Saturday, March 28, 2020

COVID-19 update March 28 2020

Here is today's update:

1) MAINTAIN SOCIAL DISTANCING !!!  TWO METRES APART MEANS THAT YOU SHOULD BE NO CLOSER TO ANYONE ELSE THAN YOUR OWN HEIGHT PLUS A LITTLE BIT MORE, OR NO CLOSER THAN THE DISTANCE FROM FINGERTIP TO FINGERTIP IF YOU EXTEND BOTH ARMS OUT.

2) WASH YOUR HANDS USING SOAP AND WATER, ESPECIALLY IF YOU HAVE TOUCHED SOMETHING ANYONE ELSE MIGHT HAVE TOUCHED !!! 

MAKE SURE YOU KNOW GOOD HAND-WASHING TECHNIQUE:  SCRUB WITH SOAP, COVER ALL SURFACES OF YOUR HANDS, FINGERNAILS, BETWEEN FINGERS.

I SUGGEST CLEANING THE TAP WITH SOAP AND WATER BEFORE YOU START WASHING YOUR HANDS.   THIS HELPS YOURSELF AND OTHERS.

USE A CLEAN TOWEL AFTERWARDS.  OPEN DOOR WITH DISPOSABLE TOWEL, WHICH WOULD THEN BE THROWN OUT.

3) AVOID GOING OUT UNLESS IT IS FOR A TRULY ESSENTIAL ACTIVITY !!!   IF YOU ARE HAVING BRIEF DAILY EXERCISE OUTSIDE, GO AT A TIME WHEN FEW OTHERS ARE OUT, AND DO NOT GO TO PLACES WHICH ARE CROWDED !!!

Other issues:

- Masks are in short supply by front-line workers who need them desperately.  But there is also pretty good evidence that widespread usage of masks in the entire population could be an effective way to reduce viral spread. The mechanism would both be to prevent exposure to viruses in healthy people, but also to reduce the release of viruses into the environment by people carrying the virus (including those who are not yet having symptoms).

-I would like to see more and better evidence about how to make a useful, effective home-made mask.  I suspect that most any mask is better than none.

-There is some evidence that the severity of illness is higher if one is exposed to higher numbers of viral particles, so any tactic to reduce viral exposure, even if it is not perfect, may reduce disease severity in those who subsequently get infected. 

My previous post about "COVID-Hotels" :  this is an idea to enlist young, healthy volunteers under age 30 to be quarantined and deliberately exposed to COVID infection, in order to gain immunity, and in order to participate in extremely rapid, rigorous, randomized trials of preventative and active treatments, including medications and vaccines.   The risk of this approach would be approximately a 0.1 % death rate, but it would be done voluntarily, and the risk is equivalent to someone volunteering to be a soldier for a 1-2 month tour of duty in a world war, or of volunteering to be a test pilot, etc.  With the new info about lower disease severity with lower viral loads, the risk to these volunteers could be further reduced by using a technique called "variolation."

This idea appears not to have attracted any attention on Twitter (@DrGarthK), which I find unfortunate since I think it could rapidly advance research in these desperate times, where hundreds or thousands are dying from this daily, and where the existing research needs to be greatly accelerated.

All of these ideas are works in progress.  I admit I could be wrong about things, and I invite everyone to critically review, scrutinize, criticize, etc. so that the ideas can be corrected or updated or discarded as needed.  This is what science is all about, and to solve this problem we need to be doing the best science as quickly as possible, on a massive scale.

Friday, March 27, 2020

COVID-19 update

I have updated my idea for a voluntary 8-week quarantine for healthy adults under age 30, in which participants would give informed consent to be inoculated with COVID-19, in order to leave the quarantine immune, and therefore able to work and help others freely, without further anxiety, without risk of getting infected, and without risk of infecting others.

See my earlier post, which I have edited: https://garthkroeker.blogspot.com/2020/03/covid-19-management-brainstorm-ideas.html


Monday, March 23, 2020

COVID-19

This is an edited copy of a series of tweets I just published this morning on Twitter (@DrGarthK).


I'm a psychiatrist, and I have no business giving opinions outside my expertise, but I feel I have to say my thoughts in some public way about what I think should be done:

Massive-scale social distancing is absolutely essential to save lives!  


But many people are not taking this seriously enough.  I have seen people gathering and playing at the beach or other public areas, seemingly oblivious to what is going on.  In other cases, I have seen people refusing to give others space on sidewalks; my impression is that some people believe that the more careful among us are over-reacting, and they are not going to indulge us by cooperating with social distancing rules.  

It is human nature, a product of psychological biases and hubris, to underestimate or dismiss personal risks of many behaviours (such as smoking or unsafe sex).  And if risks change, we are more accustomed to continue a familiar, previously safe status quo.  

In this case, right now today, we do not have the time to persuade and educate people about the risks in a casual way, as we would about smoking, sunscreen use, condoms, etc.  




Testing on a Massive Scale

We also need testing capacity for the virus increased on a massive scale, so that everyone in the population can be tested, not just once, but every week -- it should be like what one person (@paulromer) on Twitter compared to getting your morning coffee at a drive-through.  

This will require a massive investment, many billions of dollars, in testing technology, with the money supplied using the full power of the state (using emergency or war powers).  This will be far less money than what will be needed otherwise.  

On an encouraging note, I see that news about better, faster testing technology, is coming out every day.  

If we test EVERYONE, we can isolate every single positive person immediately (including the many asymptomatic people) and theoretically end the pandemic in weeks.



Massive Increase in Medical Capacity & Research

We are likely to need a massive increase in hospital capacity urgently, so just like in Wuhan we should build new temporary hospitals immediately.  We will need doctors and nurses urgently trained to do intensive care.  Most doctors and nurses do not know how to do intubations or manage patients on a ventilator.  A training program is needed similar to the mass rapid training of fighter pilots in World War II.  

Non-essential or luxury spaces such as hotels need to be appropriated as temporary hospitals or quarantine units, again using emergency powers of the state. 

Massive, unlimited government funding needs to be given to urgent vaccine and medication development, on a scale similar or greater to the Manhattan Project in World War II.

Identifying People who have Recovered or who are Immune

People who have recovered from the virus, or who could be shown through new serological testing to be immune, should be identified to prioritize them as workers to help others, assuming they can be proven to have immunity.  I am not sure if recovered patients could be able to donate plasma, or contribute to treatment research efforts in other ways, but of course this should be emphasized and given limitless funding.  

STAY HOME 

Meanwhile, I urge all of you to stay home, keep your distance from others, don't touch your face, wash obsessively, as much as is possible.  Learn about correct hand-washing technique, check these on youtube or other online sources.  The virus probably spreads through contact with contaminated surfaces as well, so wash your hands whenever you have touched something that someone else might have touched or coughed on.

CANCEL MEETINGS

Cancel all non-essential meetings, even if you might disappoint or let other people down.  I've noticed myself how when I have agreed to something (like to visit someone, to have a professional appointment, or to celebrate a birthday), it is really hard to call and cancel.  There is a real pressure to please other people, or to avoid letting them down.  FORGET ABOUT ALL THAT FOR NOW, AND JUST STAY HOME!  If someone is mad at you for not showing up, they will be grateful to you once this is all over.  

By staying home and doing these other safe actions, most of us are more likely to save other people's lives than our own.  Think of others!

THINK OF THE CELEBRATION WHEN THIS IS OVER

When this is all over--and I think it could be in months to years--let us come together, celebrate and rebuild our freedom, and do our best as a global society to never let such a disaster ever happen again.  

NEVER AGAIN  

This will require a spirit of care and generosity for all of us in society, including people who are poor or marginalized.  This will require a spirit of care and generosity towards other nations.  Even the most selfish of us must see that helping others is the best way to help ourselves.  

Let's make a goal for everyone, not only in our communities or countries, but in the whole world, to have guaranteed basic income and health care.  If you are wealthy, you can surely enjoy your wealth a whole lot more knowing that everyone around you is taken care of.

GRATITUDE 

Thank you to some of the great contributors on Twitter about COVID, such as @NAChristakis, @MaxCRoser, and so many others.  As you gather news about COVID, start with them.  

There are many heroes among us, including community health workers, emergency response workers, ER physicians & nurses, cleaning and support staff in hospitals, and of course ICU specialists and all supporting staff.  They should be paid more, and their families should be taken care of, just like we take care of (or should take care of) our veterans and their families.  

I wish you all health and peace.  


On a closing note, I encountered a poem by Lynn Ungar which I found moving and beautiful.  It's called Pandemic.  Have a look, her website is lynnungar.com/poems/


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