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COVID-19 Update May 8, 2020: More Lessons from East Asia- Beware the Bounce, Don’t Leave Anyone Out

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.
  • Live Virus Swab– this is the swab which attempts to swipe live virus from one’s nose or throat tosee if you are currently infected.
  • Antibody Test- (aka serology test) this is the blood test which looks for antibody to the SARS-CoV-2 virus tosee if you have been infected in the past.

Spreadability

More lessons from East Asia

I don’t know about you, but I like solutions that work.  Whether it’s the right paint for my house, or a new patch for my computer, or a just a new pen, I like the paint to stay vibrant and not peel, the patch to make my computer work better, and my pen to work.  I don’t really care where the solution comes from nearly as much as it working.

So it has always puzzled me why we wouldn’t ask the same for solutions to this pandemic.  As noted in Real Answers, many, many East Asian nations have crafted approaches that work.  We don’t use even one of them.  Why wouldn’t we want to use solutions that would keep our deaths to a minimum, and allow us to work and play again?

Today, we get to share three lessons of how East Asian countries slipped or succeeded, and paid a price in COVID-19 roaring up and forcing them to retreat substantially, just the sort of trauma everyone wants to avoid.  Each made their mistake, each fixed it, each is doing so much better than us having done so, and in each instance, we are making the same mistake with no sign of noticing, certainly no sign of fixing it, and we pay the price.

MISTAKE #1- The Bounce, Japan

COVID-19 first appeared largely in its far Northern island, Hokkaido, where as Time Magazine reported in its May 11 issue, a third of Japan’s cases were raging.  Hokkaido shut down on February 28. Three weeks later the people of Hokkaido were outraged at the economic impact and re-opened on March 19, to great joy.  By April 12, about 3 weeks after the re-opening, COVID-19 was raging across Hokkaido again, forcing another lockdown.  This was a failed re-open, and the virus took full advantage.  But Japan acted rapidly and contained the damage.

MISTAKE #2- Forget the Poor, Singapore

Singapore is famous for its extraordinary efficiencies.  When COVID-19 hit, they employed state-of-the-art population screening, testing, contact tracing.  Cell phone GPS tracked all identified infecteds and their contacts to ensure all were tested and all positives isolated.  The spread of the SARS-CoV-2 virus was halted, dramatically, and Singapore re-opened on March 23.  But Singapore left one group out of testing, tracing and isolating infecteds- their migrant workers, which total 1 million of their 5.6 million population, or about 18% of Singapore.  Left out of testing, essentially neglected, the SARS-CoV-2 virus was left to spread, and it did, a lot.  The result?  In one week in April, Singapore suffered 10,000 new cases, an explosion of a 250% rise in numbers.  Singapore still struggles to this day to return to the low level of spread it once achieved.

SUCCESS- Taiwan

No slips, just pure screen and test to identify as close to all infecteds, trace and test all their contacts (using cell phone GPS), isolate all infected outside the home. Period.  No one left out, same level of action without let up.  Result:  In a nation of 24 million people:

  • A TOTAL of 439 cases  (scale up to the US and we would have 5800 not over 1 million cases)
  • A DAILY TOTAL OF 10 new cases a day   133  (scale up to the US and we would have 133 cases a day now, not 25,000)
  • A TOTAL DEATH COUNT of 6 deaths, with most days having ZERO deaths.  (scale up to the US and we would have 80 deaths, not 72,000)
  • Far less economic shutting down

THE US PERSPECTIVE- Do these mistakes sound familiar?

They should.

In our United States, we are running to a bounce.  Throwing caution to the warm, springtime, sun shiny wind and excited to go shopping once again, at least in some states.  Our own experiences and those of Japan teach us the virus is lying in wait, and will be happy to roar again if we choose to let it.

In our United States, we have for many deep reasons decided not to really identify any group’s infected people, but this has resulted in massive outbreaks wherever people are concentrated and have limited resources:

  • Nursing homes
  • Meat-packing plants
  • Poor and communities of color neighborhoods
  • Prisons

And just like in Singapore, no surprise, let go of any segment of the population, and these groups might reach towards the 18% mark in Singapore, and the SARS-CoV-2 virus is happy to spread from nursing homes, plants, neglected neighborhoods, and prisons, to soak surrounding towns with infection and suffering and death.

But sadly, in our United States, there is no state that has done what we all should know really works well, the Taiwan model.  Look at where we would be today if we had.  Consider where we will be in a few months if we do not.

The Hope for Seasonality Fades

Check out how a true blue seasonal virus, a winter virus, the influenza virus behaved from October 1, 2020 to today:  https://www.cdc.gov/flu/weekly/index.htm#ILIActivityMap.    It was nowhere to be seen in October, began to appear all over the country in December, raged around every state in January, February, and March, then began disappearing in April, and is essentially gone in May.

Did the SARS-CoV-2 virus do this?   We all held our breath in February hoping it would.   We now know for sure there was no April slow-down, and no slow-down in sight in May.  We will see if summer brings a respite but spring so far has truly not.

If it turns out to not be seasonal, we will have to realize the virus remains all over the US, ready to pop once we gather again, even in warm weather.  We will either do what works or suffer the consequences, no matter the season.

Severity

How does the COVID-19 Pandemic of 2020 Compare to Other American Epidemics?

We are only 5 months into this pandemic, and since the 1700s when we began modern tracking of pandemics, each have lasted about 18-24 months, so we could easily be only about 25% of the way to the end of this one.

But it may be helpful to ask, just how deadly has this epidemic in America been compared to past American epidemics.   Here are some numbers which each are the number of people who died in that epidemic, just in the US:

  • Cholera in 1832- 8,000 in Cincinnati alone
  • The regular seasonal influenza winter epidemics:  average 51,000.
  • The H1N1 influenza pandemic of 1918:  675,000 in it its first year
  • The H1N1 influenza pandemic of 1957- 70,000
  • The H1N1 influenza pandemic of 2009: 12,000 (57 times lower death rate in the US, compared to the world)
  • Typhoid epidemic of 1906-1907 (“Typhoid Mary’s):  10,771
  • Polio epidemic year in the 1950’s:  3,000- far more paralyzed than died though
  • Diphtheria prior to the DTaP and TDaP- 15,500
  • In early colonial times, there were massive malaria and yellow fever epidemics that took the lives of as many as 95% (native Americans) and 20-80% (European colonists) of a village.

And so even just 5 months into this pandemic, with only about 5-10% of Americans infected with the SARS-CoV-2 virus, this pandemic has cost more lives than any but the unique instance of the malaria/yellow fever epidemics of 1609-1800, and the worst one year pandemic on record, the one in 1918.

Treatment

Many are hard at work but there is no medication and there is no vaccine available for COVID-19 at this time.

Social Dimensions- How a Germ can Teach a Human

We tend to think of infections as an attack.  There is the germ and then there is me.  The only connection is the attack of the germ on me and the impact of that attack.  The germ is not me and I am not the germ.

And yet.

When a germ washes over a community, it reveals a tremendous amount that group of people.  A simple example is when a germ such as the bacteria Salmonella shows up in a community, it might infect one person and not spread very much, or enter the water supply and kill many people.   The difference might be entirely due to how well the community delivers water cleansed of bacteria.  This is not a theory.  Cities with modern and effective water treatment and delivery systems have little in the way of Salmonella’s dread typhoid fever.  And, across the world, cities and villages with no way to clean water suffer massive epidemics of deadly typhoid, even today.

We are not the germ and the germ is not us, but when the germ does what it does, tries to spread, how well it spreads speaks volumes about groups of people, who they are, what they can do, what they care about.

And so it is with the SARS-CoV-2.  We know that germs appear and spread, they always have and always will.  What does this new germ, the SARS-CoV-2 virus, tell us about America as it is today?

Many, many things:

American Know-How

The United States, across its history, has been known as the land of science, and the land of fantasy.  We have been awarded nearly 400 Nobel Prizes, and mostly in Medicine (!).  Only 3 nations in the world have won more than 100.  But we are also the country of Barnum and Bailey, the land of the huckster, and its close cousins, the conspiracy theory.  As noted above, in 2009, we led the world in outperforming everyone in keeping people alive in a pandemic.  Today, in this pandemic, with this SARS-CoV-2 virus, we are doing the worst job in the developed world with more deaths by far.  In 2009 the virus showed the United States could be a towering center of effective, know-how thinking and can-do action.

Right now, the virus shows we are shunning science and have let tens of thousands die because of it.  America today is more Barnum and Bailey than Nobel Prize winner.  This is the America as directed at the top.

American Generosity and Striving to Succeed

Our White House may have decided to shun science, but not we the people.  Across the United States, regular people, like each of us have indeed reduced exposure.   Those who could have stayed home, shops are closed.  The people are hungry for information.  And so this virus, the SARS-CoV-2 virus, has revealed that most Americans are truly striving to avoid harm, willing to do what it takes to survive the pandemic.  And acts of generosity abound.

American Aversion to Ensuring All are Safe

The Founders started our Constitution with We the People, and from time to time our nation has embraced the notion that We are a People, as is any nation.  But a powerful force, deeply exposed by the SARS-CoV-2 virus, is another very strong trend in America- the idea that only some people deserve security and safety.  This tendency gets far worse, as noted in the next paragraph.  But only for a brief period in our history, reaching a peak from 1932-1980, did the nation focus its attention on making sure that anyone living here had a minimum level of safe security.  Just think of Social Security, the VA, Medicare, Medicaid, food and financial supports for those with limited means.  This approach, the idea of We are a People, came to a dramatic halt in 1980, with occasional exceptions, such as Medicare Part D and Obamacare, but for the most part from 1980 to today the dominant thinking in America was that government is the problem, and so we began fixing that by taking apart as much government as we could, and dropping the idea of regular people seeking any help with protecting their incomes.  And so, when this virus hit, we found that most people only had a few days of savings to help them through, foodbanks erupted into miles long lines, situations not seen in other developed nations.

The SARS-CoV-2 virus revealed that the last 40 years have succeeded in reducing the regular American’s financial and food security.  The lack of any real increase in wages for the last 40 years is one concrete example of how policies translate into mass unemployment and hunger in a few weeks across a nation.

The American Story of Color

If security for most Americans has eroded in the last 40 years, the decision by America to define some groups as different than other groups of humanity goes back over 400 years.  The two main groups placed into positions defined as less than have been those people here when we landed, and those who came here by chain.  For the native American, and African-American communities, the pandemic of COVID-19 has been catastrophic.  There is no actual biology to explain this, except for the biology of chronic shunning and deprivation of one group against another.  When people ask me, how can one say the burdens of slavery still exist today when so much prosperity has been achieved by all Americans, I only have to point to infant mortality.  It is still the case today that a baby whose parents have more color in their skin is at least twice as likely to not live to be one year old than a baby of European descent, in America.  This is true whether the parents are rich or poor.

And so it is with COVID-19.  The facts are widely known.  City after city sees that about 15-20% of their people are communities of color, but 40-70% of the deaths in that city are in those same communities.  How can that be?

One clue is that 75% of the people still in working in contact with others (e.g., grocery clerks, delivery people, post office workers) are from communities of color, this group has much higher rates of exposure than the white community.  But it goes far, far deeper.  It is now known that the high blood pressure that plagues the black community far more than the white community, is not related to simple genetics, but rather reflects those 400 years of trauma, which as infant mortality, and many other measures, demonstrates, still is very much alive.  This is now known science.

This is a particularly deadly and dramatic example of how a germ can teach humanity.  For this SARS-CoV-2 virus teaches us all that centuries of trauma that still persist today, can lead to problems such as population-wide and severe hypertension, that then directly translates to more death by COVID-19.

BOTTOM LINES

  1. Given recent rumors, the first Bottom Line today must be that there truly is a new virus spreading around the globe. It’s name is truly SARS-CoV-2.  And the facts establish that it evolved all on its own from bats in remote southwest China.  No human created or promoted this virus.  Many humans have erred grievously in managing the spread, but none created it.
  2. The nations of East Asia have succeeded far more than any others in stopping the spread of this virus, and preventing many deaths.  But even in E Asia there have been mistakes.  In Singapore, 1 million people were left out of control measures, and in Japan a province re-opened too early.  Both mistakes cost true huge outbreaks with loss of life unnecessarily.  No reason we should be making these same mistakes, but we are.
  3. Across the history of America from 1609-now, this COVID-19 Pandemic of 2020 in just its first 5 months has killed more than any epidemic in our history, with the exception of devastating malaria and yellow fever losses in colonial days, and the 1918 H1N1 influenza pandemic.   This, our current, pandemic is one of the worst in over 400 years of American history!
  4. Many are hard at work but there is no medication and there is no vaccine available for COVID-19 at this time.
  5. In our last post we asked what makes us sick with infection, the germ or us?  In this post we ask, what can a germ teach humanity?  This SARS-CoV-2 has taught all of us in America quite a bit so far.  It has exposed most people as incredibly eager to be safe, to be generous, to be interested in what is happening.  It has also shown that we live in a time when science is held by many with profound suspicion.  And that we have neglected the concept of all people living together in this nation deserving security.  And that our original crime of defining some groups as less than other groups still plays itself out in shorter lives for those shunned.

This is May, which in the United States, has been chosen to be the month of trying coming out of our homes and return in some manner to work and play.  As we do so, let us remain aware of the nature of this very real virus, what has succeeded in protecting people and what has not.  And let us all begin to think on what this virus has taught us all.

And all of us at Advanced Pediatrics wish all Mothers a very Happy Mother’s Day this Sunday.  We hope every Mother’s wish comes true, that we all get through this safely and well.

To your health,
Dr. Arthur Lavin 

 

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