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COVID-19 Update: April 5, 2020 The East Asian Model – Some Recent Signs of Trouble?

By Dr. Arthur Lavin

Glossary

  • Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
  • Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
  • SARS-CoV-2– the specific name of the new coronavirus
  • COVID-2019– the name of the illness that the new coronavirus is causing
  • Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
  • Epidemic– a sudden burst of an illness that comes and goes over a limited time
  • Pandemic– an epidemic that bursts across the world not just one region
  • Spreadability– how contagious is the disease, how many people will end up infected
  • Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
  • Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
  • Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
  • Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
  • Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.

 

Spreadability

Readers of Real Answers will know that one of the most hopeful models of how humanity can stop the spread of the virus has come from 5 nations/regions in East Asia, namely:

China and its Special Administrative Region, Hong Kong; Singapore; Taiwan; Japan; and South Korea.

In each instance, these five national communities crafted a strategy founded on two key principles:

  1. Identify(diagnose) as many infected people as possible.  This required population wide and constant screening for presenting symptoms, esp. fever.  Then ensuring everyone with symptoms came to a place where they could be evaluated to see if they were infected, a place where no contagion could occur.
  2. Isolate.  Place all identified mildly infected individuals in places outside the home.  Nice facilities, with only infected people in them, all staying until no longer contagious.  All severely infected people to be hospitalized in COVID-19 safe facilities, again, to stop transmission.

This is, as you will recall, in stark contrast to the European and American strategy, also essentially two steps:

  1. Ask the entire nation to remain at home.  Instead of testing as many as possible and managing those infected, this strategy relies on everyone keeping distance to deny the virus the chance to spread.
  2. Place infected people in the home.  Mildly infected people stay at home, able to infect anyone else in the home, not in separate contagion-proof facilities.

Until recently, the E Asian model was vastly outperforming European/American strategy.  The five nations had halted the spread of SARS-COVID-2, Europe and in particular America, had not.

But now the picture has changed.   The spread of the coronavirus is taking off again in many of the five regions in East Asia that were once the only places in the world that had stopped it.  Let’s take a look at each:

  • Unfortunately, data from the People’s Republic has been determined to be highly unreliable, and so we will not be reporting trends from China unless verified by an outside, credible source.
  • Hong Kong.  Hong Kong had been a world-wide success story.   https://www.worldometers.info/coronavirus/country/china-hong-kong-sar/ The shape of this curve shows it truly halted spread of the SARS-CoV-2 virus almost completely.  We were there visiting our son and his family and on February 2 they had found 50 cases.  Hong Kong kept the count in the 50-150 range, unheard of in the rest of the world, through March 16.  On March 17 they imposed a mandatory 14 day quarantine on every traveler entering Hong Kong.  Expatriates who had fled Hong Kong at the end of January, thronged back to their homes by March 16 to beat the rule, and sparked an epidemic there with the virus that returned with them.  As of April 3, the case count boomed to 862, it remains to be seen if the successful strategy of Jan-March will work again.
  • Japan has also been a place of high compliance with screening and isolation, to very good effect.  That is, until last week.  Somewhere around March 24, the rate at which new cases developed began to climb, now hinting at the familiar exponentially rising curve seen in every European nation and across the US. https://www.worldometers.info/coronavirus/country/japan/
  • This community, like, Hong Kong, is small in area but has millions (5.6 million) of people in what can be thought of as a densely populated city-state.  Singapore had a grand total of 72 cases on February 15, and even by March 10 still only had 166.  But something happened in Singapore, and it is now seeing cases expand exponentially, since a bit into March.  https://www.worldometers.info/coronavirus/country/singapore/
  • The island nation of Taiwan had a tiny number, 18 cases, on Feb. 15, and still only about 100 in mid-March, but it’s curve like Hong Kong, Japan, and Singapore, has accelerated and clearly now has the shape of an exponential curve.  https://www.worldometers.info/coronavirus/country/singapore/
  • South Korea.  This remains the only nation on the planet with a credible claim to have stopped exponential rise of COVID-19 cases and deaths over a sustained period of time.  https://www.worldometers.info/coronavirus/country/south-korea/ You can see in these graphs that the number of cases is rising in South Korea, but not much.  On March 7 there were about 7,000 cases, on April 4 about 10,000, not exponential, and not exponential for nearly a month.

The climb seen in of the five trustworthy sources is highly disturbing for 2 reasons:

  1. These were communities showcasing this virus’ spread could be truly slowed, even halted, by choices people make.
  2. The climb in cases calls that into question, and cannot be explained by failing to test or know the actual rate of infection, each of these East Asian communities instituted population wide testing early on.

The question these communities present to all humanity is now this:  What has South Korea done that has not been done in Japan, Taiwan, Singapore, or Hong Kong?

All these nations and regions have adopted the strategy of population wide screening and testing, and isolating infected people out of the home.  But South Korea has done something distinctive, and this observation just might hold an answer for how any nation could stop the spread of the cause of COVID-19 before we have a medication or vaccine that will do it for us.

Now, take a look at Europe and America, from the Financial Times excellent tracking graphs, https://www.ft.com/coronavirus-latest

This graph shows the number of new cases in each country, plotted against the day after that nation first hit 30 cases.

The steeper the curve, the faster new cases are identified, the higher the curve, the higher the total number of cases diagnosed.

The most striking aspect of this graph to my eye is how all of the European nations, and the US, were all tracking the same rate of new cases for their first 2 weeks after they hit 30 cases.  But what about after each nation’s first 2 weeks of this threat?  From the threat of death by pandemic?  In every single example, every nation in Europe protected its people far better than the United States.

By this measure, our nation, the United States, performs the worst of all the nations graphed.

All these nations, including ours, as noted, depend essentially on everyone staying home to stop the spread.  This approach is slowing the spread everywhere, but way more everywhere but here.

BOTTOM LINES

So we leave the discussion on contagion, or spreadability, with two questions:

  1. What is South Korea doing that no one else is, and how can we all start doing that?
  2. What are we, the US, doing that no one else is, how can we all stop doing that?

This is not an exercise in blame, but rather, in learning.   A deadly virus is loose, killing thousands, one day millions.  Doesn’t it make sense to learn from every nation’s efforts, what helps and what hurts?

To your health,
Dr. Arthur Lavin

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