Love of flying in the Time of Coronavirus

[gsxrpilot]

Just now, aviatoreb said:

Huh - why did that multiply post?!  Sorry about that folks!

You can delete the extra posts. At the bottom of your posts you'll see this.... click Options and chose Delete.

[aviatoreb]

39 minutes ago, Browncbr1 said:

 

The problem with people like you is that you’re unable to accept that other people might have a different view than your own.   In doing so, you resort to disrespect and dismissal in attempt to silence others.    This thread is full of long winded opinion, but you can’t take a couple sentences contrary to your opinion?  Come on man. 

 

 

I both agree with you in this remark, and I resemble this remark!  I must be one of those long winded people you are talking about!  I'll accept that remark as true and descriptive.  To my defense, I will say - I disagree with your position, strongly, but I hope you understand that by offering long winded description of my opinion, I am actually attempting to respect you by offering justification to counter argue - so it is a form of respect - intended anyway, so I hope you take it that way.

Now!  Back to the business of disagreeing with you substantively!  I do think this is an important matter and that it is a matter of critical health life and death for many people which is why I am taking the time to post why I think you are wrong.  Respectfully....

Edited March 13, 2020 by aviatoreb

[aviatoreb]

1 minute ago, gsxrpilot said:

You can delete the extra posts. At the bottom of your posts you'll see this.... click Options and chose Delete.

THANKS!!! I just figured it out- and I just did.

[Browncbr1]

15 minutes ago, aviatoreb said:

I both agree with you in this remark, and I resemble this remark!  I must be one of those long winded people you are talking about!  I'll accept that remark as true and descriptive.  To my defense, I will say - I disagree with your position, strongly, but I hope you understand that by offering long winded description of my opinion, I am actually attempting to respect you by offering justification to counter argue - so it is a form of respect - intended anyway, so I hope you take it that way.

Now!  Back to the business of disagreeing with you substantively!  :-)

100% agree.   I fully respect your opinion and believe you should be able to share it free of baseless identity attacks. 

Oh, and my original comment was meant to be a general comment on what I see in media and people on the ground.   It wasn’t direct toward anything on MS. 

Edited March 13, 2020 by Browncbr1

[flyboy0681]

27 minutes ago, aviatoreb said:

It’s amazing to me how many people watch tv and think the whole world is a dichotomy of left vs right.  Sometimes things happen that aren’t politics.

 

I always watch both networks knowing that the truth is probably somewhere in the middle. But I was surprised by Tucker Carlson three days ago when he broke from the herd and said:

“People you trust, people you probably voted for, have spent weeks minimizing what is clearly a very serious problem. They tell you to calm down,  in the end, this is just like the flu. It’s definitely not just the flu.”. His broadcast was followed minutes later by Trish Regan opening up her show about the "Coronavirus impeachment scam".

Me, I take Limbaugh's view, it's not any worse than a common head cold  (as he boards his Gulfstream  G550). 

 

 

[aviatoreb]

15 minutes ago, flyboy0681 said:

 

 

15 minutes ago, flyboy0681 said:

I always watch both networks knowing that the truth is probably somewhere in the middle. But I was surprised by Tucker Carlson three days ago when he broke from the herd and said:

“People you trust, people you probably voted for, have spent weeks minimizing what is clearly a very serious problem. They tell you to calm down,  in the end, this is just like the flu. It’s definitely not just the flu.”. His broadcast was followed minutes later by Trish Regan opening up her show about the "Coronavirus impeachment scam".

Me, I take Limbaugh's view, it's not any worse than a common head cold  (as he boards his Gulfstream  G550). 

 

 

I'll take Angela Merckel's view over Rush Limbaugh.  She has a PhD in biochemistry, and as the leader of Germany she has access to the collective advice of the country's public health epidemiologists. She says this thing is very deadly and that estimates are that 60-70% of Germans will likely get it.  The large fraction will recover but a massive number nonetheless will not.  Limbaugh has his hunch, and also whatever he thinks will continue to pay for the fuel in his G550.  I'll take Angela.

One person came here and noted asking how many Americans have died so far. That is an interesting point of view.  I haven't been to Texas in years.  So for me Texas is far away.  I have been to Germany twice in the last year and London twice, and I have had emails or skypes with people there within the last week - so in many ways they are much closer to me than Texas.  This is a world economy and a world pandemic issue.

Edited March 13, 2020 by aviatoreb

[afward]

30 minutes ago, aviatoreb said:

It’s amazing to me how many people watch tv and think the whole world is a dichotomy of left vs right.  Sometimes things happen that aren’t politics.

Binary thinking is incredibly common in the U.S. (and probably elsewhere), no matter the education or intelligence level involved.  Don't get me wrong, we can be certain the left & right are actively looking for ways to spin this and other things to their advantage.  Politicians gonna politic, to butcher a phrase (and the English language).  But the truth is there's a huge range between both sides, and even other viewpoints that don't "fit" on that spectrum at all, so lacking any form of nuance is just a sad state of things today.

To the thread topic, though, I think (and you've pretty much stated as much) that the salient point is, "It's not about you, the individual."  To be blunt, from a public health perspective, none of us matter individually.  The guidelines may help each of us not get sick while a vaccine or treatment is developed, but the actual goal is to reduce the infection & death rates.  Not awesome to contemplate, but it's the truth.

The front-line healthcare professionals I know (my wife being one of those) are nearly universally annoyed with the way this is playing out.  On the one hand, mass media and InstaSnapYouTwitFace (did I miss one?) are absolutely freaking everyone out, making it hard to get real information out to people.  On the other hand, people are doing _dumb_ things and making it worse, all while the healthcare system itself cannot handle a large epidemic (and the pro's know it).

[jaylw314]

33 minutes ago, aviatoreb said:

It’s amazing to me how many people watch tv and think the whole world is a dichotomy of left vs right.  Sometimes things happen that aren’t politics.

i don’t watch tv at all and I don’t watch or read either of those media choices.

i have spoken Skype (for b usiness reasons) to a colleague in London yesterday.  I have watched macron’s 27 minute address to France on France 1 in French yesterday.  I have read Angela merciless remarks - translated.  Something is happening in the world and it’s not about anyone’s desire to spin it as a fox or cnn story or a republican or democratic spin.

i am not afraid I am a pragmatist.  One a storm is afoot I react and I don’t call people limp twisted pansies for choosing to get the weather report read the radar and choose to either fly around a t-storm rather than through or to fly another day.

I read that 2007 article from the proceedings  of the national academies of science in about 2008. I didn’t just find out about it because cnn just told me about 1918 yesterday.  You seem to assert that no one has opinions or knowledge - that all opinions are fake knowledge inserted by talking heads from cnn or fox.  This is an unfortunate view of the world and an unfortunate view of humanity and in a moment like this a dangerous distracting impediment keeping many people from reacting.

 

Sadly, the scientific process and scientific data have a tendency to be offensive to a lot of people on both sides.

---

Like all epidemics and pandemics, the current one:

• Will not kill the vast majority of people
• Will not infect the vast majority of people
• Will not the vast majority of people you know
• Will not infect the majority of people you know

This applies to every epidemic in the past 150 years, including the Spanish flu of 1918.  If you have an epidemic that only kills one out of 400 people, so what's the BFD, right?  It's all just "hysteria" (a term attributed to the theory that origins of insanity from neurosis were from a uterus and that men were not capable of getting it).

I can see how this logic is appealing for people who have an insular worldview, which we all do to some extent.  I'd like to think, though, that I have a capacity to care and be concerned about someone else's grandmother, not just my own grandmother.  It's the capacity to have that concern for others that helps you realize that steps should be taken for protection--not to protect me, but to protect people like someone else's grandmother.

[neilpilot]

18 minutes ago, jaylw314 said:

This applies to every epidemic in the past 150 years, including the Spanish flu of 1918.  If you have an epidemic that only kills one out of 400 people, so what's the BFD, right?

Accepted estimates of deaths during the 1918-1919 Spanish Flu pandemic range from 50-100 million.  The global population was 1.5-1.7 billion.  That implies that it "only" killed at a minimum one out of 35 people, and possibly as many as 1 in 15.  You might feel that's not a BFD, but other's here might disagree.

[Scott Dennstaedt, PhD]

18 minutes ago, jaylw314 said:

I can see how this logic is appealing for people who have an insular worldview, which we all do to some extent.  I'd like to think, though, that I have a capacity to care and be concerned about someone else's grandmother, not just my own grandmother.  It's the capacity to have that concern for others that helps you realize that steps should be taken for protection--not to protect me, but to protect people like someone else's grandmother.

Just got off the phone with someone who lives in the "war zone" in Italy and I won't describe what he said to me (first hand, not media) since it is really horrific and just honestly too disturbing to write. I can guarantee you that what I heard was 100X worse that I ever thought. The media isn't covering these details...fortunately. We really don't have a clue and every measure taken is a small glimmer of hope it won't be even a fraction as bad as what has been occurring elsewhere in the world.

[flyboy0681]

I wasn't born yet for the polio outbreak in the 1950's. Anybody here live through that and if so, what was it like?

[MooneyMitch]

24 minutes ago, flyboy0681 said:

I wasn't born yet for the polio outbreak in the 1950's. Anybody here live through that and if so, what was it like?

As a small child then, it was frightening!  As for my parents, I’m sure they were deeply concerned as most parents probably were.  My parents were wonderful and calming to us.   

[Browncbr1]

1 hour ago, aviatoreb said:

 

I'll take Angela Merckel's view over Rush Limbaugh.  She has a PhD in biochemistry, and as the leader of Germany she has access to the collective advice of the country's public health epidemiologists. She says this thing is very deadly and that estimates are that 60-70% of Germans will likely get it.  The large fraction will recover but a massive number nonetheless will not.  Limbaugh has his hunch, and also whatever he thinks will continue to pay for the fuel in his G550.  I'll take Angela.

One person came here and noted asking how many Americans have died so far. That is an interesting point of view.  I haven't been to Texas in years.  So for me Texas is far away.  I have been to Germany twice in the last year and London twice, and I have had emails or skypes with people there within the last week - so in many ways they are much closer to me than Texas.  This is a world economy and a world pandemic issue.

This assumes that Merckle’s motives aren’t duplicitous, while Limbaugh’s most certainly are...    the facts are the facts.   So, all that’s left are objective opinions with perspective and opinions formed through motive.     Nothing works to justify big government like a frightening pandemic.   Politicians and their children have much to gain through the establishment world order.   Most politicians just go with the flow of the party.   Limbaugh sells advertising air time and syndication, and the media (all media) wants buttons to be clicked.

I think as of now about 5000 people (globally) have died of this virus.  41 domestically.   Compare that to murder numbers just in the US alone.   The same comparison could be made with many other forms of death ..   all in seems that SARS and other past viruses were actually worse.   IMHO

 

Edited March 13, 2020 by Browncbr1

[flyboy0681]

2 minutes ago, Browncbr1 said:

This assumes that Merckle’s motives aren’t duplicitous, while Limbaugh’s most certainly are...    the facts are the facts.   So, all that’s left are objective opinions with perspective and opinions formed through motive.     Nothing works to justify big government like a frightening pandemic.   Politicians and their children have much to gain through the establishment world order.   Most politicians just go with the flow of the party.   Limbaugh sells advertising air time and syndication.   

I think as of now about 5000 people (globally) have died of this virus.  41 domestically.   Compare that to murder numbers just in the US alone.   The same comparison could be made with many other forms of death ..   all in seems that SARS and other past viruses were actually worse.   IMHO

 

Your point is well taken, however, the virus only arrived here a few short weeks ago. It's not fair to say that there were only x number of deaths until we have the numbers after a full year. Keep in mind the number of outbreaks will rise exponentially until it starts to ebb.

[Browncbr1]

Just now, flyboy0681 said:

Your point is well taken, however, the virus only arrived here a few short weeks ago. It's not fair to say that there were only x number of deaths until we have the numbers after a full year. Keep in mind the number of outbreaks will rise exponentially until it starts to ebb.

Good point

[aviatoreb]

3 minutes ago, Browncbr1 said:

This assumes that Merckle’s motives aren’t duplicitous, while Limbaugh’s most certainly are...    the facts are the facts.   So, all that’s left are objective opinions with perspective and opinions formed through motive.     Nothing works to justify big government like a frightening pandemic.   Politicians and their children have much to gain through the establishment world order.   Most politicians just go with the flow of the party.   Limbaugh sells advertising air time and syndication.   

I think as of now about 5000 people (globally) have died of this virus.  41 domestically.   Compare that to murder numbers just in the US alone.   The same comparison could be made with many other forms of death ..   all in seems that SARS and other past viruses were actually worse.   IMHO

 

Check back in here in one month.  I will be very happy to declare publically then that I was wrong.  

[afward]

1 minute ago, aviatoreb said:

Check back in here in one month.  I will be very happy to declare publically then that I was wrong.  

No offense intended, but I really hope you have to do just that.

I've no illusions, though...

[Browncbr1]

5 minutes ago, aviatoreb said:

Check back in here in one month.  I will be very happy to declare publically then that I was wrong.  

We shall see how it plays out.   I always say there is no shame in being wrong later because everything made sense at the time.   I actually didn’t mean to be about who is right or wrong.   I am just saying what I’m saying because there are so many people freaked out scared out of their minds buying out the grocery stores...   there has been a real panic stirred and apart from the economic impact, anxiety and stress just further weaken immune systems.   I just don’t like seeing everyone so frightful.   

Edited March 13, 2020 by Browncbr1

[aviatoreb]

2 minutes ago, afward said:

No offense intended, but I really hope you have to do just that.

I've no illusions, though...

Here here!  Me too!

[aviatoreb]

1 minute ago, Browncbr1 said:

We shall see how it plays out.   I actually didn’t mean to be about who is right or wrong.   I am just saying what I’m saying because there are so many people freaked out scared out of their minds buying out the grocery stores...   there has been a real panic stirred and apart from the economic impact, anxiety and stress just further weaken immune systems.   I just don’t like seeing everyone so frightful.   

I don't mean to turn it into I'm right and you're wrong even if implicitly what a heated discussion becomes. But clearly we disagree and seems like we won't agree.  So I was just noting that time will tell.

[MooneyMitch]

When the going gets tough, the tough go flying!!!  I think I shall.....

And have a couple of these too ...

[flyboy0681]

When it comes to prediction of future events and outcomes, I'm reminded of the old Little Timmy thread about nine years ago. In it, the original poster insisted that Social Security would be a thing of the past by the year, ahem, 2020.

[KLRDMD]

This is the best discussion I’ve seen on this topic:

From Brian Brian Yoshio Laing, a physician at UCSF

CRITICAL INFO on COVID19 below. PLEASE SHARE.

Summary points from expert panel at UCSF on 3/10/20:

- SOCIAL DISTANCING IS KEY. Avoid any unnecessary travel and anyone over age 60 should stay home.

- Current goal is to lower the peak of the surge of infected patients that will hit our hospitals. We may come to a point where isolation rooms and ventilators have to be rationed. We are buying time in hopes that a treatment will be developed.

- We are beyond containment. 40-70% of U.S. population will be infected over the next year and 1.5 million Americans may die.

- We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.

Panelists:

• Joe DeRisi: UCSF’s top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford). Co-inventor of the chip used in SARS epidemic.• Emily Crawford: COVID task force director. Focused on diagnostics• Cristina Tato: Rapid Response Director. Immunologist.• Patrick Ayescue: Leading outbreak response and surveillance. Epidemiologist.• Chaz Langelier: UCSF Infectious Disease doc

What’s below are essentially direct quotes from the panelists. The few things that are not quotes are in brackets.
 

• Top takeaways:

At this point, we are past containment. Containment is basically futile. Our containment efforts won’t reduce the number who get infected in the US.Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.How many in the community already have the virus? No one knows. We are moving from containment to care.
We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.

40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population. [Baker Lab told me the same 30-70% at our March 1 dinner]

[We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.] The fatality rate is in the range of 10X flu. This assumes no drug is found effective and made available. The death rate varies hugely by age. 

Over age 80 the mortality rate could be 10-15%. Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu didI can only tell you two things definitively. Definitively it’s going to get worse before it gets better. And we'll be dealing with this for the next year at least. Our lives are going to look different for the next year.

• What should we do now? What are you doing for your family? 

Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).

How long does the virus last? On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this. The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based. Avoid concerts, movies, crowded places. We have cancelled business travel. Do the basic hygiene, eg hand washing and avoiding touching face. 

Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing.

Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous. Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous. We would say “Anyone over 60 stay at home unless it’s critical”. CDC toyed with idea of saying anyone over 60 not travel on commercial airlines. We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes then are not letting them out of the house. The other members of the family are washing hands the moment they come in.

Three routes of infection: Hand to mouth/face, aerosol transmission, fecal/oral route.

• What if someone is sick? 

If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldn’t do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on. If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER. There is no accepted treatment for COVID-19. 

The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis. If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines. [More I found online.]

Why is the fatality rate much higher for older adults? 

Your immune system declines past age 50. Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults. Risk of pneumonia is higher in older adults.

• What about testing to know if someone has COVID-19? 

Bottom line, there is not enough testing capacity to be broadly useful. Here’s why. Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating”. A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA. However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives.The PCR test requires kits with reagents and requires clinical labs to process the kits. While the kits are becoming available, the lab capacity is not growing.

The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation. Expanding processing capacity takes “time, space, and equipment.” And certification. ie it won’t happen soon. UCSF and UC Berkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified. Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.

• How well is society preparing for the impact? 

Local hospitals are adding capacity as we speak. UCSF’s Parnassus campus has erected “triage tents” in a parking lot. They have converted a ward to “negative pressure” which is needed to contain the virus. They are considering re-opening the shuttered Mt Zion facility.

If COVID-19 affected children then we would be seeing mass departures of families from cities. But thankfully now we know that kids are not affected. School closures are one the biggest societal impacts. We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects. If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services. Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis. They do not have the capacity to sustain for outbreaks that last for months. Other solutions will have to be found.

What will we do to handle behavior changes that can last for months?

Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed. Kids home due to school closures [Dr. DeRisi had to leave the meeting for a call with the governor’s office. When he returned we asked what the call covered.] The epidemiological models the state is using to track and trigger action. The state is planning at what point they will take certain actions. ie what will trigger an order to cease any gatherings of over 1000 people.

• Where do you find reliable news?

The John Hopkins Center for Health Security site which posts daily updates. You can sign up to receive a daily newsletter on COVID-19 by email. http://www.centerforhealthsecurity.org/newsroom/newsletters/e-newsletter-sign-up.html

The New York Times is good on scientific accuracy.

• Observations on China.

Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19. While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent. Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots. Early on no one had info on COVID-19. So China reacted in a way unique modern history, except in wartime.

• Every few years there seems another: SARS, Ebola, MERS, H1N1, COVID-19. Growing strains of antibiotic resistant bacteria. 

Are we in the twilight of a century of medicine’s great triumph over infectious disease? 

"We’ve been in a back and forth battle against viruses for a million years.” But it would sure help if every country would shut down their wet markets. As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa. See article on Wired magazine on sequencing of virus from Cambodia.

[KLRDMD]

COVID-19

Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.

The Center for Health Security will be analyzing and providing updates on the emerging novel coronavirus. If you would like to receive these daily updates, please sign up here and select COVID-19. Additional resources are also available on our website.

March 13, 2020

Note: although we include case counts to help provide situational awareness to our readers, the numbers are constantly changing. Please refer to the WHO or the public health agencies of affected countries for the latest information.

EPI UPDATES The WHO COVID-19 Situation Report shows a total of 125,048 confirmed cases (4,613 deaths) worldwide. There have been 6,729 new cases in the past 24 hours. French Polynesia, Turkey, Honduras, and Cote d’Ivoire have all reported their first COVID-19 cases in the last day. The Johns Hopkins Center for Systems Science and Engineering (CSSE) dashboard is reporting 137,066 cases and 3,337 total deaths as of noon today. Iran’s Ministry of Health reported 1,289 new cases of COVID-19 and 85 new deaths, bringing the total there to 11,364 cases and 514 deaths. The Italian Ministry of Health reported a total of 12,839 cases and 1,016 deaths. The Singapore Ministry of Health reported200 total cases, of which 103 are currently hospitalized and 11 are in critical condition. Spain reported a total of 4,209 cases and 120 deaths. The US CDC reported a total of 1,215 cases and 36 deaths across 42 states and Washington, DC. Of those cases, 125 are travel-related, 102 are close contacts of known cases, and 988 are still under investigation.

The South Korean CDC reported a total of 7,979 confirmed COVID-19 cases, including 67 deaths. Epidemiological links have been identified for 79.8% of cases. The most recent report provides an updated breakdown of cases by region, sex, and age group, providing additional insight into the ongoing epidemic. Females represent 61.9% of cases but only 41.8% of deaths. The unadjusted case fatality ratio for individuals aged 80 years and older is 8.30% (21 deaths out of 253 cases), and it is 4.74% for those 70-79 years old and 1.42% for those 60-69 years old. For cases under the age of 60, the case fatality ratio is only 0.12%. Notably, there have been only 2 deaths below the age of 50, despite 4,712 confirmed cases. The epidemic in South Korea has been driven largely by the community around the Shincheonji religious group (4,780 cases; 59.9% of all cases).

REPORTS OF HEALTH SYSTEM BURDEN IN ITALY The New York Times reported that Italy’s health system has become rapidly overwhelmed in just 3 weeks, leading to severely limited availability for ventilators and necessitating difficult decisions regarding how ration medical care among patients. The rapid spread and increase in the number of severe cases prompted Italy to enforce radical social distancing measures and to strongly encourage other countries to rapidly implement these measures as well. As reported yesterday, Italy implemented strict quarantine measures nationwide, including closing many businesses. People will still be able to access public areas under certain conditions, but they are encouraged to remain at home and avoid non-essential gatherings. A pre-print recent report from faculty here at the Johns Hopkins Center for Health Security and collaborators also addresses the need for rapid implementation of social distancing measures to slow the spread of epidemic and mitigate health system burden. 

SINGAPORE ANNOUNCES NEW RESTRICTIONS Singaporerecently expanded its travel restrictions to include visitors with travel history to Italy, France, Spain, and Germany in the last 14 days. These individuals will not be allowed entry or transit through the country, and those already in the country with travel history from those countries will receive stay-at-home notices. Singapore already had travel restrictions in place for China, Iran, and South Korea. 

US RESPONSE The US Senate will cancel the recess scheduled to begin today in order to remain in session to draft and debate legislation related to the US COVID-19 response. Senate Majority Leader Mitch McConnell was under pressure, including from fellow Republican Senators, to keep the Senate in session in order to finalize coronavirus legislation. The US House of Representativesand the White House are still negotiating a legislative package that aims to address economic and other effects of the COVID-19 epidemic in the United States. Reportedly, the bill is close to being finalized, with hopes that the House of Representatives could vote on it today. Key issues include free coronavirus testing, paid sick leave for COVID-19 patients, and increased support for states to address funding for unemployment and food assistance programs.

According to NPR, the Office of Personnel Management now requires agencies to incorporate telework into their continuity of operations plans, reversing a trend of scaling back telework infrastructure among government employees in recent years. 

ECONOMIC DECLINES CONTINUE TO BEAR MARKET NPRreported that recent wide-scale stock sell-offs have now led to the start of a “bear market,” which could potentially forecast an impending recession. The Dow Jones Industrial Average has dropped 28% since its high point on February 12. The South China Morning Post also reported similar declines in Asian financial markets.

US SCHOOL CLOSURES AND SOCIAL DISTANCING MEASURES Note: for the most up to date information about individual communities, please visit the relevant jurisdiction's website directly. Ohio Governor Mike Dewine announced that all K-12 schools will be closed through April 3, and the state banned all mass gatherings of more than 100 people. Michigan Governor Gretchen Whitmer also announced that all K-12 schools will be closed through April 5. Notably, Governor Whitmer also expanded access to telemedicine statewide, and she called for President Trump to initiate a special enrollment period for the ACA to ensure access to healthcare during the COVID-19 pandemic. Maryland Governor Larry Hogan announced closure of all schools through March 27 as well as a series of other response measures, including a ban on gatherings larger than 250 people, the closure of cruise ship terminal in Baltimore, and the activation of the Maryland National Guard to support the response. The announcement comes on the heels of Maryland detecting its first reported instance of community SARS-CoV-2 transmission. Washington, DC, public schools will be closed from March 16 - March 31. Spring Break for these schools has been rescheduled for March 17-23 (formerly scheduled for April), and students will participate in distance learning from March 24-31. Meals will be made available for all students during that period at designated schools throughout the District. 

In addition to Ohio, Michigan, Maryland, and Washington, DC, several other states have closed schools in certain higher-risk areas. Washington Governor Jay Inslee ordered K-12 schools closed in King, Pierce, and Snohomish counties through April 24, affecting 600,000 students in high-risk areas. Schools in San Francisco and part of nearby Contra Costa County in California are also closed, but the state has not mandated closures statewide. Pennsylvania Governor Tom Wolfe announced that schools in Montgomery County (13 reported cases) will be closed for 2 weeks. Pennsylvania is also mandating remote work for state employees, and the state is implementing a 10-day paid leave policy for individuals who cannot work remotely. The governors in Georgia and Kentucky both recommended that schools consider closing, but they did not mandate closures.

Many government agencies are recommending or mandating that people avoid crowded spaces and large gatherings, particularly if they are exhibiting COVID-19 symptoms, but this may be more difficult (or impossible) for individuals experiencing homelessness. In Washington, DC, the Department of Health Services (DHS) is coordinating with homeless shelters and local healthcare systems to provide support for these individuals who may need to undergo quarantine. DHS Director Laura Zeilinger said that individuals who seek care for symptoms would not be returned to shelters or other congregate settings. DHS is also providing additional assistance to increase access to hand sanitizer and improve hygiene and sanitation at shelters and locations where food is served.

Considering the elevated risk to older individuals, some adult long-term care facilities (e.g., nursing homes) are taking additional measures to protect their residents and patients. As seen in Seattle, nursing homes can be high-risk environments for spreading SARS-CoV-2 among a particularly vulnerable population. Nursing homes are beginning to screen and limit visitors in order to reduce their residents’ risk of exposure, and efforts are ongoing to increase the quality and effectiveness of disinfection and hygiene efforts to reduce the risk of transmitting within facilities. Concerns remain, however, about the toll of prolonged isolation from friends and family for residents of these facilities.

The NCAA announced yesterday that all remaining winter and spring sports championships, including the Men’s and Women’s basketball national championships (also known as March Madness), are cancelled due to concerns about coronavirus. The NHL announced yesterday that it is suspending the 2019-20 seasonindefinitely. Major League Baseball, Minor League Baseball, and Major League Soccer all announced a range of cancelations, restrictions, or suspensions in response to COVID-19 as well. Additionally, officials from the Boston Athletic Association and Boston Mayor Martin Walsh announced that the Boston Marathon will be postponed until September 14.

CLINICAL COURSE OF COVID-19 A study published on March 11 in The Lancet provides analysis of the progression of the COVID-19 disease in survivors and non-survivors. The study involved 191 hospitalized COVID-19 patients (54 deaths, 137 discharged) in Wuhan, China. Notably, the study describes the timing of various aspects of disease progression in hospitalized patients, including the time from first symptom onset to the onset of various symptoms/conditions, including dyspnoea, sepsis, and ARDS as well as their duration. The article also reports the time to and duration of ICU admission. The study found an increase in the odds of death with increased age, and the mean duration of viral shedding was 20 days from symptom onset in survivors and continuously until death in non-survivors (maximum duration: 37 days). The study found no evidence that antiviral treatment reduces the duration of viral shedding.

SPOUSE OF THE PM OF CANADA TESTED POSITIVE Prime Minister Justin Trudeau’s wife, Sophie Grégoire Trudeau, tested positive for SARS-CoV-2, according to a statement by the Prime Minister’s Office. At this time, her symptoms do not appear to be serious, and she will be self-isolating for at least 14 days. Prime Minister Trudeau will not be tested at this time because he is not exhibiting symptoms, but he will self-quarantine for 14 days as well. He does not expect this to affect his duties as Prime Minister. There are growing reports of political leaders from various countries becoming infected or exposed to COVID-19.

[Scott Dennstaedt, PhD]

17 minutes ago, Browncbr1 said:

I am just saying what I’m saying because there are so many people freaked out scared out of their minds buying out the grocery stores...   there has been a real panic stirred and apart from the economic impact, anxiety and stress just further weaken immune systems.   I just don’t like seeing everyone so frightful.   

The other end of the spectrum is that nobody reacts at all and uses the "it'll not happen to me" or "attend at your own risk" that ends in a horrible outcome with the healthcare system overwhelmed, hundreds of thousands (if not millions dead) and eventually the financial market takes an even greater tumble with entire companies wiped out.  Don't confuse preparation with panic.  People are not really in panic mode...I don't see people jumping off of bridges yet.  

Edited March 13, 2020 by Scott Dennstaedt