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"Actions that look ridiculous today will look most reasonable in 3 weeks"

Updated: Dec 28, 2021

So this is the message I was dreading to write. I hope I am wrong.

Please remember. Nothing has changed from yesterday. Your risk today is only slightly higher than yesterday. But our actions today, determine the outcome of the rest of this month.

It has been obvious to those of us objectively studying this outbreak that containment and eradication was not possible. Once the virus grabbed a foothold in the USA, were only ever going to succeed with control and mitigation.

This is a pandemic. Get used to that word. That doesn’t change anything. It’s not a word of fear, it just means that the virus has sustained human-to-human transmission throughout the world. For the first time in human history we have a chance to change the outcomes of a pandemic, but it is going to take some adjustment, pain, and very different quality of life for a while.

As I wrote earlier in the week “actions that look ridiculous today will look most reasonable in 3 weeks”. Some of those changes are happening now, others will come later, maybe too late.

The estimates are that the USA is 2 weeks behind Italy in the growth of cases. Please let that sink in.

Australia, especially NSW where sustained human to human transmission is now evident in Sydney, is about ~4 weeks behind.

The USA is showing exponential growth in cases. This is a factor of enhanced testing, but also a demonstration of community spread. Cases are doubling every 24 hours. The USA is going to be Italy in 3 weeks if something is not done quickly.

In Massachusetts, the State government is taking aggressive action to limit the spread of the virus. All UMass Campuses will be moving to online education for the foreseeable future; gatherings of more than 50 people are to be limited. Expect schools to follow suit in the next few weeks. Why not now? Well closing schools, and the ramifications that come from closing them, are large. No school lunches, unequal access to technology for remote learning etc.

These aggressive measures are required to slow down the outbreak. Why do we need to slow it down? You may have seen some graphs that show spreading out the epidemic curve, yes, that…. But, I thought I would write something that puts that curve into real-life perspective. Drive the point home.

Read on, but be prepared to be gutted.

This is a description from inside Lumbardy region in Italy by a person on the frontline. This was from a few days ago, the situation has deteriorated further. I have modified it a little bit for ease of reading.

“Lumbardy is the most developed region in Italy and has extraordinarily good healthcare. The outbreak in our region have hospitals running at 200% capacity. We have stopped all routine procedures, all operating rooms have been converted to intensive care units and they are now diverting or not treating all other emergencies like trauma and strokes. There are hundreds of patients with severe respiratory failure and many of them do not have access to anything above a reservoir mask. Patients above 65 or younger with comorbidities are not being assessed; I mean not assessed and no ICU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed. My friends are calling me in tears because they see people dying in front of them and they can only offer some oxygen.

We have seen this pattern in different areas of Italy weeks apart. A few positive cases, first mild measures, people are told to avoid hanging out in groups, everyone says not to panic. Then some moderate respiratory failures and a few severe ones that need a tube, but regular access to the emergency department is still possible and everything looks great. Then tons of people with moderate respiratory failure, that overtime deteriorate and saturate the capability of the ICU’s first, then access to ventilators, then CPAP hoods, then even O2. Staff gets sick so it becomes difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.”

The ability to treat a massive influx of sick people is not possible. We must work on mitigation. If you have been on the fence about the severity of this outbreak previously, get off it, and do your part.

You should be practicing social distancing

You should be minimizing unneeded travel and errands that take you to crowded places.

You should be washing your hands frequently (but not so much as the skin is broken).

You should be prepared for the day-to-day to not look normal

You should buy some extra food and supplies and donate it to a food kitchen

You should NOT hoard anything.

If this does deteriorate over the coming week. If you have friends or family that work in healthcare, consider what you can do and what you can offer to them to help make them as resilient as possible. Day care, a cooked meal...

Be nice. People will be scared. Talk to your kids, their lives will change too....

Importantly, none of this is new. The same precautions apply. Attention to personal hygiene and being ready to reduce interactions is important. Pandemic is a technical label, not a change in the nature of the disease. Pay attention to public health authorities, do not ignore what they ask you to do.

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