05.03.20 at 11:30 am:
Dear friends and neighbors:
Good morning! It’s been a few weeks since my last update on COVID-19 in Boone County and Missouri, so here goes:
(1) As of yesterday, we have 96 positive COVID-19 patients attributed to Boone County (with 1 death) and 8154 positive patients in Missouri (with 351 deaths). You can find the latest data on PPE, ventilators, and hospital bed availability on this public website: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/gov-dashboard.pdf
(2) The CDC recommends that everyone wear cloth masks in public, but it is very important to understand that cloth masks are not a substitute for social/physical distancing. In ALL activities for the near future, please be sure to continue to stay six feet apart from those outside your family. Good hygiene, regular handwashing, and cleaning/disinfecting regularly-touched surfaces is also extremely important.
(3) In the past two weeks, the chief medical officers of both Boone Hospital and the VA Hospital have spoken with our physicians in Boone County. All three local hospital systems are working closely together, and they want everyone to know that:(a) Preventive care, and treating chronic medical conditions, remain very important. Physicians’ offices are still open and doctors are seeing patients via telemedicine virtual visits; if you have concerns about any underlying medical condition, please contact your healthcare provider.(b) Your hospitals are open and ready to take care of you: Hospitals are keeping patients positive for COVID-19 or awaiting results) in restricted areas; using rigorous disinfectant protocols; limiting visitors & unnecessary foot traffic; exercising physical distancing in clinics and hospitals; and screening all patients/visitors/employees for fever before entering the hospital.(c) Please goto the emergency room for medical emergencies. Virtual visits and drive-through COVID-19 testing has improved hospital capacity, to enable the hospitals to serve patients with other urgent needs.(d) Please continue to closely follow CDC guidelines, especially regarding the 6 feet of social/physical distancing in all activities.
(e) There is still much that we don’t know, but our biomedical community has made a lot of progress in better understanding COVID-19 over these past 3 months.
(4) Beware of scams! There are unscrupulous and predatory folks selling defective PPE and antibody tests to the unwary.
– If anyone offers you an “FDA-approved point-of-care antibody test” to see if you’re immune, THEY ARE LYING (and should probably be reported to the attorney general). As of today, there are *zero* FDA-approved diagnostic antibody tests. Everyone thinks that if they have antibodies against COVID-19, that they are protected — but we simply do not know that:
– The problem is in our science: we don’t know that antibodies will actually neutralize the SARS-CoV-2 virus; you need a cellular response (and NOT just antibodies) to have immunity to any virus (for example, having antibodies to HIV doesn’t actually protect you); and even if it turns out that there are protective antibodies, we don’t know the necessary titers/levels of antibodies to be protective — nor how long they might last (which is why you need “booster” shots for certain vaccines). Oh, and viruses mutate….
=> Quite simply, antibody testing does NOT prove durable immunity to COVID-19 at the current time.
(5) Importantly, most public health officials are predicting secondary waves of infection, whether over the summer, or this fall.
– By the way, I personally agree with the idea of opening up the state again (especially as days continue to lengthen, and we get more UV light and excellent ventilation while we’re outside).
– We can all help protect ourselves and each other by maintaining that six feet of social/physical distancing.
– Importantly, we have all been informed that if there is a huge surge of cases, the Governor *is* prepared to “tighten things up” again.
(6) Below are some of my notes from the update that Dr. Randall Williams (our state health commissioner) gave to physicians in Missouri yesterday. Any errors or typos in these notes are strictly my own:
=> There are significant risks to deferring healthcare, so if you have an unusual mole, or rectal bleeding, or a breast lump, there are risks to putting that off for weeks and weeks. Please contact your primary care provider for any health concerns.
– We are starting to do some more elective surgeries; our hospital capacity is pretty good, and we have been stockpiling PPE (and will continue to do so).
– We are now reopening the state, but need to continue with social/physical distancing. For reopening of churches, a family of 10 can all sit together, but the next family needs to stay six feet apart from them. With multiple services on the same day, there should probably be some consideration to cleaning/wiping down hymnals and bibles and other surfaces between those services. We also need to be sensitive to sacraments like communion, as COVID-19 can clearly be spread by saliva.
– Outdoors graduations, like what we saw at the Air Force Academy, are fine as long as everyone stays six feet apart. Whoever is handing out diplomas, if they’re within 2 feet of everyone, should wear a mask.
– “Exhaust fans in businesses are probably *not* a good idea, since that may actually spread the respiratory droplets by which COVID-19 spreads.”
– “We’re doing pretty well, compared to other states like Illinois and North Carolina. North Carolina had its highest number of cases ever on Thursday; Illinois is twice as big as us, but has 7 times the cases and 7 times the mortality.”
– “We are now able to do 60,000 tests per week. We are in the top 16 in the country, for testing capacity, and we are now expanding testing to asymptomatic patients.”
– “There seems to be a propensity for congregated facilities like nursing homes and meat-packing plants (there’s one case of 34 cases out of 3000 employees). There are questions as to whether workers at the meatpacking plants got COVID-19 at work, or on the buses to get to work, or at home (up to 7 workers might live in the same room!).
– “There are a whole bunch of unreliable antibody tests.”
– “If you are positive for COVID-19, that needs to be reported to the health department within 24 hours”
I invite all of you to forward this e-mail judiciously, if you wish.
Stay safe, well, and panic-free,
– Albert Hsu
PS: for the most up-to-date information, please visit <https://www.cdc.gov/>, <https://health.mo.gov/>, and <https://www.como.gov/>
PPS: the article below might also be of interest….
How some cities ‘flattened the curve’ during the 1918 flu pandemic
Social distancing isn’t a new idea—it saved thousands of American lives during the last great pandemic. Here’s how it worked.
3 MINUTE READBY NINA STROCHLIC AND RILEY D. CHAMPINE
PUBLISHED MARCH 27, 2020
PHILADELPHIA DETECTED ITS first case of a deadly, fast-spreading strain of influenza on September 17, 1918. The next day, in an attempt to halt the virus’ spread, city officials launched a campaign against coughing, spitting, and sneezing in public. Yet 10 days later—despite the prospect of an epidemic at its doorstep—the city hosted a parade that 200,000 people attended.
Philadelphia
Weekly deaths per 100,000 from 1918 pandemic above the expected rate
Deaths per 100,000 after
24 weeks of pandemic
748
Duration of social
distancing measures
250
San Francisco
200
Philadelphia waited eight days after their death rate began to take off before banning gatherings and closing schools. They endured the highest peak death rate of all cities studied.
673
Deaths per 100,000
150
150
After relaxing social distancing measures,
San Francisco faced
a long second wave of deaths.
100
100
50
50
0
0
1
8
WEEKS
16
24
1
8
WEEKS
16
24
Sep. 11 1918
Feb. 19 1919
St. Louis
New York
358
452
Deaths per 100,000
Deaths per 100,000
New York City began quarantine
measures very early—11 days
before the death rate spiked.
The city had the lowest death
rate on the Eastern Seaboard.
St. Louis had strong social distanc-
ing measures and a low total death
rate. The city successfully delayed
its peak in deaths, but faced a sharp
increase when restrictions were
temporarily relaxed.
150
150
100
100
50
50
0
0
1
8
WEEKS
16
24
1
8
WEEKS
16
24
RILEY D. CHAMPINE, NG STAFF. SOURCE: MARKEL H, LIPMAN HB, NAVARRO JA, ET AL. NONPHARMACEUTICAL INTERVENTIONS IMPLEMENTED BY US CITIES DURING THE 1918-1919 INFLUENZA PANDEMIC. JAMA.
Flu cases continued to mount until finally, on October 3, schools, churches, theaters, and public gathering spaces were shut down. Just two weeks after the first reported case, there were at least 20,000 more.
The 1918 flu, also known as the Spanish Flu, lasted until 1920 and is considered the deadliest pandemic in modern history. Today, as the world grinds to a halt in response to the coronavirus, scientists and historians are studying the 1918 outbreak for clues to the most effective way to stop a global pandemic. The efforts implemented then to stem the flu’s spread in cities across America—and the outcomes—may offer lessons for battling today’s crisis. (Get the latest facts and information about COVID-19.)
Deaths per 100,000 after
24 weeks of pandemic
Duration of social
distancing measures
Weekly deaths per 100,000 from 1918 pandemic above the expected rate
807
Highest
death rate
after 24 weeks
Pittsburgh
Philadelphia
New Orleans
Boston
San Francisco
Denver
Fall River, Mass.
Nashville, Tenn.
Washington, D.C.
807
748
734
710
672
631
621
610
608
Cities that ordered social distancing measures later and for shorter periods tended to have spikes in deaths and higher overall death rates.
Birmingham, Ala.
New Haven, Conn.
Kansas City, Mo.
Providence, R.I.
Baltimore
Omaha, Nebr.
Albany, N.Y.
Newark, N.J.
Buffalo, N.Y.
592
587
574
574
559
554
553
533
530
Portland, Oreg.
Los Angeles
Spokane, Wash.
Cleveland
Richmond, Va.
Oakland, Calif.
New York
Cincinnati
Seattle
505
494
474
452
451
414
508
506
482
Cities that ordered social distancing measures sooner and for longer periods usually slowed infections and lowered overall death rates.
Lowest death rate
after 24 weeks
Dayton, Ohio
Louisville, Ky.
Chicago
Columbus, Ohio
Rochester, N.Y.
St. Louis
Milwaukee
Indianapolis
Minneapolis
410
406
359
373
358
312
359
290
267
RILEY D. CHAMPINE, NG STAFF. SOURCE: MARKEL H, LIPMAN HB, NAVARRO JA, ET AL. NONPHARMACEUTICAL INTERVENTIONS IMPLEMENTED BY US CITIES DURING THE 1918-1919 INFLUENZA PANDEMIC. JAMA.
From its first known U.S. case, at a Kansas military base in March 1918, the flu spread across the country. Shortly after health measures were put in place in Philadelphia, a case popped up in St. Louis. Two days later, the city shut down most public gatherings and quarantined victims in their homes. The cases slowed. By the end of the pandemic, between 50 and 100 million people were dead worldwide, including more than 500,000 Americans—but the death rate in St. Louis was less than half of the rate in Philadelphia. The deaths due to the virus were estimated to be about 358 people per 100,000 in St Louis, compared to 748 per 100,000 in Philadelphia during the first six months—the deadliest period—of the pandemic.
Dramatic demographic shifts in the past century have made containing a pandemic increasingly hard. The rise of globalization, urbanization, and larger, more densely populated cities can facilitate a virus’ spread across a continent in a few hours—while the tools available to respond have remained nearly the same. Now as then, public health interventions are the first line of defense against an epidemic in the absence of a vaccine. These measures include closing schools, shops, and restaurants; placing restrictions on transportation; mandating social distancing, and banning public gatherings. (This is how small groups can save lives during a pandemic.)
Of course, getting citizens to comply with such orders is another story: In 1918, a San Francisco health officer shot three people when one refused to wear a mandatory face mask. In Arizona, police handed out $10 fines for those caught without the protective gear. But eventually, the most drastic and sweeping measures paid off. After implementing a multitude of strict closures and controls on public gatherings, St. Louis, San Francisco, Milwaukee, and Kansas City responded fastest and most effectively: Interventions there were credited with cutting transmission rates by 30 to 50 percent. New York City, which reacted earliest to the crisis with mandatory quarantines and staggered business hours, experienced the lowest death rate on the Eastern seaboard.
In 2007, a study in the Journal of the American Medial Association analyzed health data from the U.S. census that experienced the 1918 pandemic, and charted the death rates of 43 U.S. cities. That same year, two studies published in the Proceedings of the National Academy of Sciences sought to understand how responses influenced the disease’s spread in different cities. By comparing fatality rates, timing, and public health interventions, they found death rates were around 50 percent lower in cities that implemented preventative measures early on, versus those that did so late or not at all. The most effective efforts had simultaneously closed schools, churches, and theaters, and banned public gatherings. This would allow time for vaccine development (though a flu vaccine was not used until the 1940s) and lessened the strain on health care systems.
The studies reached another important conclusion: That relaxing intervention measures too early could cause an otherwise stabilized city to relapse. St. Louis, for example, was so emboldened by its low death rate that the city lifted restrictions on public gatherings less than two months after the outbreak began. A rash of new cases soon followed. Of the cities that kept interventions in place, none experienced a second wave of high death rates. (See photos that capture a world paused by coronavirus.)
In 1918, the studies found, the key to flattening the curve was social distancing. And that likely remains true a century later, in the current battle against coronavirus. “[T]here is an invaluable treasure trove of useful historical data that has only just begun to be used to inform our actions,” Columbia University epidemiologist Stephen S. Morse wrote in an analysis of the data. “The lessons of 1918, if well heeded, might help us to avoid repeating the same history today.”