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COVID-19 Update April 9, 2020: Lockdown – Works and Does Not Work; Unique Features of the Infection in America

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-19- 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

The Lockdown Strategy- It Works and It Does Not Work

How can a strategy succeed and fail at the same time?  Purely by asking what challenge it solves.

If we are asking a strategy to interrupt the ability of the SARS-CoV-2 virus to spread from one person to another, then the evidence the lockdown is working is now convincing.

If we are asking a strategy to end the pandemic, then the lockdown strategy will have to be viewed as completely ineffective and unable to produce this result.

Let’s take a look at the evidence to date and sort out what these two statements mean.

Readers of Real Answers may now be growing tired of references to the different strategies of East Asia and Europe/America.  But it is worth repeating this important point to make sense of why we thing the evidence that the lockdown is interrupting the spread of  the SARS-CoV-2 virus is now very strong.

You will recall that in E Asia the two-pronged strategy was to identify infected people and isolate them outside the home until not contagious. This strategy has proven beyond any doubt to work.  Every nation that has adopted this strategy has seen the spread of the SARS-CoV-2 virus essentially stop.

And you know by know that in Europe and in the US, the strategy has been to have everyone stay home and to identify infected people only when sick enough to require hospital care.   This strategy has clearly not worked as well as E Asia’s approach, so the question has been, for many tense weeks, would it work at all?  Europe began its experience before the US, so the answer we knew would emerge there first.  For awhile it wasn’t clear that the everyone stay at home strategy would work, Italy seemed to have infections roaring out of control.  But now the data are convincing.  In Spain, and Germany, and Italy, clear evidence of fewer deaths and therefore fewer cases is in hand.

In the US we are seeing early evidence of the same, in Washington state, California the number of cases and deaths although still increasing, is decelerating.  And time and again, when people gather, the virus rages.   And not just in cities, Albany GA had 2 funerals light the town, a small rural town, on COVID-19 fire.  States resisting lockdowns have higher rates of spread of infection.

The everyone stays at home, or lockdown, strategy is working.

So if lockdowns work to slow the spread of the SARS-CoV-2 virus, how do they fail?

This is important.  If the SARS-CoV-2 virus is in a nation, and many people in that country isolate at home, the virus cannot spread to those isolated at home very well.  But if those people step outside their home and come into contact with the SARS-CoV-2 virus, it will spread to them.  The strategy of isolating people cannot stop the spread of the SARS-CoV-2 virus once you stop isolating.

Imagine that I have never had COVID-19.  I stay at home and see no one.  If I have no contact, I cannot catch the SARS-CoV-2 virus.  And so I have protected myself from the spread of this virus and getting COVID-19.  But huddling alone at home does not immunize me.  Even though I sit at home alone, my body can still get infected.  It just isn’t getting infected because the SARS-CoV-2 virus is not near me.  I can stay at home for a year, and still be able to be infected.

This is how lockdowns or isolation fail to truly stop the pandemic.  Since sitting at home changes none of my ability to get infected, only my opportunity to be infected, once a lockdown is lifted,  the SARS-CoV-2 virus can start spreading and infecting again.

To end the harm this pandemic is wreaking only 3 options are known to work:

The SARS-CoV-2 virus will infect everyone it can ending the pandemic

A medication curing COVID-19 will be invented and available to all

An immunization for COVID-19 will be invented and enough people, in the world, will be immunized to stop the SARS-CoV-2 virus from infecting anyone

We are not very close to any of these options, and so isolation is our only intervention, either via identifying infected people and selectively isolating, or isolating everyone.

Safe Disinfectants

The environmental agency called PEHSU (Pediatric Environmental Health Specialty Units) does great work in helping families know about safe environmental health practices.

Recently the Western PEHSU, headed by Dr. Mark Mitchell developed a sheet on how to know if the disinfectant you are using in your home is safe.

Click sheet to see the 2 page sheet

Where Spreadability and Severity Are Connected- The American Story on this Pandemic, as of Today

The American experience with COVID-19 included many stories of extraordinary effort, heroism.  Some examples, not all by far, include:

  • The willingness of our nation to go into lockdown across most states, as noted above, when done, it slows the spread and reduces deaths.
  • The willingness of so many workers, in grocery stores, utilities, hospitals, doctors offices, to continue working, knowing that it is dangerous to do so
  • Many states, and many towns and cities, have taken the pandemic as seriously as any nation in the world, have devoted resources to stopping the spread and protecting its inhabitants, and are making a huge difference
  • The people of the United States have poured out their hearts, generosity is widespread
  • Industries in the US are working hard to make products available and get them where they need to be
  • The military, including the Army Corps of Engineers and the National Guard have built field hospitals, filled staffing needs.
  • Scientists are working hard to develop medications and vaccines that hold our only real hope of stopping this plague completely before it ends itself.

The American story also stands alone in the world in some very tragic ways, ways that have led to needless suffering, even death:

  • There are no other major, developed nations in the world lacking a national strategy to stop the pandemic.
    • Only in the US is there no national strategy to obtain materials to sustain life such as masks and ventilators
    • Only here is there no national strategy to isolate or lockdown
      • Leading to the tragic spectacle of some states actually encouraging people to congregate, inviting the SARS-CoV-2 virus to spread and create new hot spots, which is actually happening.
    • Only here is there no national strategy to staff hot spots’ medical centers
    • Only here does the national leadership waste precious time on blame and projection, instead of problem solving.
  • The result is America has a dramatically larger outbreak of COVID-19 than any nation in the world, more cases, more deaths, less idea of who is infected, simply less control and the worse outcomes.

Four areas of failure are especially tragic:

  1. Rescues only work if done quickly.  Everyone knows this.  Someone falls down a well, there is no credit for a rescue if the rescue team first goes on a 2 month vacation, then retrieves the child.  Rescues delayed mean lives lost that could have been saved.  Our nation had ample warning.  China released the facts on this virus December 31, 2020.  We had a confirmed case in the US January 24, 2020.  The first real response was a series of lockdowns beginning around March 16, 2020.  That means that we had information for over 3 months to do something to get millions of tests, masks, hospital beds, and thousands of ventilators ready, and our population to act promptly to lockdown to stop the spread.  None of this happened at our national level over that precious time.  The rescue team took a break during the moment of need.
  2. The testing debacle.  If you want to save the child who falls down a well, you have to know where the well is.  Testing is the foundation of any response to an epidemic.  If you don’t where it is hot, and where it is going, you cannot act intelligently, the virus wins.  We failed, and continue to fail, to know where the SARS-CoV-2 virus actually.  Lucky for us, locking down everyone is working (see above), but if we had adequate testing we could manage this lockdown much better.  Hopefully we will one day have adequate testing.
  3. The PPE debacle.  The lack of very cheap materials can be dated back to the elimination of all the departments charged with stockpiling and maintaining supplies for a pandemic early in this adminstration.  This has left medical, grocery, delivery, and other vital workers vulnerable, and many have died as a result.
  4. A national history of oppression.  This is the ongoing story of our nation deciding that one group of its members will suffer because of skin color.  We see it on full display once again with this pandemic.  People of color make up 60-75% of recorded deaths by this virus, in some cities, African-Americans are 7 times more likely to die from the SARS-CoV-2 virus than others!    Some Americans wonder, how could this be?  Others wonder, don’t African-Americans have more diabetes and hypertension, so it isn’t skin color, but racial incidences of such conditions?  The pandemic in the US is only 6 weeks old, but the answers to these questions go back well beyond 6 weeks, really more like 400 years.  Here is a very brief perspective

Race and the American Pandemic

How does the color of a person’s skin consign them to having a 6 fold greater chance of dying from COVID-19?

The evidence proves it has nothing to do with skin color, and that skin color has nothing to do with underlying conditions such as diabetes or hypertension.  Many, many studies have proven this beyond further doubt.

The answer lies in other patterns.  One striking pattern, true for all of American history, has to do with the fact that a baby born is far less likely to live to be one year old if the color of their skin is deeper brown or black.  Today in modern America that difference is around 2-3.  That is, a child born African-American is 2-3 times more likely to die before reaching one than a white baby.  This is true today.   The same pattern is seen in life expectancy, in chances of surviving any type of cancer, of household wealth, of individual income, almost any measure of what anyone would hold dear in life.

Close studies of these trends firmly demonstrate that they flow from choices made, but not by our African-American community, but by the majority, white community.  These conscious choices began around 1619 and have continued very steadily since.  Over the centuries they have become American habits of choice, to the point most of us in the majority community don’t even notice them, but the choices still have their impact, as the story of infant mortality makes very, very clear.  Two excellent references on this history are Stamped from the Beginning, likely the best published book on the deep history of how racism came to be and works in America.  And White Fragility, a rather awesome book for white America, to learn how our recoiling from such discussions actually may be the most powerful mechanism to keep the work of racism in place.

These trends are part of every American institution, which of course, sadly includes the medical world, where the increased chance of dying from illness can be traced to as well.

So, it is this broad structure of choices we have made as a nation that we call racism that causes the infant mortality to vary by color, but also to increase the chance of developing diabetes and hypertension, of living with far less money leading to working in menial positions that will not allow one to work at home, that will force one to remain in contact with many others in grocery stores and delivery services, all of which combine to explain the outrage of this fourth aspect of the American experience of this pandemic, the fact that in many cities nearly three-quarters of COVID-19 deaths are in people in our African-American communities.

It grieves me to write these passages, I grew up proud of American know-how and can-do spirit.  And in all past pandemics in the modern era, the US has indeed led the way, helping the world manage SARS and Ebola and Zika.   Our last pandemic, the H1N1 influenza pandemic of 2009, the US actually outperformed the world, with a chance of dying from that virus 57 times less than the world average.  How sad, tragic really to see us let go of our know-how and perform so poorly.  How sad to see one more event force us to see the impact of racism on millions of our fellow Americans.

I can only hope that knowing this spurs our nation to do better.  I know we can do better on the first three points, we can respond more rapidly to the threat in front of us, we can manufacture needed materials and goods, and we can test.  As to the question of racism, I hope more than know we can do better.  To be specific, I know that our nation can stop oppressing, that we can, but know that this requires us to choose to do so and that I cannot be so confident we will.

BOTTOM LINES

  1. Isolating people from each other blocks the new coronavirus from spreading.  This works only as long as people remain isolated.   The virus awaits us gathering once more.
  2. So it is great news that the European and American strategy of isolating everyone at home is slowing the pandemic, but everyone needs to know that interrupting the spread IS NOT THE SAME THING as getting rid of the virus.  Stop the spread and infections become less frequent, but as soon as we gather again, the virus will reappear.  This has already happened in Singapore which is already in its second battle to stop a raging pandemic.
  3. The American story of the COVID-19 pandemic of 2020 already features tremendous positive features including the willingness of millions of Americans to help.
  4. Tragically, there are features of the American story that have led to needless loss of life.  Most can be described as part of the deep reality that truly emergency-level rescues only succeed if the rescue happens quickly.  Our national government has simply not acted quickly, resulting in the debacle of inadequate testing and of inadequate supplies, leading the US to have the most out of control pandemic experience in the developed world.  Especially painful to say since even just a few years ago we led the world in pandemic management.
  5. The endless decision of the majority of America to deny equal opportunities to our colleagues in the African-American community has kept tragedies such as double or more the rate of infants not making it to one year of age for centuries.  These realities that so many of us like to not notice are now in full view with some cities reporting that if your skin has color, you are 6 times more likely to die from COVID-19.

All catastrophes reveal deep flaws in every nation, this pandemic has certainly revealed much about us as a country already.  Let us hope it moves all of us to take action to change these realities.

And, let us be aware, we have slowed the virus from leaping from person to person, but it is still there, and if we come out of isolation without a smart plan to do so without exciting a surge of COVID-19 cases, we could be in deep trouble again quickly.  This conundrum will persist until the virus exhausts itself, or we have a vaccine or have a medication that will truly work.

To your health,
Dr. Arthur Lavin

 

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