Tag Archives: Community Wellness

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.

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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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