March 15, 2020 Update
Dear All,
Here is today’s post. As always, email with any additional questions.
We keep hearing the US’s trajectory will follow that of Italy as the best comparator country. What is the current situation in Italy?
Here is a Viewpoint published in JAMA, a leading medical publication, written by physicians in Lombardy, Italy. A few key points to take in as you read:
· The opening paragraph describes a young, healthy 30-year old who presented on February 20th with COVID-19 and was sick enough to require admission to the ICU who acquired it from ‘community spread’ meaning this person had no known travel or obvious contacts with infected patients. While your odds of developing severe symptoms are lower if you are young and healthy, they are not 0%. Some young, healthy folks will unfortunately develop more severe symptoms requiring admission to the hospital. This is not to cause alarm and panic, but to present the facts that we are all at risk. Just like older people are at higher risk of cancer doesn’t mean young people don’t get cancer. The same analogy holds here. Everyone is at risk of developing severe symptoms. The younger and healthier, the lower the odds, and the older/sicker, the higher the odds. Thus, it’s imperative EVERYONE regardless of age, health status, do their part for themselves and the community to start taking action now. As we discussed yesterday, you should not panic if you develop symptoms or test positive, but you should not adopt the attitude that you’ll definitely get COVID, and therefore, take no precautionary measures.
· Pay attention to the speed at which ICU admissions increased from February 20th to March 8th. The dramatic increase in ICU admissions is what led to a quarantine in Lombardy on March 8th and an eventual lockdown in Italy by March 10th.
· This is not meant to cause panic but rather to show the seriousness of what we’re dealing with. Each community in this country will have a different ‘day 0’ or February 20th moment in Lombardy. The best thing each community can do is start taking major actions now.
· The last and final point: Back on February 20th, when the average Italian citizen looked out their window in Lombardy, everything in their community looked perfectly fine. By March 8th, they were in a forced lock-down due to uncontrolled disease spread. Imagine if the authors and the Italian people had the ability to hit the ‘reset’ button and go back to February 20th knowing what they know know. This is where most US communities are. Do not be reassured with how ‘normal-appearing’ your community looks today. This could happen in your community if no actions are taken. Act now. Pay the bill. I’m sure Lombardy would give anything to be able to go back in time and have a chance at a ‘re-do’ on how they handled things.
Lastly, here is a tweet from Dr. Scott Gottlieb, former FDA Commissioner, who I follow closely on Twitter with the latest mortality numbers from Italy.
I am young and healthy and have accepted I’ll probably get COVID and therefore don’t see the benefit of taking action such as no longer going out to eat, going to the gym, congregating in large groups at the bars etc. Why should I care?
See the opening paragraph to the JAMA article above. However, if you’re not concerned enough about your own health, then take actions to help your community and those who are at higher-risk. When you become sick, you may not develop progressive infection but you will still spread the infection to others. In fact, when folks become symptomatic, they shed billions of viruses into the environment and become what is called a ‘super spreader’. There is evidence of one person easily infecting 50 or more people from casual contact. I would assume most us don’t want to be that person.
If we do not collectively take action now, it would not be surprising to see many of our communities forced to take more extreme measures like we’re seeing in Italy and Europe, not to mention, increase the risk of out-stripping our hospital / ventilator capacity.
This still feels like an over-reaction?
That’s the point! Everything we do before a pandemic feels like an over-reaction and alarmist, until it’s too late. We will never know the counter-factual of what would happen if we do nothing.
What we do know is how bad things could get if we don’t take action (see Italy’s experience above). We only get one window of time to make this choice. Just as you saw in Lombardy, we won’t get a do-over afterwards if we don’t like the results. In my opinion, ‘over-reacting’ today is the only choice.
My office isn’t closing and I have to go to work tomorrow. What should I do?
- Keep your space from others.
- No handshakes or hugs
- Frequently wash hands and hard surfaces that you and others must touch frequently.
- Avoid communal food trays, water dispensers, coffee dispensers. People should prepare their own food, beverages for time being
- Avoid touching your face
- Start strategizing with colleagues and superiors how you would work remotely if/when the office closes. Similar to school closings, it seems inevitable to me most offices will be closed at some point over the next month. Prepare now.
Personal Update:
- Continue to feel well overall, 85-90%
- No further fevers
- Have developed a mild, dry cough that is new.
- Impossible to know if this is COVID or some other process.
- Will try to get tested as it becomes more widely available but since my symptoms are mild, still trying to conserve the testing available to others with more severe symptoms.
Be safe,
Harry