Sunday, March 29, 2020

How Did We Get Here?



An old photo looking back at NYC, from a train headed north.
My heart goes out to you, New York.
Every storm runs out of rain.

***Post updated 4 April 2020


***Disclaimer: I am neither a Physician nor an Epidemiologist, but I am a scientist and I can read.

Like many of you, I wake up each morning and ask, “How did we get here?” Things seemed to change overnight, and yet they didn’t. There were plenty of people trying to sound the alarm, but again people have refused to listen to science, and instead trusted their leadership, and outside a few bright spots in this – folks like Massachusetts Governor Charlie Baker, Boston Mayor Marty Walsh, New York Governor Andrew Cuomo, LTG Todd T. Semonite, and Dr. Anthony Fauci – there has been a failure of leadership at practically every level, and a delay in taking action.

***
There are a couple of really good articles that detail the timeline:

Abutaleb, Yasmeen, Josh Dawsey, Ellen Nakashima, and Greg Miller. 2020. The U.S. was beset by denial and dysfunction as the coronavirus raged. The Washington Post. 4 April 2020.

Schumaker, Erin. 2020. Timeline: How coronavirus got started. ABC News. 25 March 2020.

***

All through January and February, there were the continued reports out of China, and the extreme efforts taken there to try to contain the virus. But, as early as 31 January, the first two cases had been confirmed in Rome. And by 1 February, the Diamond Princess cruise ship reported its first confirmed case, which would lead to the multi-week saga of the quarantined passengers on the ship docked in Yokohama, Japan. It had gotten out.


16 February 2020. The US Embassy announced they would bring home the US citizens onboard the ship for treatment and quarantine.

25 February 2020. In a press conference, Dr. Anne Schuchet from the CDC said:

“Current global circumstances suggest it’s likely that this virus will cause a pandemic. It’s not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen, and how many people in this country will become infected, and how many of those will develop severe or more complicated disease.”

Alex Azar, Secretary of Human Health Services stated:  

“Abroad, this is spreading quite rapidly. In the United States, thanks to the President and this team’s aggressive containment efforts, this disease as Dr. Schuchet  said, is contained. As we’ve always said, we expect to see more cases.”


By this time, Italy had recorded 10 deaths and a total of 322 cases, and Iran had experienced a second cluster.

26 February 2020. First case of locally transmitted COVID-19 in California, unrelated to foreign travel (Schumaker, 2020).

28 February 2020. President Donald Trump, speaking at a campaign rally in South Carolina, called the Democrats’ criticism of his coronavirus response their “new hoax.”



True, the wording in his speech is ambiguous, and it’s not clear whether President Trump was saying that the coronavirus itself was a hoax, or the fact that Democrats were talking about it in their speeches and “politicizing” it. Either way, the problem is that words matter. President Trump’s blatant disregard for the potential hazard had a grave trickle-down effect in Government. For a president who values loyalty above all else, everyone knows that disagreement is not an option, if one wants to stay in the game.

President Trump’s early dismissal and false reassurances that the coronavirus was contained and would go away set the wheels in motion allowing continued spread, in the absence of rigorous testing, which was not available, and delayed action across the country at all levels of Government. 

For example, New Orleans Mayor LaToya Cantrell said they never considered canceling Mardi Gras because the message from the Federal Government was that the virus was contained, and there was no warning otherwise (Finch, 2020; Montgomery, Cha, and Webster, 2020). New Orleans has become a new hot spot due to revelers unwittingly spreading the virus there. Mardi Gras (Fat Tuesday) was on February 25th.



Later that same week, in a similar way, Biogen proceeded with its conference in Boston 26-27 February, leading to a cluster of cases in the Boston area that grew from three cases to nearly 100, and likely continues to spread.

The following series of video shows the progression of President Trump’s messaging, saying that it would go away, “like a miracle,” and that everything was well under control.


6 March 2020. President Trump visited the CDC and said that “anybody that needs a test can have a test,” and Alex Azar promised “up to 4 million test kits available in the United States by the end of next week.” It’s the end of March, and we’re still waiting.


11 March 2020. WHO declared a global pandemic. That night, President Trump made an Address to the Nation, and appeared to finally grasp the severity of the situation.


12 March 2020. US declared a National State of Emergency.

What changed? A lot of people theorize that someone finally got President Trump’s ear, and showed him the predictions scientists were making about fatalities and number of patients requiring advanced care, such as ventilators.

16 March 2020. The Imperial College Report was published (Booth, 2020; Ferguson, et al., 2020). Authored by Neil Ferguson’s group, the report predicts death rates, based on modeling the effects of mitigation, virus transmission, and severity of cases. In some ways it’s not so different from modeling the flow of groundwater through a porous media, such as a sandy aquifer. In this case, the model requires knowledge of the virus properties, and how the population helps or hinders its transmission. By social distancing, we can be more like clay, and less like sand and gravel, and slow the flow.


Here’s a link to the report, and you can read it for yourself.


It is painfully ironic that Neil Ferguson himself recently contracted the virus, and I wish him well as this crisis now hits close to home for him.

I am also grateful to all the healthcare workers and all those on the front lines – grocery store and restaurant workers, pharmacies and delivery persons – for taking care of us, while we stay home.

***The President presented predictions on possible number of fatalities this past week on 31 March 2020, as if it were new news, but the math has been out there literally for months. The numbers out of China showed a fatality rate of about 2 to 4 percent of diagnosed cases. And we’ve been told that we can expect that eventually 40 to 70 percent of the Earth’s population will eventually contract the virus. So, let’s say the US population is 327 million, and to make the math easy, let’s just call it 300 million, and let’s say one third of the population gets infected, i.e., 100 million people. Eighty percent will have mild symptoms or no symptoms at all, and will probably not even be tested. The other 20 percent will have more severe symptoms, and these cases probably account for the bulk of the diagnosed cases in the US right now (test positive). For these 20 million cases, even with a one percent mortality rate, this would result in 200,000 deaths. If two thirds of the population gets it, just double this number. If the virus is more lethal, the numbers could double or even triple. These are just back-of-the-envelope calculations that people were doing even way before the Imperial College report came out.

***

The numbers continue to climb. The US has over 100,000 confirmed cases, and 2,000 deaths. Massachusetts has over 4,000 cases, and 44 deaths, when it suffered its first death only one week ago. The true number of cases is likely at least twice that, if not tenfold, given the limited testing. For every confirmed case, there are probably at least a half dozen or more cases where people had mild symptoms or no symptoms at all.

Which is why for now we have to act as if any one of us might have it.

***
A week later (4 April 2020) and the US is approaching 300,000 cases, and over 7,000 deaths.

***

It must be hard for places in the Midwest and elsewhere that are a week or two behind us. New York City is a week or two ahead of us, and offers a chilling preview of what might be to come.

There is hope.

People who have already had the virus might have immunity, we’re told. Imagine what you could do, if you had immunity. We could go where others dare not tread. In addition to increasing testing to determine who has the virus, it may be equally if not more important to test to determine who has immunity. Ironically, as I was scratching this very thought out, pencil on paper, the CBS News Sunday Morning show aired a segment by Dr. John LaPook this morning, suggesting the very same thing. 


Because, eventually there will be a vaccine, and eventually the virus will run out of new victims, just as every storm runs out of rain.

Song for the day: “Every Storm (Runs Out of Rain),” by Gary Allen.

#MoreTestingLessSpreading


***
A big THANK YOU to Governor Charlie Baker and Robert Kraft, for using the Patriots plane to fly over a million N95 masks back from China in an extraordinary humanitarian mission. THANK YOU!!!

***

References

Booth, William. 2020. A chilling scientific paper helped upend US and UK coronavirus strategies. The Washington Post. 17 March 2020.

Ferguson, Neil, et al. 2020. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College COVID-19 Response Team. 16 March 2020.

Finch, Chris. 2020. Video: New Orleans Mayor Cantrell says city saw no reason to cancel Mardi Gras, needs medical supplies. Fox8. 28 March 2020.

LaPook, Jonathan. 2020. Dr. Jon LaPook on the value of antibody tests for past coronavirus infection. CBS News Sunday Morning. 29 March 2020.

Montgomery, David, Ariana Eunjung Cha, and Richard A. Webster. 2020. ‘We were not given a warning’: New Orleans Mayor says federal inaction informed Mardi Gras decision ahead of covid-19 outbreak. The Washington Post. 26 March 2020.

Schumaker, Erin. 2020. Timeline: How coronavirus got started. ABC News. 25 March 2020.

© 2020 Rosemary A. Schmidt
Rose Schmidt is the author of “Go Forward, Support! The Rugby of Life” (Gainline Press 2004). The views expressed herein are solely those of the author, and do not reflect the views of any other agency or organization. Use of individual quotes with proper citation and attribution, within the limits of fair use, is permitted. If you would like to request permission to use or reprint any of the content on the site, please contact me. Twitter: Rosebud@GainlineRS


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