March 20 update..... and running the gauntlet of international travel

You are going to see a lot of claims over the next few days/week on drugs that work to inhibit the coronavirus. Be hopeful, but don’t read a lot into these claims yet. Many doctors will try their favorite drug cocktail on a limited number of patients and then publish the results. Some will be promising. From these limited tests (5-10 patients), if something works it needs to go into bigger trials to test efficacy. “If” something works, you are looking at a few months before it rolls out. There are some great leads by repurposing old drugs, but it will take time.

Importantly, if taking a drug inhibits the virus’s march through our body, it may also curtail the development of immunity to the virus. You may end up being ‘recovered’ but still susceptible to reinfection. So these drugs, if they work, may be great for the most serious cases (reducing mortality and severity) but they are not a cure.

Australia. Things are accelerating and will accelerate more in the coming weeks as expats come home (today) and become symptomatic. You have tested 3x more people than the USA, with only 8% the USA population. This is great and is why you are in a pretty good spot, but things are still getting away from you. In my brief experience in Newcastle things week, people are talking about the problem, some are reducing travel and social distancing, but for many, it appears to be business as usual. This approach is not sustainable unless you want a massive wave of infected people overwhelming your healthcare system.

It’s great that Australia has closed borders. Most of your cases are and were imports. But now you have human-to-human spread within quite a few communities, so it’s here and it is getting away from you. I feel you have about 1-2 week before you will find serious restrictions on your movement. The virus is still rare in your communities, but we’ve seen from experience what delay does.

If the government restricts movement, tests robustly, and people engage in social distancing (they all have to go together), I feel optimistic about the outcomes for you. It’s really in your individual hands now. Get your home prepared, buy a few extra things (don’t hoard), and wherever possible support small and local businesses. I have personally seen how much small businesses are hurting already.

USA. We are now Italy 11 days ago. Let that sink in. Our federal response in inept, our state responses are better. Some state governors are acting aggressively in the hope of protecting their citizens. Testing is still a huge issue, capacity is improving, but it’s state by state. Some are doing great, others are lagging badly. The governors are leading this (if they chose to).

Why haven’t we heard from the CDC? It’s been 9 days since we have had a briefing from them.... in the middle of the biggest public health crisis to face the USA in decades. It appears they have been sidelined/muzzled. Is it because we do not have a plan? There is no other explanation.

In light of no federal plan, we will see a haphazard approach around the country. This will solve nothing unless we are planning on closing all movement between states. We need a coherent federal response that doesn’t involve dropping cash from helicopters to citizens. Yes, economics are important, but so is biology. Solve the biological problem and then we can back to business as usual.

I have heard our federal leaders say this snuck up on us and we didn’t expect it. Sorry, but I call BS on that. In January, I set the curriculum for my university course for this semester. My class’s project, studying the CoV epidemic in China. If I could see it, and every epidemiologist and virologist on the planet could see it.... where was our national preparedness.

My student‘s corona-board.

Finally, a glimmer of hope in the USA. We have now crossed 15,000 infected, but only 217 dead and strikingly only 64 in critical condition. In comparison, Italy, Spain and France have 1000s in critical condition. Why are we not seeing the same level of mortality and serious cases in the USA?

It’s all speculation. We could be on the precipice of something worse, or hopefully, there may be differences in populations. Potentially, older populations in those European countries. Maybe more multigenerational homes in Europe? A higher prevalence of smoking in Europe? I don’t know the answer but I hope the trend for low numbers of critical patients continues in the USA.

As a final note. My family and I are about to run the gauntlet of international travel in an attempt to get back to the USA from Australia. So I need to focus on the crazy changing travel landscape right now to ensure I get my family home.

I will post as I can.

Be Nice.

Support local. Support our healthcare workers.