Editor’s note: Before getting to Dave’s analysis and recommendations, some of which I think it’s absurd we don’t have in place anywhere and should have been implemented months ago, I will just add some notes about the severity of the situation today. First of all, if you haven’t done so, I think everyone should understand what’s happening in hospitals in COVID-19 hotspots right now by at least reading these to articles:
- This respiratory therapist treats coronavirus in New Orleans. He says the virus is a lot worse than you think.
- What it’s like for a doctor treating coronavirus, in one Twitter thread
By the way, my understanding is that the situation right now in Louisiana is such that people who absolutely need medical care are being blocked from coming to the hospital or in some cases treated outside. The situation will surely get worse. It will also get worse in many places that are behind Louisiana and New York City.
In fact, given when COVID-19 started breaking out in the US (to the best of our knowledge), and given how long it takes for the most severe symptoms to start showing and for people to reach critical condition, I think the story is going to get dramatically, horrendously worse in the US in the coming 2–3 weeks. Getting to the end of this editor’s note/intro, I’ll quote one of our readers, André Balsa, from the comments below:
The correct message right now is something anybody can do:
This will “flatten the curve”.
All of that said, I don’t think it negates or contradicts Dave Lee’s plan below. As he notes, we will have to go back to work in time. As we do, we need strong policies in place to limit infections and to maximize the extent to which we can get back to an operational society.
Extreme “shelter-in-place” orders have been rolled out throughout the country to mitigate the spread of the coronavirus COVID-19. However, these orders are not sustainable, as evidenced by the grievous economic devastation experienced by millions of people.
Going forward we must adapt our plans to be more comprehensive and sustainable in an effort to mitigate the spread of the virus while not causing massive economic despair.
I urge policy makers to adopt the following 10-part comprehensive plan immediately that will protect the elderly and vulnerable, mitigate COVID-19 spread, and safeguard our economy from further calamity. Tens of millions of Americans are counting on our government leaders to take smart measures to get our nation back to work.
1. Shelter-in-place of elderly/vulnerable
COVID-19 is a virus that disproportionately affects the elderly and immunocompromised.
The mortality rate for the elderly is significantly higher than those younger. Thus, it’s important to isolate the core problem we’re trying to solve, namely that is to protect the elderly and immunocompromised while not devastating the economy and the lives of millions already economically vulnerable.
While the younger population still can fall ill and require hospitalization with the COVID-19 virus, the fataility rate for younger people is far lower than for the elderly or for those with existing conditions.
As of March 22, 2020, South Korea has tested 331,780 people with 8,897 confirmed COVID-19 cases. 0.6% of the total population (51.5m) has been tested for COVID-19, making it one of the countries with the highest % of total population tested.
Most of the deaths (over 90%) have occurred for those over 60 years of age. In fact, out of the 331,780 people tested and 8,897 confirmed with COVID-19, they have seen only TWO deaths from people under 50 years of age. Currently, South Korea has yet to see a death of a person younger than 30 years of age with COVID-19.
According to the Italian publication Il Post, as of March 16, Italy saw just 14 deaths for those under 50 years old out of a total 1625 deaths overall. Further, the fatality rate of those with confirmed cases under 50 years old was 0.4% or lower.
Data in every country shows a similar trend, namely that the coronavirus COVID-19 disproportionately impacts the older population. As a result, a shelter-in-place order that targets just the elderly and vulnerable can protect those who need protection the most while not punishing others who need to make a living to make ends meet.
A targeted shelter-in-place order would require the elderly and vulnerable to shelter in home during this pandemic crisis. However, as the elderly and vulnerable “shelter in place,” they will need access to services from safe providers, and also our society must still mitigate the spread of COVID-19 until the release of a vaccine. Thus, the targeted shelter-in-place order must be accompanied with the following measures.
2. Certified safe provider protocol for those servicing elderly/vulnerable
In order for the targeted shelter-in-place order of the elderly/vulnerable to be successful, we need to pair it with a health protocol for those who provide services to the elderly/vulnerable. Some examples are as follows:
The government should require those delivering groceries to the elderly/vulnerable to be recently tested for COVID-19, wear masks/gloves, and sanitize all items being delivered.
The government should require every person entering a nursing home to have a recently cleared COVID-19 test, wear mask/glove, have temperature checked upon entry, and follow hygiene protocols.
By providing a certified safe provider protocol, we can ensure the elderly/vulnerable get the services they need in a safe manner.
3. Workplace health crisis protocol
Many countries in Asia are able to continue allowing companies to operate because they are implementing health crisis protocols in the workplace. We need to borrow strategies from countries that are being successful in mitigating the spread of COVID-19 while continuing to allow their economy to operate
Employees should be required to wear masks at the workplace, have their temperatures checked upon entry, observe social distancing, and have ample hygiene/sanitation supplies available. Further, any employee who shows any possible symptoms of COVID-19 infection should be promptly tested.
The use of masks can help reduce exposure to viruses and can help decrease transmission rate.
“Live influenza virus was measurable from the air behind all surgical masks tested. The data indicate that a surgical mask will reduce exposure to aerosolised infectious influenza virus; reductions ranged from 1.1- to 55-fold (average 6-fold), depending on the design of the mask. — Journal of Hospital Infection, May 2013.”
In fact, many Asian countries attribute mask-wearing as playing a crucial role in their coronavirus mitigation efforts.
By implementing smart strategies such as the use of face masks, temperature checks, and rapid testing (i.e., 45-minute turnaround tests), we can mitigate the spread of COVID-19 while allowing companies to get back to work and employee millions who have lost their livelihoods during the shutdowns.
4. Transportation health crisis protocol
We need to prevent the spread of the virus via our transportation hubs. These measures should be temporary measures exercised only during this time of pandemic crisis.
At airports, we need a health protocol to check the temperature of each passenger before they board the plane and after they leave the plane. We should require the wearing of masks on the plane. Further, any person attempting to fly yet showing a fever or symptoms should take a rapid turnaround (i.e., 4 hour) COVID-19 test.
In taxis and ridesharing vehicles, we ought to require the use of masks and a plastic barrier between the front and rear seats.
While these measures might be inconvenient, they are a fraction of the current costs of economic shutdown.
5. Gathering health crisis protocol
We ought to limit the size of gatherings. And for small gatherings (i.e., 10–20 people) we should require certain health crisis protocols, such as social distancing and masks.
As we’re able to make progress containing the virus spread, we can gradually increase the size of gatherings allowed.
6. Free testing for everyone who wants it
While the U.S. is finally ramping testing, we need more ambitious goals. We ought to provide free testing for everyone who wants it.
When a person can be tested, they can find out whether they have the COVID-19 virus and then take appropriate precautions to limit spread and contact with others. However, with limited testing, people don’t have access to the data they need to be empowered to help prevent the spread.
Jack Ma, an individual, recently sent the U.S. 500,000 tests and Africa 1.1 million tests. Surely, our country can secure millions of tests for those who want them. We must act fast and think outside the box. And we ought to be open to securing tests from other countries as well. We should have a goal of providing testing to at least 10 million people in the next 2 weeks.
“By quickly diagnosing COVID-19, we’ve been able to minimize its spread and provide quick treatment, and that’s kept the mortality rate low. I hope that South Korea’s experience and approach will not only benefit other countries but also lead to greater international cooperation on preparing for the next [viral outbreak].” — Kang Kyung-wha, South Korea’s foreign minister
7. Mask procurement
While this action should have been taken earlier, we still can take action to procure masks for healthcare workers but also for the general public.
China makes 200 million masks per day. South Korea makes 10 million masks per day. Surely, the U.S. can secure enough masks for its citizens (327 million).
We need a goal to secure 1 billion masks in the next 10 days. And we need to stop making excuses for our lack of action. Government and private sector ought to make this a priority. Remember 1 billion masks is just 5 days of China’s production of masks.
In many Asian countries, masks are a crucial part of their successful coronavirus containment strategy.
Masks can help mitigate the spread of the coronavirus by those who are infected but asymptomatic and those who are infected but in their pre-symptomatic incubation stage of infection. More evidence is pointing to asymptomatic or presymptomatic carriers as the source of much of spread of coronavirus.
Further, according to virologist Peter Kolchinsky “exposure dose (to the coronavirus) matters … masks can help anyone, reducing the amount of virus released (even by breathing) or taken in. Immune system is more effective if infection starts with a low dose.”
8. Open source treatment data
We need to pool together more data on how each COVID-19 patient is being treated around the world and how effective the various treatments are.
With more data we will be able to see which treatments are working and which treatments aren’t. To gather this data, we will need to be aggressive in sending people to every hospital in the world to gather data and to establish the means of continued data transmission.
We also need to open source all the treatment data so people around the world can collaborate and improve treatment methods. By doing so, we will be able to treat COVID-19 patients more effectively and lower the mortality rate.
9. Patient choice of treatment
We need to let severe patients choose the type of treatment they will receive for COVID-19. The virus is new and spreads rapidly, so we can’t wait on bureaucracy to approve certain promising treatments (i.e., chloroquine and hydroxychloroquine). Rather, in this time of pandemic, we need to empower the patient to be able to view open source treatment data and to make their own decisions on the type of treatment they will receive. By the government empowering the patient choice of treatment, I think it’s likely we will see an improvement in regard to treatment efficacy and a resulting lower death rate.
10. Vaccine fast-tracking
Companies around the world are working at a breathtaking pace in an effort to develop a vaccine for COVID-19. However, testing and trials take many months. The government ought to be making it a priority to fast-track the testing and trials of vaccines for COVID-19 so that we can expedite the process.
According to current regulations and timelines, the earliest a coronavirus vaccine would be available in the US is in 12–18 months. Once a vaccine begins clinical trials, it can take an additional 3 months to conduct the first stage of human testing and then another 8 months to complete the next stage of the process.
Further, we need to be expanding funding for vaccine efforts for COVID-19, along with bringing together companies in different countries to collaborate on efforts.
Once we’ve made more progress in our country regarding mitigating the spread of COVID-19, then we need to urgently help the countries in the southern hemisphere as they prepare for the winter months. They urgently need testing kits for early testing, masks, supplies, and treatment protocols.
Time is of the essence.
Please share this article with as many people as possible and let’s get these ideas into the discussion with our policy leaders.
We can mitigate the spread of COVID-19 while restarting our economy and allowing millions of Americans to work again. The examples of many countries in Asia show us this virus can be contained and in a sustainable way.
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