Posted on

March 9, 2020. Tumultuous day due to Covid-19: stock market plunge and Italy and Israel impose radical sanctions

March 9, 2020.  Today, the stock market plunged 2,000 points in one of its worst days in two decades.  Investors are fearful that Covid-19 will cause a global recession.  Meanwhile, the Saudis sparked an oil trade war with Russia, and the global oil market crashed.  Meanwhile, Israel has imposed a mandatory 14-day self-quarantine on anyone entering Israel, and CNN reports that Italy has now imposed a lock down on the entire country.  As Covid-19 continues to spread, the reactions from around the world are troubling, and the endgame on this situation is impossible to predict.

Posted on

March 8, 2020. U.S. Covid-19 cases pass 500

March 8, 2020.  As of today, there are 521 confirmed Covid-19 cases in the United States.  Twenty-one people have died, and the virus has now spread to 33 states and the District of Columbia.  The death toll is more than 3,500 people globally, with over 105,000 infections.  The Grand Princess cruise ship, with more than 3,500 guests on board has been isolated at sea but is now scheduled to dock at the Port of Oakland.  President Trump had not wanted the Grand Princess to dock, although it carried thousands of U.S. citizens, because allowing them back on U.S. soil would raise the number of infected Americans, and the optics for the president would look bad.

Posted on

Covid-19 Bulletin #4

This is Covid-19 Bulletin #4 from Dr. Sheila Sund.  Covid-19, which is the proper name for the coronavirus that is currently spreading around the world, is a far more dangerous virus than the flu (twenty times more lethal than the flu), and it is likely that the rate of infection is much greater than what is known and being reported by the media–because no one knows how widespread the infection actually is.  As of today (March 3, 2020), more than 130 Americans have been diagnosed with Covid-19, and ten have died.  The numbers are growing daily.

Dr. Sheila Sund is a retired hospice and palliative care physician in Oregon.  She became involved with disaster medicine following the H1N1 influenza outbreak in 2009. As part of a statewide workgroup, she helped developed Oregon’s Crisis Care Guidance—guidelines to direct healthcare response during a public health crisis such as pandemic or mass trauma. She served as Director of the Marion County Medical Reserve Corps and physician representative on Oregon’s Region 2 Coalition for Healthcare Preparedness. She has given over one hundred presentations to community, healthcare, and business groups throughout the Pacific Northwest on topics ranging from earthquake preparedness to pandemic response.

 

Chinook CERT Plus – COVID-19 Bulletin #4, March 6, 2020

COVID-19 vs Seasonal Flu

Without a doubt, seasonal flu is a huge health problem. United States experts estimate 32 million cases and 18 thousand deaths from flu – just this year!

But as a virus, flu is “nicer” than COVID-19. A flu patient on average infects only 1.3 other people vs COVID-19’s 2.3 people. Functional time lost from flu averages about 3.5 days, whereas patients with COVID-19 may be sick for 7-14 days. The hospitalization rate for flu in the United States sits around 1% and the death rate rarely exceeds 0.1 %, whereas worldwide estimates for COVID-19 currently stand at 15% hospitalized and 3.4% dying.

Although these numbers are definitely overestimated because of testing patterns, they are still much higher than flu. And while both illnesses are disproportionately bad for older, sicker people, COVID-19 also seems to sicken and kill younger people at higher rates than seasonal flu.

Most importantly, as a society, we’re “used” to flu. Healthcare systems are prepared for it and there’s a reasonably effective vaccine. >55% of the population is fully immune in any given year. Ultimately, most healthy people consider flu an annoyance, not a problem. But we are not used to COVID-19, it is spreading rapidly, and we are definitely not prepared.

Medical Surge from COVID-19

Many parts of the United States healthcare system are overburdened at baseline. They are not capable of handling a rapid increase in very sick patients from COVID-19.

Using Marion County, Oregon, as an example:

  • Licensed hospital beds:  ~550  (~500 at Salem Hospital, one of the four largest hospitals in Oregon).
  • Average occupancy Salem Hospital (2018):   80%  (During flu season, this number can reach 100%).
  • Average “available extra beds” for COVID-19:  ~110.

If we assume 10% of patients require hospitalization, our “extra” beds could be filled by the time we have 1000 local cases (the current estimated number in Seattle).  Although that’s about 45 days from the first local infection, it’s potentially only 10-15 days from the time a local outbreak is first recognized. Care may also be limited by limited critical care beds, ventilators, sick hospital staff, and shortages of supplies and medications.

Meanwhile, at the clinic level, staffing drops from illness, quarantine—and parents staying home with kids when schools closed. At some point, healthcare for all patients could deteriorate, even if they don’t have COVID-19. And that’s one big reason why I personally am far more concerned about COVID-19 than seasonal flu!

Community Spread of COVID-19 – What should you do?

We will not know when COVID-19 arrives here. In fact, it might be here already, given the major outbreak a few hours north. Once in the community, it will spread. Most of the time, you will not know who is sick. It just becomes a game of odds—and your personal approach to risk!

Example: Marion County, Oregon – population ~ 350,000

 

Days into cluster

~Number of cases

~% of county infected

Day 0 (1st patient)

1

Day 30

100

0.03%

Day 45

1000

0.3%

Day 60

8000

2.3%

Day 75 65000

19%

 

No hospitalized patients have been identified in Marion County yet, so we are probably earlier than day 30 which means your odds of picking it up in the community are extremely low. Once it is identified, there may be another 30 days before community risk starts to climb significantly.

Risk will always be higher from what you’ve touched than who you are with—an object carries the risk of everyone who touched it since the last time it was disinfected.

 

COVID-19 Caution Spectrum – it’s your choice where you fall on it

  • Gambler:  Go about your business normally. The odds are in your favor.
  • A Little Cautious:  Follow recommended hand washing and avoid hand contact with others.
  • More Cautious:  Add cleaning and disinfecting routines.  (Particularly objects and settings where things are touched by many people.)
  • Getting Anxious:  Add avoidance of settings with multiple people within 6 feet for >15 minutes.  The greater the number of people together, the greater the risk
  • Quite Anxious:  Add gloves in stores, no group gatherings, work from home
  • Paranoid:  Minimize contact with people

For significant underlying medical conditions or over age 80, move up the caution spectrum!

AT ANY CAUTION LEVEL:  IF YOU FEEL SICK, STAY AWAY FROM PEOPLE UNTIL ASYMPTOMATIC FOR 24 HOURS!!!!

            Do not work. Do not go to school. Minimize contact with family members.

            Wear a mask around others if available (keeps you from spewing germs).

Many cases of COVID-19 will be mild and symptomatically similar to flu and other viral illnesses, yet much more contagious. You can’t tell if you have COVID-19 or a different infection, but you could be spreading it if you go out in public.

If everyone with mild symptoms stays home until better, community spread will slow.

 

Photo credit:  ID 174295771 © Buddhilakshan4 | Dreamstime.com

Posted on

Covid-19 Bulletin #3

This is Covid-19 Bulletin #3 from Dr. Sheila Sund.  Covid-19, which is the proper name for the coronavirus that is currently spreading around the world, is a far more dangerous virus than the flu (twenty times more lethal than the flu), and it is likely that the rate of infection is much greater than what is known and being reported by the media–because no one knows how widespread the infection actually is.  As of today (March 3, 2020), more than 130 Americans have been diagnosed with Covid-19, and ten have died.  The numbers are growing daily.

Dr. Sheila Sund is a retired hospice and palliative care physician in Oregon.  She became involved with disaster medicine following the H1N1 influenza outbreak in 2009. As part of a statewide workgroup, she helped developed Oregon’s Crisis Care Guidance—guidelines to direct healthcare response during a public health crisis such as pandemic or mass trauma. She served as Director of the Marion County Medical Reserve Corps and physician representative on Oregon’s Region 2 Coalition for Healthcare Preparedness. She has given over one hundred presentations to community, healthcare, and business groups throughout the Pacific Northwest on topics ranging from earthquake preparedness to pandemic response.

 

Chinook CERT Plus – COVID-19 Bulletin #3, March 3, 2020

COVID-19 in Oregon and Washington and my concerns about testing

As of today, Oregon has identified three cases of COVID-19, with twenty-seven in Washington. Many are thought to be community acquired. But if you look closer, descriptions of the identified cases are all either:

1) hospitalized with severe illness (including death) or

2) known contacts of other cases.

Despite the risk of community spread, the actual number of tests for coronavirus is quite low—only 25 in Oregon since the first community case was identified on February 28. It is not a problem with testing availability. Oregon can now run 80 tests a day and Washington up to 500.

Instead, state health officials are still following CDC criteria for testing:

    1.  known contacts with fever and signs of lower respiratory illness
    2.  travel from affected areas plus fever, signs of lower respiratory illness, and hospital
    3.  no known contact but fever and severe lower respiratory illness (ie critical care)

 

My opinion:

When testing is limited to these criteria, it is impossible to determine if COVID-19 is spreading in the community:

1) If each patient only infects two others (current estimates), the likelihood of finding both those “two cases” by testing a limited number of contacts is low.

2) Limiting testing to critically ill patients will miss 95% of cases who never get that sick.

Even worse is the danger of “losing” healthcare workers with this approach to testing.

Critically ill patients average 3-7 days in the hospital before testing is performed—yet are infectious the entire time! Dozens of hospital staff from Kaiser Westside in Hillsboro are now quarantined at home after the initial Oregon case was identified in their facility. Similar quarantines are being implemented at other hospitals around the country.

An additional 10% of infections will be hospitalized but never tested by current criteria—thus never identified as contagious.

Besides being unfair, the loss of healthcare workers can seriously impede our ability to respond to outbreaks of COVID-19. In turn, this could lead to a higher overall fatality rate from COVID-19, as well as affecting availability of healthcare for everyone, infected or not.

(Sorry for the rant, but this has caused me more alarm than anything else about COVID-19 so far!)

 

Preparations for community spread of COVID-19

At work:

  • Desktops, tabletops, and counter tops.  Clean and disinfectant (wipes or spray) daily when sitting down
  • Repeat daily – more often if used by more than one person.  Disinfectant should stay wet for several minutes
  • Door handles, phones, keyboards, other objects used jointly:  disinfect daily
  • Avoid handshakes, hugs, and other physical contact with coworkers
  • In meetings, position yourself at least 6 feet away from others when possible.  If not possible, orient yourself away from other people’s faces.   Corner or wall locations can decrease shared “face space.”
  • Go to restroom every hour and wash hands – set an alarm!
  • Also wash hands immediately before eating.

DO NOT TOUCH YOUR FACE

            DO NOT WORK IF YOU FEEL SICK

            DO NOT LET OTHER EMPLOYEES WORK IF THEY FEEL OR ACT SICK

At home:

  • Consider establishing a “dirty area” at the entrance of your house.  Anything from outside the house stops here!
  • Shoes, purses, backpacks, grocery bags (unpack bags from dirty area)
  • Avoid setting anything from outside on counter tops.
  • Groceries and supplies go immediately into cupboards.
  • Thorough hand washing:

As soon as you enter and set down “dirty” things

After putting away purchases

After cooking (and touching “dirty” things) and before you ea’

  • Clean and disinfect tables and counters once or twice a day.  Only if they come in contact with dirty hands or dirty things
  • House door handles, car door handles, steering wheel, other “touchable” car areas:  disinfect once a day (or after outings)

BE PREPARED FOR QUARANTINE!!

If your coworker, friend, schoolmate, or housemate gets coronavirus, congratulations! You may win an immediate fourteen day (or more) forced home vacation, possibly with your family!

You’ll be expected to phone in your temperature and symptoms twice daily. Other than that, don’t expect much help. Better make that grocery run now for fourteen days of supplies. Quarantine could happen tomorrow!

 

Photo credit:  ID 173074233 © Akesin | Dreamstime.com