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Ughh....

So yesterday was a rough day. There was some good news on the immunity front, and some really terrible news everywhere else. The data is rough


I will start with the terrible news.


Infection of our healthcare workers: We are starting to see young, healthy, healthcare workers being infected at work. Some of the Seattle ER doctors are in serious condition. We are also seeing healthcare workers infected in NY and WA. It is becoming clear that the hospitals do not have the equipment or the resources needed to deal with the patient influx. Just today, MA received only 10% of its requested supplies from the strategic national stockpile. We need to mobilize our workforce.


Bad News 2: Researchers at the Imperial College in London published a paper yesterday that caused the UK to change their strategy (and the USA as well). Basically, if the disease run is allowed to run its course through the USA without mitigation, we would expect 81% of the population infected and 2.2 million deaths. This does not account for extra deaths associated with the healthcare system being overwhelmed. The peak of an unmitigated response would be roughly June 20th 2020. Hospitals would be overwhelmed by the second week in April, and at its peak hospital bed capacity would be exceeded by 30-fold.


This is why we needed to act sooner and more boldly. The mitigation strategies implemented in the USA over the last 2 weeks will help flatten the curve. But we need to do everything, school closings, university closings, case isolation, household quarantine, and social distancing. Doing all of these things flattens and delays the peak. But, even with all of these mitigation steps we still exceed critical care bed capacity by 8 fold.


The bottom line from the authors were that mitigation is our only option right now and that mitigation strategies need to stay in place for at least 12-18 months until a vaccine is developed. This means no school, no university, extreme social distancing, and home quarantine for over a year. This is clearly not sustainable, the social and economic impact would be profound.


I will note that there were a lot of assumptions made in this article. Some of which may not materialize. Paper can be found here: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf


As I said a few days ago, we need testing on such a massive scale that we can identify every infected person, isolate them, and get ahead of the virus's march through us. This will stop the infection curve in its tracks. The testing capacity is building, but this is where we are... Grad students, Post-docs, Professors... all volunteering their time to process samples.


We do have public health labs testing as well, but they do not have the personnel or the lab capacity to run he number of tests we need. We are still testing at a rate near the lowest in the developed world.


We need testing, testing, testing. Otherwise nothing will change until a vaccine is made. You can see the difference between South Korea and the USA here. Through their testing, they were able to keep their country going, very little mitigation like we now have in the USA.


We all need to yell at our politicians (Aussies are you listening! You have a tiny window of time to test, test, test! so ou dont' get locked up like the everywhere else).



Another gut punch was this article regarding pediatric patients and COVID-19.


https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf


We have been under the impression that being young provided protection. Youth does seem to protect you from dying from this disease. That is clear. However, the data from China demonstrate that children can get very sick; roughly 5% of infected children required hospitalization.


Just as a reference:

  • Asymptomatic: infected by no symptoms

  • Mild and moderate: pneumonia and fever that can be treated at home

  • Severe: Hospitalization

  • Critical: Hospitalization and mechanical ventilation

So our kids are in this with us.... they are just not asymptomatic vectors many people believe.


Bad news - good news. It is now clear that people can be harboring the virus and appear perfectly normal (asymptomatic). The data from the Diamond Princess and from Italy shows that asymptomatic carriers are critical to the spread of this disease. Asymptomatic carriers are less infectious than symptomatic cases. But they asymptomatic carriers contribute more to the overall transmission of the virus than the symptomatic cases. Basically, someone coughing and showing symptoms of infection you will avoid.... someone that looks healthy and uninfected you are more likely to engage. This asymptomatic but infectious state greatly facilitates the spread of the virus throughout the community. This is why countries are locking borders. you just don't know who has it. Basically, we all need to isolate until we know the prevalence of the virus in our community. (testing testing testing.... )


Finally, I will finish on some good news from Australia. In an article published in Nature yesterday, this wonderful team of scientists from the Peter Doherty Institute reported on the first 5 recovered cases of COVID-19 in Australia. They have strong data to suggest that recovery from mild and moderate cases of COVID-19 leads to a robust humoral and cell mediated immune response (adaptive immunity). This is the exact type of response you need for a vaccine to work. There are many limitations to the data, poor sample size and no idea on the longevity of protections, but hey, it's a start. I will take all the good news I can get.


https://www.nature.com/articles/s41591-020-0819-2


An added plus, given the demonstration of antibody mediated protection, it may now be possible to collect serum from recoverd patients to treat the most severly ill.


Bottom line is;

All countries can and must do more.

Kids can have bad outcomes

Lots of people will be infected, not showing any signs, and shedding the virus

Unless we find a pharmaceutical intervention, can perform massive testing, or we just sacrifice a percentage of our population (sorry, being blunt), we will have long-term social disruption, school closings etc, for 12-18months.

There is evidence that a vaccine is feasible.





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