Sunday, April 5, 2020

COVID-19 update April 5 2020

The main advice about COVID-19 is just the same as before:  very strict social distancing (stay at least 2 metres, or 6 feet away from other people at all times), stay at home as much as possible,  wash your hands very thoroughly after touching anything that someone else might have touched, and do not touch your face unless your hands have been very carefully washed.

Please keep in mind that the 2 metre or 6 foot social distancing guideline is an arbitrary recommendation.  It would clearly be more effective to have 4 metres of social distancing!  The 2 metre recommendation is a starting point, but it would be best of all to avoid all crowds entirely, and even to avoid places which have been crowded in the previous hours (especially indoor places). 

These measures alone are helping to contain the spread of the disease, but we need to keep this up for many more weeks or months.

It has become clear (unsurprisingly) that disease spread can be significantly reduced if as many people as possible are wearing masks, especially in crowded places such as grocery stores or public transit.  Masks probably are most effective to prevent a person with COVID, including the many people without active symptoms, from spreading it.  Therefore, mask usage, if it is to be optimally effective, has to be used on a massive scale.

However, we have a terrible shortage of medical masks.  So it will be necessary to make home-made masks, or use scarves, until we have an abundant supply for the public of medical masks.  Medical masks need to be prioritized for medical workers, community workers, transit drivers, and grocery store staff.

It is valuable to look closely at what China, South Korea, and Taiwan have done to get their COVID-19 infections under good control.  We should be well-informed about their strategies, and copy.  Generally, my impression is that their strategies are similar to what we are doing here, but much more strict and enforced.

One of the issues of the week has to do with hydroxychloroquine and azithromycin as possible treatments for COVID.  The only evidence for these comes from so-called "in vitro" experiments; there is not yet any supportive evidence for their use in people with COVID.  But it is still important to study the question, which has to be done in a randomized controlled fashion.  Results of this research will take weeks.   I am neutral on this question, as we have no good evidence to guide us one way or the other on it, except for a recent negative study showing that it is not useful in severely ill patients.  It remains to be studied whether they could be effective if given early in the disease process, or prophylactically.   It is very clear that these drugs should not be endorsed, as they have potentially dangerous side effects.  And the public focus on this issue in the U.S. may distract people from focusing on what actually IS proven to help, which is social distancing, staying home, hand washing, and mask use.

I have thought of a modification of my "COVID hotel" idea, (see which is much less controversial.  It would seek participants for the hotel from a cohort of people working in high-risk zones, such as hospital staff, emergency response workers, and grocery clerks.  A cohort of several thousand such people would be followed closely, with a COVID test being given daily.  There would be no inoculation--each person who ended up with COVID would have acquired it in the course of their work.  Every person with a positive test would be promptly enrolled in the COVID-hotel study.  The advantage of this technique compared to present research studies, is that we could be guaranteed that every participant had become positive within the previous 24 hours, therefore would all be in an equivalently early stage of infection.  I hypothesize that any treatment intervention (such as an antiviral drug) would have the best chance of working if given as early as possible in the infection process.  Since everyone in the study would begin treatment at the exact same stage of infection, it would greatly reduce variability in outcome simply due to giving the drug at a different stage.

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