If you think you are doing too much, you are probably doing the right amount

You can see the USA plan emerging. As a nation, we are going into various forms of home isolation or extreme social distancing, for at least 2 weeks. This was driven in response to seeing the case numbers rise exponentially over the past week, as well as the large increase in people in serious or critical condition. We only had 64 serious or critical less than a week ago, today we are over 800.

As a country, we have had a terrible response, for example, see Florida and the massive explosion of cases occurring there, and all the ones they are exporting around the country following Spring Break antics.

As discussed previously, our efforts today, will not show themselves for at least 2 weeks. So expect to see the numbers of infected people continue to rise dramatically. But I caution, we cannot read a lot into those numbers. We can now offer more testing capacity, but, we are seriously limited in the equipment needed to acquire those samples (swabs, PPE etc). We have seen that NY state deciding to only test those who are hospitalized. This is in an effort to preserve testing supplies. So while the numbers will rise substantially, it will not give a true reflection of prevalence in our community. A recent article suggested that we were only detecting ~13% of all cases in the USA.

With this 2-week isolation plan, we would expect to see the numbers of new infections start to taper off around the 7th April. This accounts for the minimum time it takes for the virus to move through a household. Roughly 2 weeks after the new case peak, we would expect to see a peak in number of people dying from infection. Mortality usually happens 2-3 weeks after first symptoms appear.

So to be clear, in 2 weeks’ time, we are going to look much worse than we do today. Given that knowledge, I believe it to be overly optimistic to think that any restrictions are coming off in April. On the upside, my belief is we have seen as deep as the restrictions on movement will go (in MA), but I am fairly confident that all of April will look the same with school and business closures.

e.g. quote from the Commissioner of Elementary and Secondary Education Jeffrey C. Riley "my general feeling was that schools will continue to be closed beyond April 7……. Therefore, please plan for school closure beyond April 7th. You will be notified immediately once anything is definitive."

The caveat being that the President is chomping at the bit to let people get back to business (Sunday night’s tweet). “That the cure (lockdown) can’t be worse than the virus (3% dead)”. He is making a calculation that after being locked up for a few weeks that the American people will rather sacrifice a portion of their citizens than give up on economic prosperity and freedoms for any length of time.

So back to the plan.

Defensive plan: The plan appears to be an almost country-wide lockdown for the next few weeks, more likely 4+ weeks, to try and take the air out of the virus’s expansion in our community. This length is supported by Italy’s numbers; it appears that Italy is emerging on the other side of its outbreak, but it took 30 days of highly restricted movement to achieve this result. We must hope that our lockdown has been done soon enough that the number of serious and critical cases will not to overwhelm our health care system. We have been preparing, see efforts at Yale and Gov Cuomo ordered a 50% increase in bed capacity in NYC.

Only when we see new case numbers drop, and know that the health care system can keep up, will some restrictions start to come off.

Offensive plan: Once numbers of cases drop from the lock down, some restrictions can be lifted. But for that to happen, the government will need to be on the offense by testing massively. We must test-isolate-quarantine or we will just go back into the epidemic growth again.

On the news front:

1) it took:

• 67 days from 1st reported case to 100,000 cases

• 11 days for the second 100,000 cases

• 4 days for the third 100,000 cases

2) A stronger association is emerging with smoking and poor outcomes. This is as good as reason as any to quit.

3) The WHO has launched mega-trials on the four most promising treatments. A drug combination used against HIV; a malaria treatment drug first tested during WWII; an antiviral drug that was developed to fight Ebola.

4) There are actually 69 drugs identified to inhibit viral protein interactions.

5) There is a really strong association with outcomes and viral dose. The higher the viral dose on exposure, the poorer the outcomes. Basically, this is why healthcare workers are getting smashed as they are being exposed to a high viral dose in work environments.

6) Interesting finding – 30% of COVID-19 cases reported a symptom of losing their sense of smell and taste

As a final thought. If you think you are doing too much, you are probably doing the right amount.