Sunday, April 5, 2020

Pandemic mode, episode 3

As expected, New York City exceeded 100,000 confirmed COVID-19 cases this week, and fully descended into Coronavirus hell. Watching the train wreck from afar, I could still feel a bit of the pain from the overwhelmed hospitals, doctors, nurses, and morgues-- and the heartbreak of thousands of personal tragedies. Obituaries of prominent people have started to appear. Shortages of ventilators, PPE (personal protective equipment), and beds are becoming acute, and testing shortages continue to plague the health system.

A silver lining is that the doubling time in the US increased from 2.5-3 days to 5-6 days. Most places are starting to see the effects of social distancing measures started 2-3 weeks ago. Though North Carolina confirmed about 1,500 cases this week, that is hardly an exponential rise from the nearly 1,000 cases the week before. Hopefully new confirmed cases will actually number less than 1,500 this week, but we'll see.

Watauga County, and a great many counties like it, has seen a few imported cases but is yet to see local transmission. With over two weeks of social distancing now under our belts, it seems that we passed the first test. The virus did not catch us unawares. Hopefully we will develop the ability to rapidly test for the virus here in the coming week, since it's inevitable that, sooner or later, local transmission will start to occur. But hopefully it will be a low rate of transmission, and we will not need the capacity we have developed at the hospital to deal with a huge influx of Coronavirus patients.

Confirmed US cases now exceed 300,000, though I suspect the real number is at least twice that when accounting for testing delays and untested cases. Soberingly, that represents only 0.1-0.2% of the population, while many experts predict over half the country will contract the virus before it burns itself out or a vaccine is available. With aggressive measures and improved testing, I'm not convinced that's necessary, and hold out hope that a relatively small minority of Americans will contract the virus before we have a vaccine. But again, we'll see.

Despite all the continued uncertainty, many things started to become clear this week. New Jersey, Chicago, New Orleans, and Miami have emerged as the next epicenters of the crisis. Smaller but more concentrated hotspots in the town of Albany, Georgia, and towns in Colorado, Connecticut, and Idaho, exemplify the danger the virus poses to communities of all sizes. A pattern of flare-> social distancing -> curve-flattening -> relaxation of restrictions -> resurgence seems to be emerging from Asia, and I'm sure we will see that pattern start to play out in the coming two months.

Italy's crisis peaked last week and started to improve, though thousands of new cases are still emerging there every day and their nationwide lockdown will continue to be enforced for at least a couple more weeks. A report also came out that the virus has a rapid 4 day average serial transmission time, and that asymptomatic transmission accounts for a disturbingly large percentage of the transmission, making social distancing an absolute imperative and public mask-wearing a very good idea.

Calls for a relaxing of restrictions in relatively spared regions will start to arise in the coming weeks. In fact, a few midwestern and southern states like Alabama, Iowa, and the Dakotas still haven't ordered residents to shelter in place, though that will change if a hotspot emerges in one of those locations. Which seems inevitable. As our ability to rapidly test becomes a reality, hopefully we will see the emergence of a smarter, more targeted approach to social distancing. Until then, stay calm and self-isolate on.






No comments:

Post a Comment