TPM Reader RS is a physician in California …
At my hospital, it feels like the proverbial calm before the storm – we have not seen many COVID-19 cases yet, but the numbers are increasing and we are watching the news from Seattle and NYC with grim anticipation. All our effort is focused on preparation right now – sorting out testing challenges, developing diagnostic algorithms, building staffing models, and trying to calm the fears and anxieties of patients, families, staff, and colleagues.
I will try to graph this later. But a quick point I wanted to flag. There is some possible – I stress possible, not at all certain – that the horrific outbreak in Italy is starting to slow down. Over the last three days the number of new infections have tracked down from 6,557 > 5,660 > 4,789. The fatality numbers have tracked 794 > 651 > 601. If the 21st was the peak day, that would be 13 days after the lockdown in Lombardy on March 8th (followed by a national lockdown a day later.)
This is notable because the number days between the lockdown of Wuhan and the peak day of new infections in China was 12 days.
We’ve heard a lot of conflicting and confusing information in recent days about testing. Public officials in different areas have announced that the time for testing has passed and in some areas efforts at mass testing – drive through testing, and such – is being scaled back. This comes after a couple weeks when rapidly expanding testing was the central focus of preparedness, containment and mitigation efforts. On Sunday longtime TPM Reader BB wrote in that he “can’t quite get my head around what we think wider testing is going to accomplish” and then listed a series of critical reasons why officials in hot zones are now in some cases moving to limit testing.
Let me try to answer this by ‘answer’ here I am simply trying to synthesize as best I can the thinking and arguments of public health experts and clinicians whose reports and commentary I am following as closely as I can.
You’ve likely heard the story about how the Peace Corps has not only withdrawn its more than 7,300 volunteers from countries around the world but also fired them. All of them. Immediately. Evacuation was probably inevitable and wise – though it seems reasonable to ask whether some volunteers may have been safer remaining in country than returning to the US. The decision to fire them all summarily was callous, gratuitous and inane.
But I wanted to TPM Reader MA’s story of his son’s rushed evacuation from Peru.
So I am a long time reader and member at TPM, and I thought I would share my son’s crazy story of getting out of Peru as a Peace Corps Volunteer.
As you know Peru went on total lock down this week. Before that my son and other PCV personnel had traveled to Lima from their home sites to hold their Completion of Service (CoS) ceremonies. My son’s last day in the Peace Corp was slated to be May 22nd. So, they had their ceremony and then last Saturday night before they were to head back to their sites, they got an email from their local director that they should stand pat; no one was going to travel until further notice. Inadvertently my son also got an email of a screenshot between some higher ups that that an evacuation order was coming worldwide.
Just this week’s reminder that all of our COVID-19 Crisis coverage is outside the Prime paywall. We will continue this for the duration.
A bit more on donating personal protective equipment to local hospitals and care providers … As I noted, many of us have at least small supplies of these things in our homes. I used to have boxes of n95 masks for woodworking. Maybe you have a few boxes of latex or nitrile gloves for some home DIY project. Some readers have noted that in areas where hospitals are not yet under great stress they don’t want donations because they can’t validate the chain of custody of the materials. But in other areas with emerging locals epidemics they are desperate for really anything people have on hand. Google your local hospital or state health department. You’ll likely quickly find out what’s needed in your community.
We are getting more information about the demography of COVID-19. I have not yet seen detailed age and gender breakdowns nationwide. But the chair of the New York City Council’s health committee just tweeted out a breakdown of the fatality numbers so far out of New York City. The total numbers remain small in statistical terms though heartbreaking in the metric of individual people’s lives, with 99 people succumbing to the disease in the city.
TPM Reader BB makes a good suggestion. Do you have personal protective gear you can donate? If you do maybe you’ve thought of this. But many hospitals around the country are now asking, begging for contributions. Perhaps you have latex or nitrile gloves for some other work you do. When I used to do woodworking I had a ton of n95 masks. I pitched them all when I had to close up my workshop. But many of you who’ve done woodworking or various fix it projects that use toxic chemicals might have them. Think about it. I bet there’s a hospital nearby that may need them.
Senator Rand Paul’s twitter account just announced that he has tested positive for COVID-19 and is now in quarantine. The Twitter announcement says that he is currently asymptomatic. He appears to be the third members of Congress and the first Senator to test positive.
A new article authored by a group of physicians in Bergamo, Italy proposes a radical theory of the COVID-19 outbreak and how it must be addressed. (It is published in a new peer-reviewed journal from the New England Journal of Medicine. Article here; write up in StatNews here.) The authors write that “Western health care systems have been built around the concept of patient-centered care,” but that doctors must now move to “community-centered care.”