some interesting data tools they use to track movement by GPS. Below is a link to their Social Distancing Scoreboard.

Yesterday, Dr. Lee Norman of the KDHE talked about the importance of the stay-at-home order. At our current ~35% reduction in Kansan movement, the infection doubling time is around 3.6 days. If we can get to a 45% reduction, the doubling time increases to ~6.5 days. At a 55% reduction, it jumps to almost 10 days.

Why is this so damn important, you ask? Because at 55% reduction & 10 days doubling time, Kansas has ample medical resources to handle it. 45% & 6 days pushes the health systems to their limit. The health system becomes stressed and overloaded at our current 35% reduction or anything below that.

Stay safe, friends! Minimize movement and help each other out, if only with a wave and a smile.

 

NY_Foundling_Hospital_-_Operating_Room_-_circa_1899_-_Byron_Company_-_MNY25924

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What is best?

High school-aged kids are going to screw up.  That’s a given.  It is part of being young and stupid.  You think you will not get caught, you think nobody will know or find out, and you think nobody cares.  As a parent and coach, I don’t like it.  I wish kids wouldn’t behave badly. I wish they would make good decisions 100% of the time 24/7.  But they don’t.  The learning curve of life is shaped by mistakes and failures.

But, what do we adults do? Do we turn a blind eye? Do we slap their wrist and tell them not to repeat the bad behavior event? Do we bring the hammer down?

Tough questions. I have no good answer. I don’t like the solution which completely takes away the activity from the kid. In our high school, I felt football kept a great number of our young men coming to school every day (more than any of us wanted to admit). Being part of the team kept them connected. Without the sport and without the team, many of them drifted away.

Paddle

With a sports coach, I like the multi-facet discipline approach to a player in trouble. I think the most effective enforcement comes three directions—the parent, the administrator, and the coaching staff. Not too severe from either direction, but enough to turn the thumb screws and make life in trouble an uncomfortable situation for the kid.

Not easy topics.  Mistakes and punishment are right at the bottom of the list of things coaches want to take care of during a season. But, they happen. They happen more than any of us want to admit. When they do occur, how we handle these issues has a long-term positive or negative impact on the kid. No pressure, right?

I don’t know the way to solve all these problems. High school kids will continue to get in trouble. Are we going to respond in a way the helps the kid in the long run or hurts the kid in the long run?

It’s never easy.

 

 

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The Rule

The Mrs. Hays recently brought up the subject of her need to develop a set of rules for her new classroom. I suggested, “Mrs. Hays is the Queen of this Classroom; diligently follow every word that flows from her mouth.”

She said that my suggestion was not really a classroom rule, it actually is a universal law. What she needed, she said, was a simple set of rules like the set of “No” rules you find at the swimming pool. No running, no rough-housing, no sitting on shoulders, no diving, etc. and so on. My train of thought and immediate interest in the subject waned with the memories of the hours upon hours of the young me sitting on hot pool decks kept prisoner from my friends and the refreshing, cool water by over-zealous lifeguards and their “No” rules.

With my husbandly duty of suggesting rules to the wife successfully completed, my mind drifted away to behavior rules I’ve run across or used in coaching sports. One of my favorites from my personal stable of behavior rules is this concise, to-the-point, original Coach Hays rule:

“Nothing you do on the field of play can make up for acting like a piece of crap off the field.”

Another one I like, which may or may not be a Coach Dail Smith-ism, is this one on keeping a well-ordered locker room or team bus:

“Your mother is not here, so pick up after your own self.”

But my all-time favorite rule on behavior came from the late Coach Melvin Cales. I lived with Melvin’s son, Monty, in college. As luck would have it, the college happened to reside in the same town as Monty’s grandmother. Melvin and his wife would often drive down and visit his mother on Sundays and then stop by our place on the way out of town. After the visit, Melvin would stop at the door and say to Monty. “Behave yourself.” Then he’d add the one line on behavior which I have repeated hundreds of times over the years to my own self, to athletes and most importantly, to my own children:

“Don’t do anything you wouldn’t want your grandmother to read about in the paper.”

So there you have it Mrs. Hays, a rule for your students and, indeed, a great rule for life. Smart, sage, and simple advice from a smart, sage, and simple man.

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