April 26, 2020 Update
Dear All,
Apologies for the delay in getting blogs out. Very busy with other responsibilities but wanted to send an update given so much that has happened since the last post 2 weeks ago.
When/How will the country re-open?
We’ve learned a lot about this over the past 2 weeks with it becoming clear that each state will dictate its own rules on re-opening. This makes sense to me since every state has a different set of circumstances regarding the safety of re-opening. It’s been encouraging to see the federal guidelines and many state governors (though not all of them) highlight some of the same principles we discussed in our prior blog, specifically, the goalposts of:
1) Widespread testing availability
2) Contact tracing
3) Local hospital capacity
In reality though, it is unlikely states will have widespread testing available when they re-open. I don’t know of anywhere in this country that truly has widespread testing and doubt anywhere will have it in the coming weeks. Even though we all agree it’d be best to have widespread testing in place before re-opening, it’s not going to happen before many states choose to re-open. Instead, we will have to do our best in spite of limited testing to reduce the risk of an outbreak.
Will an outbreak happen in my community?
Maybe. Outbreaks in some form or fashion seem inevitable to me, but the extent of the outbreaks remains uncertain. For example, it seems likely to me that certain stores, office buildings, or other gathering spots (including healthcare settings potentially) will need to be shut down if they become a source of outbreak. We’ve seen this in a Wal-Mart in Colorado that needed to be closed and a meat plant in South Dakota both of which became COVID-19 hotspots.
One thing to note is the reported lack of distancing and other precautions that were not being followed at either place. It is likely not following simple distancing and hygiene practices contributed to these outbreaks.
In New York, almost all groceries and pharmacies have a security officer at the entrance that limits how many people can be in the store at one time. Although annoying to wait in line outside to enter a store, it almost certainly reduces the risk that a store will become a hotspot. Limiting the number of people inside at one time enables folks in the aisles and check out lines to keep 6 feet apart from each other at all times. Further, these stores require everyone entering to wear masks of some kind. Although inconvenient, steps such as this will limit the chance of an outbreak.
I’ll be surprised if there aren’t more of these hotspot type of events requiring store/office closures. But, it’s less clear to me whether entire cities or states will have to re-enter lockdown. Part of this will depend on our own behavior once things re-open.
When things re-open what can I do to prevent the need to go back into lockdown?
Keep doing the same things you’re doing now. Leave the house when needed for essential things recognizing that the word ‘essential’ will be individual to you and less strict than before. Perhaps getting a haircut is essential or visiting a friend/family member is essential. Going to work is certainly essential. The idea is you do what you need to do for your physical and mental health while trying to take precautions. Being outdoors will always be advantageous as opposed to being indoors with closed ventilation so take every opportunity to move your activities to an open air setting when possible.
Any updates on antibody testing and immunity?
There have been some developments but nothing that is groundbreaking. We still don’t know with confidence:
- Which antibody tests are accurate? (See great New York Times article here detailing where we are on test accuracy)
- If I do have antibodies, does this mean I can’t catch it again?
- How long does my immunity last?
Unfortunately, the honest answer to all of the above is we don’t know. The tests are getting better, but they’re still not terribly accurate or widely available.
The jury is still out on whether antibodies do confer immunity, though I am still optimistic that those who generate an antibody response will prove to be less likely to catch it again.
And we certainly don’t know how long immunity lasts, if at all.
My hope is we’ll know more about all 3 of these questions in the next 1-2 months. Although the past 2 months have probably felt like 2 years to many of you, the scientific community has made incredible strides since early March (less than 2 months ago). I am confident we’ll continue making tremendous progress in better understanding these important questions over the next 1-2 months.
Any updates on treatments?
Nothing noteworthy in my opinion. There have been anecdotal reports of Remdesivir looking promising out of a University of Chicago study only to be rebuffed by another study a few days later.
Hydroxychloroquine has now fallen out of favor with the general public and has been taken out of the standard treatment protocols at many hospitals (including NYU). I was back in the hospital last weekend and will shed more light on what it looks like on the ground 2 weeks after the surge in tomorrow’s blog.
Bottom line – We still don’t have any proven therapies at this time but have several robust trials underway that should teach us a lot more over the next 1-2 months. I am not counting on any of the drugs under investigation to be a miracle drug or cure. Rather, my hope is that one or several of the treatments will show improved outcomes as compared to placebo but wouldn’t expect any of them to work all the time.
Is there any good news?
Yes. There is a great reason for optimism. While there have been several cities hit very hard with COVID-19, many have remained relatively unaffected from the virus in terms of hospitalizations and death. This is not by chance. It is because all of you took aggressive action to hunker down and stay home. I can assure you the counter-factual of continuing to live life with no adjustments over the past 6 weeks would’ve led to far more disease transmission and death. I recognize these actions have caused tremendous pain in other ways whether that be economic, psychological, or in lifestyle but the sacrifices have not been in vain.
Rather, taking the actions before the virus spread uncontrollably as it has in other areas will enable your communities to return to ‘normal’ faster and safer with far less loss of life.
Tomorrow, I will send out my observations from being back in the hospital 2 weeks after the peak surge and what I’m hearing about resuming elective surgeries.
Thanks and be well,
Harry