Less than 500 tests had been done in the US as of Feb. 28 due to lack of testing capability, now only increasing. As of Feb. 27, only 200 testing kits were available in CA according to to Gov. Newsom. Early test kits were faulty. So of course, we have no idea how many people may be infected especially that 80% have no or mild symptoms. Also, people can transmit infections when asymptomatic.
14 infected Diamond Princess people got onto planes against CDC guidance. The whistleblower reports that the HHS workers caring for the evacuees from Wuhan and the Diamond Princess were not protected; this may have been one source of the spread. The first community case reported was in Solano County home of Travis AFB. On Feb. 27, the CDC website listed only those coming from China needed extra scrutiny even though many other countries had reported cases. Now researchers at Univ. of Washington say based on genetic data that the virus has been in the community for 6 weeks with an estimated 500-1000 infections. *The cat is out of the bag!*
Why no Federal leadership to deal with this health emergency? Trump:
1. Cut the CDC’s budget 3 yrs in a row
2. Fired the pandemic response team at HHS
3. Fired the pandemic response team at DHS
4. Fired the NSC coordinator for global pandemic events
132
@Francis Lu
There's two tracks for our action on the pandemic.
1 Immediate Public Health action- eg closing schools in areas that have ONE identified case, because there are hundreds of unidentified cases
2 Recognition that our unpreparedness is a result of GOP policy to loot the nation while people die in the streets.
22
@Francis Lu
And tests will remain scant because Trump has an interest in minimizing the numbers of diagnosed cases. Denial is his strategy.
19
@Francis Lu The CDC's budget has gone up every year under Trump.
Turns out, congress makes the budget and the President signs it.
4
Who takes up the cause of testing and assisting hourly workers who have no health care insurance and no ability to pause work?
How about those members of society who have no belief in medicine and will therefore act as unwitting conduits?
5
The writers of this article have no credibility.
They failed to mention the obvious first line of defense - the immune system. Doctors and drugs have never cured anything, ever. It is only the immune system that cures.
There are hundreds of nutrients - not drugs - that up-regulate your immune system's genes and they work within hours protecting you against everything.
Hundreds of nutrients have been peer-reviewed with clinical trials that vouch for their efficacy as anti-virals.
Quercetin is effective and safe against SARS, a coronavirus; it interferes with the virus' docking on your cells.
https://www.ncbi.nlm.nih.gov/pubmed/22350287
There are many more that are safe and effective and cheap, including Vitamin C and D3.
Take responsibility for your health, use Dr. Google, and don't expect much from a healthcare system that is ranked 27th in the world and is responsible for 250,000 avoidable deaths of people per year.
3
While I get the general theme of this article and support it, I noted one glaring inaccuracy:
"Up until this week, the federal Centers for Disease Control and Prevention has been doing all the lab testing for Covid-19"
This statement is factually inaccurate. My county has had the ability to test locally, using the CDC kits for more than a month now. This is true for a handful of counties who had early incidence of cases confirmed.
What is true is that CDC had strict and narrow limitations in place as to who could be tested, and counties had to comply or lose access to test kits. And it is true that CDC performed a confirmation on every positive test in the field. It is also true that due to CDC incompetence somewhere along the line, their first iteration of kits were defective, and they took entirely too long to remedy and ramp up volume quantities of kits.
FACTS and ACCURACY are important on all matters related to COVID-19 Tom Inglesby and Anita Cicero, most especially from medical professionals.
4
Working this at every level includes something this article didn't even mention - individuals.
It means changing unemployment laws to allow unemployment payments to anyone who misses ANY work due to coronavirus - whether due to quarantine, actual illness, or layoffs due to decreased business.
It means banning eviction actions by landlords and lenders for the duration of the crisis.
It means guaranteeing that no individual will be charged for any portion of the cost of a coronavirus test, or for costs associated with non-voluntary quarantines.
It means putting plans in place right now to provide food, medicine and other necessities, including for pets, to all households under mandatory quarantine orders.
It means requiring employers to allow any employee to work from home that can conceivably do so once the outbreak has reached a certain point in that area.
All of the care and attention in the world focused on companies will not stop this from becoming a catastrophe for our society if equal care and attention is not put into safeguarding indviduals' financial situations.
34
We stayed at a modestly priced hotel this weekend that included a buffet breakfast. While eating in the morning my wife and I were watching our fellow hotel guests serve themselves their food. We decided that no James Bondian evil genius could possibly design such an efficient and foolproof means of virus transmission. We are in big trouble.
24
@JBG
There is as of now, no evidence of food born transmission of this virus, and I have to assume that the buffet complied with local health codes for things like glass sneeze shields, etc.
As long as you assume that the glass sneeze guards, and serving spoons could possibly be contaminated and sanitize your hands before sitting down to your table to eat, and do not touch your face before hand, you should be fine.
3
We need:
free drive-through testing
work-at-home options
paid medical and work leave
free medical care for all who test positive for this virus
Instead, we have:
Cuts to the CDC, cuts to social services
An apparent mass firing of CDC employees today
Pence the science-denier offering prayers
Trump downplaying the pandemic as nothing more than a cold
40
These are all important points; however, the speed of spread will increase the need to focus on the now. Critical care beds and staff capable of dealing with critical care patients already have a high occupancy rate. The concept of triage needs to taught to the American people now. The problem of losing personnel is already being demonstrated in Washington were first responders are being quarantined and isolated. Who will replace these people? The work load is next to nothing at present. Will it be necessary to keep care givers in house, in order for them to keep working after exposure? Do we need to issue a call to retired personnel for help? I retired and did not renew my RN license but have thousands of hours of critical care and ER experience and I am sure that there are many like me that might consider helping in a professional capacity but I don't hear anything about utilizing this resource.
24
Oh, for God’s sake. Trump is quoted as saying his rallies are “very safe.” How stupid, how clueless. How can he make such an ignorant pronouncement! He clearly lives in a world of his own fantasies.
Good protocol for COVID-19? Ignore every single word out of Trump’s mouth.
45
I have my doubts about any political rallies being safe at moment.
5
I would love to see an article on why the CDC found it necessary to develop their own (faulty) testing kit when one was readily available from WHO. The lack of testing has contributed to the spread of the coronavirus. Those 2 deaths in Seattle? If they had happened a week ago they would not be counted as coronavirus deaths as they would not have been tested since they didn't meet the narrow requirements (connected to Chinese travel or contact with traveler). No doubt there have many other deaths that have not been counted.
22
@Theresa
We are flying blind, and I'm not sure if it's by design or incompetance. Inevitably real numbers will show up, and if they don't, then reality will hit without sufficient warning or countermeasures to slow its advance. The result I would expect would be panic, chaos, and many preventable deaths.
2
It’d be the surprise of a lifetime if we do half of what’s needed to control the spread of this virus. Even if general infection if the population were inevitable, we’ll never know because we didn’t try. Pathetic!
8
Ok, we'll wash our hands! But what about the larger issues?
Nicholas Kristof’s NYT column says--- “the US is vulnerable with longstanding deficiencies in our health care system. We are the only major rich country without universal health insurance and paid sick leave…”
NYT– How to Prepare for the Virus -----
… “many people who work in minimum-wage jobs do not get sick days. Ofen they must work when ill, despite their contact with with the public.”
Per Wikipedia— “Paid sick leave is a statutory requirement --in most European, many Latin American, a few African and Asian countries…” But not U.S.
W. Post -- “Gig workers face the spread of the coronavirus with no safety net. Drivers for Uber, Lyft and delivery people for Instacart and DoorDash are independent contractors and do not receive sick leave or health-care benefits.”
Reports say that 27.5 million Americans lack health insurance. In other democracies NOBODY lacks health insurance.
How can the US be an operating democracy when we’re still fighting about this basic right, labeled as left wing socialist interference by big govt in our so -called ‘Freedoms’?
This is an issue directly affecting life, death, well being, and financial security of Americans. Yet candidates can just say we must ‘improve’ our system. The GOP would destroy even the progress ACA has made.
Since the 20th Century, other capitalist democracies have given their citizens far better representation for their taxation than Americans get.
30
"The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary."
H. L. Mencken
...Which Republicans will probably meet by slashing taxes and budgets.
Amazing with all the hoopla about this virus I have read and seen nothing about how to actually lower one's viral load such as eating garlic, black seed oil, thyme, lysine, vit C, cat's claw, cayenne, kimchi, sauerkraut, probiotics, andrographis, hydrosol silver, etc etc. Caveat emptor...read the Medical Medium and survive.
1
https://www.vox.com/science-and-health/2020/2/28/21155917/preparing-for-coronavirus-in-the-us-cdc-diagnostic-testing
“…China has had more capacity than the US, with the ability to distribute as many as 1.65 million tests per week, according to the World Health Organization…
It appeared that we had trouble distributing more than 1.65 dozen tests, last week…
Upshot would be to find out the CDC – and HHS – were more focused on preserving the unit-pricing and business-model (i.e. clinical approval, followed by through-the-roof gouging) for testing, and less focused on producing the tests themselves…
The second barrel blast in that upshot would be to find out the CDC played absolutely no material role in the testing supply chain – i.e. existing sequencing machines just had to be configured from existing RNA alphabets and primers – other than to operationally obstruct…
Of course, safety of Americans is paramount, they’d say…
Which is why we’ve come to find out this week that so many of the feedstocks for US pharmas – if not the drugs themselves – are produced in China…
Land on Trump all you want – this was four terms of nonstop willful STEM-obliviousness by his two predecessors…
Where our regulatory competence was badly hollowed out, and our regulatory integrity was badly undermined – by thinking anything can be negotiated or litigated…
Option ARMs…5G…Diesel emissions…Renewable take-or-pay…MAX/MCAS…Risk corridors…Out-of-network fees…
Could go on…
Today’s Daily Presidential Tracking Poll from Rasmussen reports 46% of likely U.S. Voters approve of President Trump’s job performance. This is down from near-record highs of 51% and 52% two and three days ago.
What “performance” is Trump supporters approving? Lies, deception, incendiary targeting of a political party, news organizations and a vehement denial of science, medicine, world health bodies and the clear evidence emerging daily of the sick, dying and dead.
This country is in the midst of a quick spreading fire. So far, no political or legal maneuver has stopped Trump, but it only has exacerbated his cruelty, sadism and lawlessness.
It will take more than “whistle blowers”, editorials, punditry, protest marches or petitions to thwart the death spiral of Trumpism. The war against COVID-19 requires autonomous actions by responsible people and agencies in each community, town, city, county and state to seize the controls and put sanity and the health of people ahead of the lies and deceptions that will proven wrong.
To deny “life and death” medical care to children in Trump cages is a form of genocide. To send immigrants back to the death squads of Mexico is a form of genocide.
To intentionally deny the American people the Truth at a time when they are potential victims of a deadly virus is also a form of genocide.
This is a critical moment in whether America is going to continue in its path toward authoritarianism or take control of the fires burning within it.
5
Great advice. Why has Johns Hopkins Hospital not taken it?
The Sky is Falling! The Sky is Falling! The Sky is Falling!!
1
Please, please correct the wording "it is transmissible though air." This is somewhat misleading.
Person-to-person spread
The virus is thought to spread mainly from person-to-person.
Between people who are in close contact with one another (within about 6 feet).
- Through respiratory droplets produced when an infected person coughs or sneezes.
- These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
- Spread from contact with infected surfaces or objects
It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.
https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html
1
"We need to bring our substantial resources and expertise to bear quickly and decisively at every level."
How can this possibly be done with the Trump administration who gaslights and spews fake facts hourly.
4
Regarding potential treatments, I wonder if the NYT might be able to find experts who could comment on whether a currently available drug, antabuse (typically used to deter alcohol abuse, but recently found to be also effective in treating Lyme disease), might be useful in treating infection with the Corona virus. The article below is too technical to be understood except by experts, except maybe to glean the basic point that antabuse disrupts the normal functions of two types of corona viruses (it inhibits proteases, which are proteins that break apart other damaged proteins so that they can be reused, if I understand correctly). Because the article deals with protein identification and analysis, and because Argonne Labs in Illinois has experts in this subject area, it might be that someone there could comment. Note that the article below does not mention the current version of the corona virus, and so, it is possible that antabuse (the chemical name for which is disulfiram) will not inhibit the version we are dealing with now. Also, the article does not seem to provide information on whether antabuse will be an effective treatment for human coronavirus infection. Typically, such studies are very expensive. https://www.sciencedirect.com/science/article/pii/S0166354217306101
2
"Health care systems need plans to diagnose people rapidly, so those who are infected can be isolated "
That sounds good but who is going to pay for the diagnostic test?
The Miami Herald reported last week that a businessman was experiencing flu-like symptoms after he came back from a China trip in January, he had private health insurance.
He felt it was his duty to go to the hospital to be tested for the virus for not only the good of his own and his family's health but also for the good of public health. He was offered a CT scan of the lungs, one of the best testing methods to detect the virus but he refused because of the cost and radiation hazards. He opted for the simple flu test and he ended up paying $3270 for the simple test from his pocket.
At this time, the CDC is the only facility equipped to test for COVID 19, or to designate other laboratories to do so. The CDC is not billing for testing for COVID 19 buy your local. hospitals may charge you.
Our health care system should make testing easier and free for people who have symptoms and a recent travel history to affected countries.
It's interesting how the immediate threat of a 2%-death-rate flu has emptied store shelves, gotten people to talk and act to contain the spread of the disease and prompted many "how-to" articles on what ordinary people can contribute to stopping Covid-19.
Nothing even remotely like this level of action, this sense that we are all responsible, in the case of global warming.
Complacency or panic. It's the human way.
We should feel relieved that in China the number of deaths is so incredibly low.
If the US, on an average year, has 5,000 deaths per month from the regular flu, and China has around 5 times our population, it's safe to assume China's monthly deaths from seasonal flu hover around 25,000 give or take a few thousands
Now, if COVID-19 is 20 times as virulent, it means that if left unchecked and if this new virus ran as rampant as the regular flu, China would be facing 500K deaths PER MONTH.
And yet, China has had so far, only 3,000 deaths in 3 months. That's just .2% of the total this country could be facing if the government hadn't acted as forcefully.
You can't ask for a better outcome. Even it the number of deaths in China increased 20 times over by the end of April (quite unlikely given that their rate of infection has slow down), with 60K deaths in 5 months it would still mean #1: it would be far less than the 125K that die in the same period of regular flu, and #2: is would still be an awesome victory against COVID-19 given that if unchecked, this darn virus could kill 2.5M Chinese in that same 5 month period!
We should be prepared, by all means. But we should not panic. The news, judging by the numbers coming from the worst-hit country on the planet, are great news. These numbers show we've been successful in containing it AND how important it is to do our darnest to keep containing it.
2
@JULIAN
China has a system of case detection and amazing early treatment that we cannot duplicate. Their theory was isolate every case at home so there was no contagion other than the immediate family. Treatment for cases was accomplished quickly and sophisticated medical care delivered. They minimized death rate by getting early treatment...Look at the USA.....bungling and inept and depending on podunk health departments with no resources. Our death rates will be much higher than those in China.
1
"The federal government needs to make clear to diagnostic companies that they will be fully compensated for accelerating the development and production of such tests."
Yes, their bottom lines must not suffer; that's the most important thing.
The heart of capitalism: profits over people.
AMBULANCE DRIVER, peering in to car wreck victim: "Hey, buddy, we're here to help you if you've got good insurance."
Everything you say makes sense. However, while the latest news from Washington state is distubring, it is also reassuring. If -- as seems to be the case -- it has been endemic for at least 4-6 weeks but we are only now seeing serious cases and deaths that suggests that most case are not serious.
Fully funding reproductive health care is also key here:
Being able to delay or prevent a pregnancy is always essential but never more than in times of impending pandemic illness, natural disaster and societal upheaval. We must acknowledge how enormously incompetent and harmful the Trump administration has been by reducing access to family planning, enforcing a gag order that interferes with effective reproductive health care. Please consider the following in light of a Covid-19 pandemic: being pregnant means being mildly immune suppressed; giving birth, for most people, means going to the hospital. Part of thriving is being able to avoid situations of great stress and vulnerability so that you can become a parent when you feel most ready, safe and supported.
Consider the staggering efforts and resources the Trump administration has poured into destroying reproductive health care in this country, gagging health care providers and defunding the organizations who do it best. This administration has put thousands of women, and women who are now pregnant, more at risk.
Reproductive health care, specifically having the ability to time parenthood is perhaps, the most powerful and sophisticated form of primary prevention there is. Along with acute health care crises, nowhere is trust, safety, truth and autonomy more important. In the future, we will have a chance to create a better primary care system -- complete reproductive health care for all must be it's foundation.
2
The most urgent measure now is to declare and enforce that testing for this virus is free of charge for the patients who request it. Otherwise, the great majority of cases will stay undetected. How early this is implemented will make or brake efforts to contain the spread of the virus. Unfortunately, this will not be easy, as it reveals the Achille's heel of the current health economic system in the US.
9
Across the media the message being delivered to the general public is "according to the government masks aren't effective and won't help prevent the risk of getting Covid-19".
And often this message is followed with advice that masks should be worn by healthcare workers, personal caregivers of a Covid-19 patient, and any symptomatic individual who ventures outside.
What the government and resultant media vehicles are failing to do is distinguish between the efficacy between a N-95 mask and a standard paper mask. N-95 face masks/respirators ARE effective at reducing the risk of contagion if used correctly. That is why healthcare personnel wear them. 3-M even makes a special type of N-95 masks for infected patients that is coated with material resilient to moisture, i.e. secretions.
Non-N-95 masks are not nearly as effective, yet may have some benefits with understood limitations.
Why don't the mask manufacturers unit and show the real face of mask effectiveness to the media outlets as well as the general public?
It doesn't solve the problem of overall limited mask supply, but the companies could shift resources to ramping up the manufacture of the most effective masks. Yes, the message is still concerning, but people should be made aware and not lulled into a false sense of security. That will only increase community spread.
2
The duck-bill N-95 mask that is effective against the airborne droplets which transmit TB must be fitted to each individual face in order to be effective. Hospital workers have this done in their workplace. You can't just buy these masks on the open market and expect to be protected.
5
We need to know how likely it is or is not that children become infected and at what age.
Children are also called "vectors" for infectious disease, as every grandparent knows. If they are susceptible to Covid-19,
we need to know and to close schools more readily.
We want to protect them, as well as ourselves, and we need to know their susceptibility to this virus.
We need to focus on this question sooner, rather than later.
3
Sure, companies are going to rush to develop a test for which there is no way to measure its accuracy or receiver operating characteristics; price it however they see fit; and then offer it to 300 million people so everybody can feel safe? And everybody who has the common cold will be treated to a course of untested antiviral agents not designed for this purpose? The number of false positives and unnecessary treatments has the capacity to bankrupt our economy. And the federal gubment is going to pay for all of it?
1
@JCX
Umm...where does this come from? False positive rate is part of the testing process. Untested antiviral agents? Where does that come from
2
As a psychotherapist, I am also a healthcare worker. My clients may report mild symptoms and consider coming to my office when needing my services. I may have mild symptoms and be torn about staying away from the office. No matter. I am asking all clients to stay home if they have a sore throat or other symptoms that could be coronavirus infection. It would be effective to offer telepsychotherapy in such instances. But although people in my profession can effectively deliver services through secure telephone and video, third party payers like Medicare and insurance companies do not readily approve reimbursement. Medicare, for instance, does not approve teletherapy sessions for clients recovering from surgery who can't easily come in. Their standard is distance from my office. The ability to be reimbursed for teletherapy must change, quickly, if we are to provide needed services during a pandemic and keep our clients and ourselves safe.
63
@Gary Very thoughtful entry. I would be good to hear from health care workers in all fields. I am an RN, recently retired. The way individuals in our communities are preparing is essential. We can learn from one another. Hospital preparation is so important but how each of us prepare is perhaps even more important. Thank you for your input.
8
@Grace Thank you, Grace. I have also posted in the Facebook group of local psychotherapists, where I shared the comment submitted to my governor, Jay Inslee. Many had already been feeling concerns, and collectively we will also approach third party payers, which can be hard to reach and be slow to respond, with mixed results.
4
Thank you for the thoughtful insights in such a clear presentation, Tommy. Nice to see you in the byline. Let’s hope we can pull through this in the best way possible. (Lori O’D, your sister’s friend from high school!)
1
RNA viruses, like the coronavirus, have a small genome and are single-stranded. Both traits increase its mutation rate. Its very short generation time also increases the replication mutation rate.
There are only about 30,000 RNA bases in the coronavirus, versus about 3 billion DNA bases in the human genome. These RNA bases are adenine (A), uracil (U), cytosine (C), and guanine (G). In DNA genomes, thymine (T) replaces uracil.
If an RNA base sequence ran: A-U-G-C, a simple 4 DNA base sequence; then a mutation in base 3, could occur if U were switched for G, with the new sequence now containing: A-U-U-C which represents a mutation for this genome. For example, with sickle-cell disease, a single DNA base pair is switched, from A to T, and this is termed a point mutation. More lethal mutations could result if a DNA or RNA base is simply deleted or added to a sequence, which would mis-align the reading frame. Since DNA bases are read in sets of 3 bases each, termed a codon, an addition or deletion of a DNA base ruins the alignment of other codons.
Since the lungs provide a huge surface area, via the alveoli, where air-borne particulates, such as mutated phlegm, can enter the body, the virus has a pathway deep into the body's cells. Also, since smokers light up a "Lucky," with its toxic components, about 20 times a day, this may be similar to the immune system being preoccupied with a pre-existing condition, and result in a more lethal virus.
3/2 M 12:23p Greenville NC
1
Knowledge is power. What Trump and his cohorts have done is muddy the waters and actually disseminate lies. This virus in not “contained,” Mr. Kudlow. No, Mr. Trump, it’s not going to “magically disappear” as the weather gets warmer. In fact, it’s predicted that it will hit us hard again in the Fall!
I’m lucky. I’m 72 but I know how to find reliable information. I have a Primary Care doctor who is affiliated with a fine hospital. We have savings. I’m saddened to think about those less fortunate who do not have my advantages, who must go to work whether or not they’re feeling ill because they live paycheck to paycheck. What happens to immigrants who are terrified of going to a doctor, lest their status is revealed? How about public transport workers and the many others who interact with scores of people every single day? They must be so frightened.
The people in charge of educating the public about COVID-19 related matters must confront Trump and Pence when they spin this as a hoax perpetuated by Democrats who want people to die! If ever there was a time to unite, this is it. Viruses don’t care about Party affiliation or economic advantages.
We must look out for each other! Thank you NYTimes and other media outlets who keep us educated and up to date. God knows, we can’t trust many of those who took an oath to serve and protect us.
23
I'm not sure how it could happen, but there needs to be a secondary workforce in place for critical institutions, both state, federal and private. Places like mental hospitals (for people confined there because they are deemed a "danger to themselves and/or others"), centers and group homes for people with cognitive disabilities, jails and prisons, nursing homes... if the virus takes off in any of these it would be very difficult to fully staff (let alone more than fully staff, to take care of so many ill who are confined in such institutions) and at least some staff will be too sick to work.
Like I said, I have no idea how that would ever work - new staff would have to be qualified and trained. We need to keep our eyes on solutions the nursing home in Washington State comes up with. And all institutions, public and private, need to plan now for the worst case.
3
We all need to eat!... and have access to food. In the many articles I have read about areas where the virus is on the move crowded grocery stores seem to be the point of contact with the virus adding to the outbreak areas. Grocery stores should be utilizing click and collect, phone, dropped of lists, and additional staff should be hired to collect and bag and set up a drive-up drive up service. This methods of disbursement of food this would keep people out of the store. It makes no sense to me to isolate people everywhere but where they need to get their basic needs. Its short sighted
6
This is a very helpful article - from a public health provider perspective. However, in the US no guidance on healthcare from the medical experts can be complete without corresponding guidance on health insurance for effected patients.
So can we not have a serious review of the entire payor/insurance side of the coming pandemic? Alex Azar has publicly stated that HHS cannot control the patient cost of an expected vaccine (translation: expect aggressive gouging from the pharma companies). Not to mention the cost of quarantine or hospitalization.
Obamacare has been largely dismantled by Trump and many red states decided not to expand Medicare. So I would expect great reluctance on the part of the lower and middle class to self-report and check themselves into care facilities, instead hoping they’ll recover on their own. Who wouldn’t wish to avoid the crippling bills? Needless to say this would only exacerbate the problem.
From Trump’s team on the issue of patients paying for coronavirus treatment: deafening silence.
18
Lack of adequate testing capability is the crux of the matter in the U.S. right now. It’s inexcusable given the lead time our government had, but their concern was obviously avoiding panic rather than disseminating facts. In fact, I heard multiple official suggestions “not to panic” - which is a sure sign panic is in order.
“issuing instructions on how to proceed when someone is sick, but not sick enough to be in the hospital”. This is another important but often ignored detail. Right now I believe I have CoVid19. But I’m holding my own at home, and finally self quarantined now that I’ve realized this is likely not a routine cold. I don’t want to waste critical testing resources on my own mild case. In addition, I’m not sure I trust our local, rural public health entities not to over-react to my case and maybe place me in more danger by hospitalizing me and maybe giving me treatments I don’t need, by inexperienced providers.
Another disincentivize to seeking testing is the tricky details of daily life: what would happen to my pets and livestock if I were whisked away for a supervised quarantine and possibly expensive treatment?
I have to assume I’m not the only possibly-infected person making these calculations and declining to enter a faulty system. The true number of cases in the U.S. is probably already astronomical, in my opinion. The basic enemy is a lack of trust in the system, due to political calculations that favor telling lies over the truth.
13
@Just Curious If I were you, as concerns your pets and livestock, I'd make sure I had more than enough food and free access to water for them all, to begin with. Then I'd go at least three-deep, maybe even more, with people who could come in and take care of them, worst case scenario. If the first one gets sick, he knows to call the second one, and so on. There are pet-sitting services online, if you don't know people who could do this, and many of them also have experience with livestock. Your vet might also have ideas of who would be experienced.
But for sure, I'd go deep. Lots of backup, and backup to the backup.
I sincerely hope you get well quickly and without serious complications. When you are better, maybe you could volunteer to help someone with pets and livestock as their backup, since you'll then be immune! : )
5
Inglesby covers my practical guide for disease mitigation exceedingly well. Bravo. My question though is why the conversation hinges so much on money. We've been spending money for years developing regional mitigation strategies for all sorts of emergencies. Disease is certainly one of them. At least on a secondary level. Where did those funds go?
Moreover, all local agencies have adequate funding through July at least. Possibly January. They routinely blow this money at fiscal year end in order to justify continuing budget allocations. Why can't they blow it now? Do we not have proper guidance on what to spend the money on? See the point about emergency planning above.
The one point where I will agree without reservation: The public needs to be informed about what we are supposed to do. The Trump administration is not only unhelpful; they are willfully counter productive.
3
A Realtor I was involved with many years ago in business had this statement ''What the client doesn't know won't hurt them'' of course later on what they didn't know could and many times did hurt them. Mr Trump will ask for money for the military to use it's weapons to shoot down the virus. Also he will ask for, or divert more money for a higher and better wall to keep out the virus from invading America. Whoops, already here and sure to be a problem those who don't know or care about the good the CDC and medical professionals can do for America.
So this is helpful, but we need more specific info.
Clean cell phone screens, OK, but how exactly, without messing up the phone?
How to clean surfaces--kitchen, handrails, transportation seats, doorknobs-- for viruses, as opposed to bacteria.
If you sneeze into your sleeve, what do you do with your coat or sweater? How long do the viruses live on inanimate (nylon), as opposed to hands. Would a run through the hot cycle of a clothes dryer help 'sanitize" the sniffle-ly-sleeve?
Does using hand cream increase hands' stickiness for viruses and risk?
What about foods? Are cooked better than raw? Canned or frozen better than raw? Can you "kill" viruses in an microwave? (I know they are not actually alive, but does this unravel their genetic component?)
If the main form of contagion seems to human to human contact, how dangerous are these mediate surfaces? I notice people avoiding handrails on subways.
Dumb questions? Maybe, but curious minds would like to know.
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@SJL: While it's unknown if Clorox wipes are effective against this particular strain of Coronavirus, there were good results in tests against other strains. I wipe my phone and computer keyboard regularly with Clorox wipes. A case can be removed and washed separately in warm soapy water and left to air dry before putting it back on the phone.
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@SJL
Not dumb, relevant.
The purpose of CDC policy in a pandemic is to delay and blunt the peak of cases so hospitals don't get overwhelmed. In Wuhan, where hospitals were swamped, the death rate (CFR) was 2.3%. Outside Wuhan, China's CFR was 0.4%.
CDC's advice for pandemic flu is relevant (I've taken the CDC's online pandemic flu course.)
From the CDC:
"To help decide when to implement NPI measures, public health professionals should consider whether a pandemic is moderate or severe. A severe pandemic – like the 1918 pandemic – is characterized by high transmissibility and high clinical severity." (CFR of 0.4 to 3 is severe)
"Preemptive school closures are more effective in slowing flu transmission in the early stages of the pandemic at the local level... (School closings) could be triggered by...
the first laboratory-confirmed flu case among students or staff in a school or school district (or neighboring school or school district). This type of school closure would be a preemptive closure to reduce transmission of the novel virus in schools and the neighboring community...
closing schools after flu virus circulation has already been established among children and in the community due to high flu-like illness related school absenteeism ... would ... be a reactive closure due to the limited capacity to maintain school operations."
In 1918, cities that closed down early saw fewer deaths than cities that didn't.
Early is better than late.
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I use Clorox wipes half the time and Lysol spray in between. Also on tv remote and all doorknobs of house.
I just bought travel size Lysol spray, also.
WA state health professionals only received the go-ahead to test for the virus a few days ago, despite well known high risk in the region. It's hard not to draw a direct line between this inexcusable delay and : 1) the 2018 dismantling of the pandemic response team by the Trump administration; 2) funding cuts to the CDC in recent years; 3) the lack of any strong federal response (including the poor choice to put Mike Pence in charge (he's unqualified and has an awful track record on such matters); 4) the false and misleading messaging coming out of this administration on this topic. Now that testing has started, there are 13 confirmed cases in WA state, suddenly, and suggestions that there are hundreds more in the region. Some people are paying with their lives for the incompetence, hubris, and resistance to facts and evidence that are the modus operandi of this administration.
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@CitizenJ
25th Amendment
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This article does not address the most critical level of danger: the millions of people in the U.S. not covered or insufficiently covered by private health insurance and who are habituated to delaying or avoiding heath care because of cost. Also, this group includes those most likely to spread the disease such as the homeless and members of families who cannot afford to stay home from work or keep their kids home from school.
Ironically, the only solution is for Trump to devise an immediate “Medicare for All,” offering medical care without the angst of how one is going to pay his or her bill.
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There are 35 countries healthier than we are. Perhaps on thing that may help is to improve the health of the American people.
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Thank you Ms. Cicero and Mr. Inglesby for sharing your views. We need to heed the recommendations of experts like these in the field of health security. While I am dismayed by the current administration's repeated decision to override and censor the CDC's official communications, I am equally hopeful that thought leaders like these two will continue to raise their voices for the safety of all. Thanks you again.
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@Peter Excellent statement.
The NYT should also allow reproduction of this editorial by every news paper in the US.
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I am staying home from work today because I have all of the symptoms of a seasonal flu. I imagine that there are millions like myself feeling the same way across the country. It would be fruitless and a waste of time for me to go to clinic where there are no testing mechanisms in place for the coronavirus. After I submit this comment, I'm going back to bed bemoaning the fact that I never got that common flu shot at CVS this year. I hope a similar shot for the coronavirus will be around at the local pharmacy's clinic for the next flu season. I am doubtful. This country should look to China and corroborate with their centers for disease control to speed up the process. Surely they are ahead of the game on the detection, treatment and prevention if the virus. We don't need to be in a trade war on this one when we are all fighting a battle for lives.
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good article. unfortunately, i have no confidence in our government to tell us the truth and to have already taken the steps that you mention are necessary.. this administration thinks only of themselves and seem to be preaching that the democrats are to blame.
i have no idea what is in Pence's plan to try and keep us as safe as possible. i have no idea if he has a plan.
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@john boeger judging by his usual blank stare i doubt if HE knows whether he has a plan
Why are all these articles so passive? What governments should do, what hospitals should do, what corporations should do... "At every level" is the headline. Really? What about at the individual level? I'm not going to stop the Corona Virus, but there's a lot I can do--and have done to keep from getting it. While in Hong Kong, I wore a mask, I used a lot of hand sanitizer and I washed my hands a lot. I made sure to wash or sanitize after specific events: traveling on a bus or the MTR subway, putting my shoes on, or taking them off. Good nutrition, getting plenty of sleep. I've beaten the flu before by recognizing the first symptom which we all notice as 'gee, I feel a bit off, I better take it easy today,' and staying home, in bed. Maybe I even had symptom-less CV in HK, could've been those days I slept for 10 hours. "At every level" should've covered, what do we do if our job is to serve hundreds of people every day? if we could work from home? if we work in crowded places? What about our families at home--should we disinfect our shoes at the door? In HK one store owner was power washing the sidewalk in front of his store--but only using water. Is that good? What does a virus like CV19 do on floors, walls? This is a practical and biological problem there's a lot more we can do other than speculate on what large entities like gov'ts and corps should do.
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@Will N
From the CDC advice for pandemic flu:
Always-
Wash hands frequently
Don't touch your eyes or nose unless you just washed your hands
Smother sneezes in your elbow (viruses live up to an hour on hands, a few hours on surfaces)
IF YOU ARE SICK, wear a mask to protect OTHERS!
If you are in close, CONTINUOUS contact (household or healthcare workers only) with sick people, a mask and eye protection may help prevent you from getting OR SPREADING the virus.
Avoid crowds. The transmission distance is about 6 feet.
In a severe pandemic like this one (this virus is ~ as transmissible and lethal as the 1918 flu) and once cases have been identified in the AREA:
Continue all the above, plus
Close schools for at least 2-3 weeks to prevent transmission
Cancel or delay large gatherings
Encourage people to work from home
Clean frequently touched surfaces with soap and water. (No need for more toxic chemicals.)
In 1918, cities that closed schools and canceled large gatherings EARLY had fewer deaths.
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Look at this situation as a gift. In terms of lethality, the next one will probably be a lot more challenging...
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What a joke.
A family member is an ICU Nurse of 40 plus years. She is being told that a paper N95 mask and open back gown without any shoe covering is what they will get to deal with infected people.
Of course that is after over a hundred medical staff UC Davis Medical Center are sent to home quarantine...
The Nurses on the front lines are going to be sent into battle with the minimum of protection that will likely fail. Their choice is to quite and loose their jobs and their pensions or go into a big game of Russian Roulette.
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@JD I believe that institutions not providing excellent protective gear is a crime. It is happening all over this country. I don't know what the nurses should do personally but we all should be exposing this in any way we can.
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Then the nurses should buy their own foot protection!
Yes...true...but what we have is leadership in the whitehouse that claims it is a hoax, and by a homophobic governor who helped spread the HIV virus in Indiana when he refused to distribute clean needles to addicts.
Oh and donnie claimed it will be over by April. No year mentioned.
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Despite "rampaging" since December of last year the virus has killed only 3000 people. Comparatively, the seasonal flu virus since December of last year has killed 14,000 people, and hospitalized more than double the number of total Corvid-19 cases.
Where's the hysterical stockmarket crash and media frenzy over the flu? I guess it's not sensational when it happens every year.
I wonder if we'll see more of this utterly ridiculous media circus next year when Corvid-19 rears its head again, and once again fails to surpass the Flu in spread and lethality. Or the year after that. Or the year after that.
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@Joel: If there's a silver lining in the panic surrounding the Coronavirus, it's that individuals are now practicing infection control techniques that they should have been using all along to prevent the spread of the seasonal flu, which as you pointed out has so far killed many more people than Covid-19. I'm grateful for that. For the first time in many years, I'm seeing people take hand-washing seriously and using their PTO rather than muscling through a respiratory infection at work while hopped up on decongestants. That's a good thing.
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@Joel
you are comparing numeraters
you should be comparing rates
number of deaths divided by number of infected is a rate
number of deaths is - a numerater, and one that exposes a likely case fatality rate that is going to be very high.
How big and how fast the demoninater - number of infected people-will grow is the $64,000 question.
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@Joel It's a percentage of the total infection. The flu's morality rate is ~ .01%; while for CV it is 2 - 4%. CV is more deadly and has the potential to kill millions. The time to assume the worst is now. What would we do if the death rate were a million? That's what we should already be doing, just In case.
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It's difficult to have any confidence that the Trump administration will do what is needed to protect Americans from this virus. With Trump in denial and mostly concerned with protecting his image and reelection and still blaming the media and Democrats, it seems there's no leadership at the highest level. Americans may needlessly sicken and die because of Trump's incompetence and callousness. Where are we to turn for help?
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@Ms. Pea
Invert anything Trump or other Republicans say, and you'll be closer to the truth.
It's clear he and the GOP are responsible for dismantling the US response to pandemic threats because they don't profit their billionaire bosses. Failing to prepare is preparing to fail.
Your local health department, if you live in a 'blue' state, will have a reasonable response, though I haven't seen any following CDC's pandemic advice for a severe pandemic (similar in transmissibility and lethality to the 1918 flu) to close schools when the FIRST case is identified in the area or NEIGHBORING areas.
We saw this in 1918. Early closures save lives.
And planning (hah!) will ensure that schools have tele courses ready, and make provisions for meals for poor students.
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@Ms. Pea
Exactly! Trump will manage to thwart diagnosis in order to minimize the appearance of an epidemic.
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@Ms. Pea Republicans have blood on their hands by continuing to gaslight this national health crisis.
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There are good spots in all this. This is a teaching moment right when we needed it as voters.
Which POTUS seeker is pushing for the American Best Health Care system choice?
When someone asks how will we pay for it, ask them, How much do you think your life is worth as a healthy person?
You might get them to think for once, It's not like what we have which is Sick Care. It's what we could have that we'd be willing to take our name's off the Sick list and put them on the Healthy list. Can we really afford what we have now? Bankrupt parents with the bills from a Sick child!
We will have only a few good teaching moments where we can change things as fast as we can now, Vote for Healthy America, not sick and dying america.
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Where is the reporting about how the Trump administration has cut funding to essential health agencies and how this has hampered the response to the virus?
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@sbratter
it's EVERYWHERE. Too much, in my opinion, especially on cable talk shows.
The "news" that Trump's Executive Branch thoroughly botched this because they do not have the experience or the intent to govern for the common good -- that's preaching to the choir.
And it gives anyone who has a cable package and a remote control everything needful to reinforce the Pence/Trump/Azar lies about callous "politicizing" of a tragedy.
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Good luck with all of that under this administration. It's not going to happen.
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Just as the threat of the virus is hitting the US, SCOTUS is preparing to strike down Obamacare, thus removing healthcare from how many million folks?
LA Times
Breaking News
Mar. 02, 2020
Supreme Court will again consider whether to strike down Obamacare
Taking up an appeal from California’s attorney general, the Supreme Court announced it will rule on a lawsuit brought by Texas and backed by the Trump administration that would strike down Obamacare, including its protections for tens of millions of Americans with preexisting medical conditions.
Twice before the high court has upheld the healthcare law. At issue now is whether the Affordable Care Act is unconstitutional because the Republican-controlled Congress voted in 2017 to stop applying a tax penalty on those who do not have insurance."
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@TDHawkes I think the method of this particular Trump crazy is: if you don't get the result you want--try, try again.
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"So the federal government, state and local governments, public health agencies, health care systems and industry should be preparing more actively to respond to a widespread outbreak of the virus."
Don't hold your breath. I read recently a proposal that emergency funds be devoted to fighting the disease. Trump's mouthpiece laughed and said emergency funds are reserved for building Trump's border wall.
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