Coronavirus Updates

Update 4/4/2020:  Confirmed cases 1,201,933 with 64,716 fatalities. The US has 311,854 cases with 8,452 fatalities. Washington state has 7,591 cases with 314 fatalities. Benton Franklin Health District has 197 confirmed cases, 59 probable cases, and 14 fatalities. Yakima Health District has 326 cases with 9 fatalities. More than 850 hospital employees in Massachusetts have tested positive for COVID-19. Spain passes Italy in case total with 124,870 to Italy’s 124,632. Italy still has higher fatalities with 15,362 to Spain’s 11,818. Germany has 95,614 cases.  France has 89,953 cases with 7,560 fatalities.

Update 4/3/2020:  Confirmed cases 1,098,762 with 59,172 fatalities. The US has 277,467 cases with 7,402 fatalities. The CDC recommends that all Americans wear a mask when the must go out in public. The US unemployment rate rose to 4.3%. US dairy farmers being asked to dump their milk because of supply chain woes. US Navy captain of the USS Theodore Roosevelt was relieved of command after publicly criticizing naval response to the outbreak on his carrier. The captain’s exposure of the incompetence of high military leadership was deemed by those leaders to be “extremely poor judgment.” Washington state has 6,966 cases with 291 fatalities. Benton Franklin Health District has 181 confirmed cases, 54 probable cases, and 14 fatalities. Yakima Health District has 289 cases with 7 fatalities. Italy has 119,827 cases with 14,681 fatalities. Spain has 119,199 cases with 11,198 fatalities, drawing close to Italy. Germany has 91,159 cases. The UK has over 38,000 cases with 3,605 fatalities. France has more than 64,000 cases with 6,507 fatalities.

Update 4/2/2020:  Confirmed cases 1,015,877 with 53,218 fatalities. The US has 245,193 cases with 6,088 fatalities. A record 6.6 million jobless claims were filed last week. Washington state has 6,585 cases with 272 fatalities. Washington state extends stay at home order to May 4th. Yakima Health District has 240 cases with 6 fatalities. Benton Franklin Health District has 171 confirmed cases, 52 probable cases, and 9 fatalities. New Jersey authorizes the commandeering of services and property necessary to fight the virus. NY governor says that new projections show the virus tapering off by August. New York City tells people to wear masks in public. Amazon has banned the sale of N95 and surgical masks to the general public. Philippine President Rodrigo Duterte announced that the military will kill quarantine violators on the spot. Spain has over 112,000 cases and over 10,000 fatalities; Spain’s numbers may be starting to level. Iran passes 50,000 cases. Germany has over 84,000 cases. Italy has 115,242 cases and 13,915 fatalities, but new cases and deaths appear to be leveling out. Italy’s fatality rate remains around 12.1%.

Update 4/1/2020:  Confirmed cases 935,189 with 47,192 fatalities. The US has 215,003 cases with 5,102 fatalities. Washington state has 5,844 cases with 250 fatalities. Yakima Health District has 224 cases with 6 fatalities. Benton Franklin Health District has 141 confirmed cases, 48 probable cases, and 7 fatalities. A six-week old infant has passed away in Connecticut from the virus. Florida issues a stay at home order. Hawaii says everyone should wear a mask when leaving home. Yesterday, President Trump warned the US to get ready for two very painful weeks. Italy has 110,574 cases with 13,155 fatalities. Spain has 104,118 cases with 9,387 fatalities. Germany has 77,981 cases. France 56,989 cases. Iran over 47,000 cases. Japan closes borders to UK and US citizens and 71 other countries. Jia county in China locks down movement after a new outbreak. Israel has asked all Israelis to wear face masks in public.

Update 3/31/2020:  Confirmed cases 854,039 with 42,017 fatalities. The US has 185,270 cases with 3,780 fatalities. Washington state has 5,300 cases with 223 fatalities. Benton County cases are testing positive at a rate 16%, more than double the state average. Franklin county is at double the state rate at 15%. This could be because of limited testing or a deeper problem. In Washington state, Snohomish County is opening an isolation and quarantine site in downtown Everett. Firefighters and first responders are seeking donations of protective gear. Social distancing appears to be slowing the spread in the Seattle area. The number of US deaths has surpassed those from the 9/11 attacks. NY governor says, “It’s more powerful, it’s more dangerous than we expected.” Italy has 105,792 cases with 12,428 fatalities. Spain has 95,923 cases with 8,464 fatalities. France and the US pass China’s total fatalities. Brazil, Portugal and Canada all record over 1,000 new cases, joining eight other countries adding at least four-digit increases per day.

Update 3/30/2020:  Confirmed cases 785,409 with 37,807 fatalities. The US has 164,121 cases with 3,163 fatalities. Washington state has 5,250 cases with 210 fatalities. Yakima Health District has 161 cases with 3 fatalities. Benton Franklin Health District has 97 confirmed cases, 42 probable cases, and 5 fatalities. New York state passes 1,300 deaths. The USNS Comfort hospital ship has docked in New York. Washington, DC issues stay at home order. Italy has 101,739 cases with 11,592 fatalities. Spain has 87,956 cases with 7,716 fatalities. Germany has 66,885 cases. South Korea begins seeing sustained increases in cases again. In some areas of the US and the world, officials are cracking down on what kinds of products may be sold by the stores that remain open, demanding that only “necessities” be allowed for purchase, i.e. no entertainment, educational, or luxury items. EasyJet airline stops all commercial flights. India’s lockdown causes a mass exodus of city day-workers trying to get to their home villages.

Update 3/29/2020:  Confirmed cases 721,562 with 33,965 fatalities. The US has 142,004 cases with 2,484 fatalities. President Trump extends federal mitigation efforts/social distancing recommendations until the end of April. US healthcare workers are beginning to speak out about the shortages of protective equipment, ventilators, and conditions in hospitals. Washington state has 4,392 cases with 195 fatalities. Yakima Health District has 140 cases with 2 fatalities. Benton Franklin Health District has 72 cases and 5 fatalities.  Florida has opened checkpoints on the border to prevent infected individuals from hot spots from entering the state. Texas has opened checkpoints to ensure Louisianans entering the state register and quarantine for 14 days. See one such interview below. Italy has 97,689 cases with 10,779 fatalities. Spain has 80,031 cases with 6,802 fatalities. Germany has 62,095 cases. France has passed 40,000. The UK is now approaching 20,000 cases with 1,228 fatalities.

Update 3/28/2020:  Confirmed cases 662,852 with 30,847 fatalities. The US has 123,428 cases with 2,211 fatalities. The first US infant death has been confirmed in Chicago. A 25-year old man with no underlying health conditions has passed away in California from Covid-19. Washington state has 4,310 cases with 189 fatalities. A doctor in Bellingham has been fired for criticizing the hospital’s virus response. The Yakima Health District has 82 cases with 2 fatalities. The Benton Franklin Health District has 54 confirmed cases and 5 fatalities and and another 21 probable cases. Italy has 92,472 cases with 10,023 fatalities. Spain has 73,235 cases with 5,982 fatalities. Germany has 57,695 cases. The city of Wuhan, China partially re-opens after two months of lockdown. Russia is fully closing its borders beginning Monday. The first NHS surgeon in UK dies from coronavirus after volunteering to work frontline. In India, the lockdown only gave four hours notice; millions have been left jobless, foodless and without money by the shutdown, sparking an exodus from major cities. Continue reading “Coronavirus Updates”

Reminder to Check on Vulnerable Neighbors

There have been some stories shared on social media of people being carefully approached by strangers who are in the high-risk categories for COVID-19 (older adults and people with heart disease, diabetes or lung disease) and asked for help with shopping or other resources, because the strangers are afraid to expose themselves by going into crowded stores themselves. Sometimes they are being given cash and a shopping list, which exposes these high-risk people to both theft and then not having supplies. If you have neighbors whom you know are in a high risk group, it is a good idea to contact them (ideally via a remote method that doesn’t expose them to anything you may be carrying) and ask if you can assist them with any preparations. You could also print them an OK/HELP sign so that they can notify neighbors if they need assistance, and the people for whom they have phone numbers aren’t able to respond to help.

Be mindful that you still need to practice good hygiene to prevent infection in either direction when passing off goods or payment.

Dr. Luks on Covid-19 Personal Risk vs Systemic Risk

The following is a post from orthopedic surgeon Dr. Howard Luks, MD, on Facebook about the difference between the personal risks of the novel coronavirus and the looming systemic risk. Most people have a pretty low personal risk to worry about the virus, but the systemic risk of an overwhelmed health care system is danger in itself.

COVID-19 Update: 3/8/20; 6AM

Confusion and messaging…. Personal v Systemic Risk:

Many people have had trouble grasping the issues we have covered as they try to make sense of it in the context of what they see on TV or read in print media.

Much of what the experts have been discussing is in fact accurate. Your “personal” risk remains very low. The risk to your children’s health is very low. So, their messaging is accurate… but incomplete. The message should be clear… your personal risk is low… period. No one is debating that. The issue that you’re not reading about is “systemic risk”.
The AHA or American Hospital Association is starting to discuss the systems side … see the second picture below for their estimates.

Personal risk aside, the issue that we need to confront, and soon, is the concept of systemic risk. I am referring to the healthcare system. Let’s dive into this again.
An example … Here are some numbers out of Italy:

10 % Lombardy doctors are infected.
At least 1060 patients are self-isolating at home
At least 2394 are hospitalized
At least 462 are in intensive care
197 have died.

The Italian Society of Intensive Therapy declared today: “It might be necessary to limit the age of people who can enter intensive therapy to preserve resources for those having more chances of surviving”. In other words, people who are more at risk will be left to die.

THIS IS WHAT SYSTEMIC RISK LOOKS LIKE.

~ Doctors/nurses getting sick: fewer to care for high numbers of patients.
~ 462 in an ICU…. and we are still very early in the spread of the infection stage. Italy will shut down large cities soon… but it will be too late. How many ICU beds do you think we have available in your community?
~ 2400 hospitalized. In the US, on average, hospitals run 65% full. In many regions of the country, mine included, that number is far higher.
~ Let’s conservatively assume that there are 2,000 current cases in the US today, March 8th. This is about 8x the number of confirmed (lab-diagnosed) cases. We just do not have the ability to test people. Period.
~ Given an R0 of 2( meaning that one person infects two people), and a doubling time of 6 days (one infection becomes two, two becomes 4, etc)
~ That means we’re looking at about 1 Million US cases by the end of April, 2 Million by ~May 5, 4 Million by ~May 11, and so on.
~ yes… math is wonky. and exponential math even more so.

Here are the current models from the AHA: Assumptions are actually conservative. Fatality rate assumption only 0.5%, etc. If that rate rises due to strained resources ….

96,000,000 infections
4,800,000 hospitalizations
1,900,000 ICU admits
480,000 deaths

Compare that to the numbers for the flu ..

35,500,000 infections
490,600 hospitalizations
49,000 ICU admissions
34,200 deaths

This is NOT the flu. Again… yes, your personal risk is low. However, the systemic risk to our healthcare system is huge. So we can change this trajectory… keep reading.

Assume there are~ 1 Million hospital beds in the US, therefore ~ 300,000 hospital beds (not ICU beds) are available in the US (assuming 65% of capacity)
~ It does not take long before our beds are full, and our resources are under strain.

To recap… your personal risk IS currently very low. If you are a young healthy adult your risk of dying from COVID-19 is lower than your risk of driving around today. That risk increases in people with diabetes and hypertension. Men are at slightly higher risk than women, and people over 80 have the greatest risk of dying (~15%).

So the messaging that you are viewing or reading is in fact accurate. Your personal risk is low. No need to panic.

Hospitals are not full right now… hospital resources are available to you. Only a few physicians, nurse, and health care workers are sick. So if you become infected now you will likely do fine.

What happens in a month when 2 Million people may be infected? Our healthcare system may not be able to offer the same level of care to those who need it. Therein lies the risk. This is systemic risk. This is why we need to stretch and bang down the “epidemic curve” or the rate of spread. The healthcare system CAN deal with many sick people arriving over a longer period of time. So we need to stretch the time course out. See the first picture below.

Why we should close schools and dramatically limit social contact via gatherings, events and conferences. It boils down to math… and the need to flatten the epidemic curve.

This is a great article that goes into the numbers and models with respect to lives saved by closing schools, working from home, cancelling gatherings, etc. It is well worth the 5 minutes it takes to read. The third picture below shows the detailed math of how closing schools etc will save lives.

https://www.linkedin.com/…/whats-your-risk-dying-covid-19…/…

So if your school district closes… don’t get on their case. It’s in the best interest of community as a whole. The risk to your child’s health in all of this is negligible. This is not a personal risk issue! I’m watching my own town’s facebook page explode with fear, personal attacks and political rants. It’s a shame. This is not a time for political wrangling. This is the time to act to keep our healthcare system running and our healthcare workforce well to be able to care for you when you or a family member becomes ill.

Yes, hand washing is critical … but it’s time to consider what else we can do to slow the spread. For your communities sake.
– we shouldn’t be going to indoor tournaments
– we shouldn’t be going to concerts
-conferences should be cancelled
– etc
Again… not because your individual risk is high… but because we need to slow the spread to minimize the risk of a systems failure.

For those interested in a deeper dive into the mathematical modeling of the spread of COVID and how it will affect our resources you can read this thread … https://threadreaderapp.com/thread/1236095180459003909.html

Doom and Bloom: Home Care for COVID-19 Patients – WHO Guidance

The Altons at Doom and Bloom Medical have a video up on the WHO recommendations for home care of a coronavirus infected patient who has been asked to stay at home after medical evaluation.

Coronavirus

In situations when hospitals may be overwhelmed or understaffed the WHO has released guidance for Home Care of patients with mild symptoms. All concerned patients should be first be evaluated in a medical facility before home care is initiated. These measures are meant to decrease public contacts and the spread of disease, and decrease the patient load on hospitals during epidemics and pandemics .

Learn which patients may be asked to stay home during illness and when they should be hospitalized. A link to a medical facility should be established for the entire duration of any home home care until all symptoms have cleared and the facility releases the patient and resolved. This connection will allow family members and the patient to be reassured there is contact with a medical professional for questions and concerns.

Home care takes planning and education about personal hygiene, basic infection prevention and control protocols, and how to safely care for the sick person without spreading it to other household members. Recommendations (from the World Health Organization) are detailed in this video. Also see our How To Build A Sickroom video.

Wishing you the best of health in good times and bad,

Related:

Organic Prepper: How to Prepare for Quarantine

Virology Down Under: Past Time to Tell the Public It Will Go Pandemic

Virology Down Under is a website run by Ian Mackay, a PhD in virology. The following article was written for the site by Jody Lanard and Peter Sandman who are experts in risk communication and have written about risks involved with Ebola, Swine Flu and Zika in addition to Coronavirus. In Past Time to Tell the Public: “It Will Probably Go Pandemic, and We Should All Prepare Now the authors discuss the fact that governments should already be telling people to get prepared for a pandemic and banned public gatherings. The time for trying to contain the virus is past and pandemic preparedness is upon us. Don’t expect the government to keep the virus from your door.

In addition to the dangers of the virus itself, people should be prepared for product shortages off all types if the coronavirus goes pandemic. There have already been reports of things like face masks, and some auto manufacturers have warned that factories will need to close because of a lack of parts from China. But there are more common everyday items that are at risk of shortage, too. For example, Procter & Gamble has warned that it may have supply problems with over 17,000 of its products because they are supplied through over 380 companies in China. Procter & Gamble is a huge supplier of consumer products including such brands as Charmin, Crest, Tide, Vicks, Gillette, Pampers, Always, Tampax, Pepto-Bismol, Olay, Old Spice, Secret, and many, many other common household names.

We are starting to hear from experts and officials who now believe a COVID-19 pandemic is more and more likely.  They want to use the “P word,” and also start talking more about what communities and individuals can and should do to prepare.  On February 22, Australian virologist Ian Mackay asked us for our thoughts on this phase of COVID-19 risk communication.

Here is our response.

Yes, it is past time to say “pandemic” – and to stop saying “stop”

It’s a good time to think about how to use the “P word” (pandemic) in talking about COVID-19.  Or rather, it is past time.

It is important to help people understand that while you think – if you do think so – that this is going to be pandemic in terms of becoming very widespread,  no one knows yet how much severe disease there will be around the world over short periods of time.  “Will it be a mild, or moderate, or severe pandemic?  Too soon to say, but at the moment, there are some tentative signs that….”

The most crucial (and overdue) risk communication task for the next few days is to help people visualize their communities when “keeping it out” – containment – is no longer relevant.  The P word is a good way to launch this message.

But the P word alone won’t help the public understand what’s about to change: the end of most quarantines, travel restrictions, contact tracing, and other measures designed to keep “them” from infecting “us,” and the switch to measures like canceling mass events designed to keep us from infecting each other.

We are near-certain that the desperate-sounding last-ditch containment messaging of recent days is contributing to a massive global misperception about the near-term future.  The theme of WHO’s and many governments’ messages – that the “window of opportunity” to stop spread of the virus is closing – is like the famous cover page of Nevil Shute’s On the Beach: “There is still time … Brother.”

For weeks we have been trying to get officials to talk early about the main goal of containment: to slow the spread of the virus, not to stop it.  And to explain that containment efforts would eventually end.  And to help people learn about “after containment.”  This risk communication has not happened yet in most places.

So here is one more pitch for openness about containment.  Officials: Please read Containment as Signal, Swine Flu Risk Miscommunication, which we wrote in 2009.

One horrible effect of this continued “stop the pandemic” daydream masquerading as a policy goal: It is driving counter-productive and outrage-inducing measures by many countries against travelers from other countries, even their own citizens back from other countries.  But possibly more horrible: The messaging is driving resources toward “stopping,” and away from the main potential benefit of containment – slowing the spread of the pandemic and thereby buying a little more time to prepare for what’s coming.

We hope that governments and healthcare institutions are using this time wisely.  We know that ordinary citizens are not being asked to do so.  In most countries – including our United States and your Australia – ordinary citizens have not been asked to prepare.  Instead, they have been led to expect that their governments will keep the virus from their doors.

Take the risk of scaring people

Whenever we introduce the word “pandemic,” it’s important to validate that it’s a scary word – both to experts and to non-experts – because it justifiably contains the implication of something potentially really bad, and definitely really disruptive, for an unknown period of time.  This implication is true and unavoidable, even if the overall pattern of disease ends up being mild, like the 2009-10 “swine flu” pandemic.

Validate also that some people may accuse you of fear-mongering.  And respond that hiding your strong professional opinion about this pandemic-to-be would be immoral, or not in keeping with your commitment to transparency, or unforgivably unprofessional, or derelict in your duty to warn, or whatever feels truest in your heart.

It may help to consider the “damned if you do, damned if you don’t” fallacy.  Feel free to say that “Jody Lanard and Peter Sandman say” that officials or experts – in this case YOU – are “darned if you do anddamned if you don’t.”  You’re only darned if you warn about something that turns out minor.  But you’re damned, and rightly so, if you fail to warn about something that turns out serious.

It’s simply not true, in principle or in practice, that you are damned if you do and damned if you don’t!  Over-alarming risk messages are far more forgivable than over-reassuring ones.

Push people to prepare, and guide their prep 

This is the most culpable neglected messaging in many countries at this point.

The main readiness stuff we routinely see from official and expert sources is either “DON’T get ready!” (masks), or “Do what we’ve always told you to do!” (hand hygiene and non-mask respiratory etiquette).

The general public, and many categories of civil society, are not actively being recruited to do anything different in the face of COVID-19 approaching.

A fair number of health care workers and communication officers tell us their hospitals and healthcare systems are just barely communicating about COVID-19. They want to be involved in how to prepare for “business not as usual.”  We’re guessing that many hospital managements are in fact preparing for COVID-19, but we worry that they’re doing it too quietly, without enough effort to prepare their staff.

Lots of businesses, especially smaller ones, are doing off-the-cuff pre-pandemic planning.  Several trade journals have articles about how specific industries should prepare for a likely pandemic.  Around February 10, the U.S. Centers for Disease Control and Prevention posted interim guidance for businesses.  But we have seen almost nothing in mainstream media citing this guidance, or recommending business continuity strategies like urgent cross-training so that core functions won’t be derailed because certain key employees are out sick, for instance.

Pandemic planning research suggests that employees are likeliest to say they will show up for work during a pandemic if three specs are met – if they think their family is reasonably safe; if they think their employer is being candid with them about the situation; and if they have a pandemic-specific job assignment in addition to or different from their routine “peacetime” assignment.

Hardly any officials are telling civil society and the general public how to get ready for this pandemic.

Even officials who say very alarming things about the prospects of a pandemic mostly focus on how their agencies are preparing, not on how the people they misperceive as “audience” should prepare.  “Audience” is the wrong frame.  We are all stakeholders, and we don’t just want to hear what officials are doing.  We want to hear what we can do too.

We want – and need – to hear advice like this:

  • Try to get a few extra months’ worth of prescription meds, if possible.
  • Think through now how we will take care of sick family members while trying not to get infected.
  • Cross-train key staff at work so one person’s absence won’t derail our organization’s ability to function.
  • Practice touching our faces less. So how about a face-counter app like the step-counters so many of us use?
  • Replace handshakes with elbow-bumps (the “Ebola handshake”).
  • Start building harm-reduction habits like pushing elevator buttons with a knuckle instead of a fingertip.

There is so much for people to do, and to practice doing in advance.

Preparedness is emotional too

Suggesting things people can do to prepare for a possible hard time to come doesn’t just get them better prepared logistically.  It also helps get them better prepared emotionally.  It helps get them through the Oh My God (OMG) moment everyone needs to have, and needs to get through, preferably without being accused of hysteria.

It is better to get through this OMG moment now rather than later.

Offering people a list of preparedness steps to choose among means that those who are worried and feeling helpless can better bear their worry, and those who are beyond worry and deep into denial can better face their worry.

Yet another benefit: The more people who are making preparedness efforts, the more connected to each other they feel.  Pandemic preparedness should be a communitarian experience.  When a colleague offers you an elbow bump instead of a handshake, your mind goes to those lists of preparedness recommendations you’ve been seeing, and you feel part of a community that’s getting ready together.

This OMG realization that we have termed the “adjustment reaction” (see http://www.psandman.com/col/teachable.htm) is a step that is hard to skip on the way to the new normal.  Going through it before a crisis is full-blown is more conducive to resilience, coping, and rational response than going through it mid-crisis.  Officials make a mistake when they sugarcoat alarming information, postponing the public’s adjustment reaction in the vain hope that they can avoid it altogether.

Specific pandemic preparedness messages

Below are links to specific preparedness messaging we drafted for a possible H5N1 pandemic.  The links are all from our 2007 website column What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five.  Each item is in two parts – a draft message (a summary sentence followed by a few paragraphs of elaboration), then a risk communication discussion of why we think it’s an appropriate pre-pandemic message.  Because these were written with H5N1 in mind, the pandemic they contemplate is more severe and less likely than the one we contemplate today.  So some changes may be called for – but frankly, in our judgment, not many.

One of the scariest messaging failures in the developed world is not telling people vividly about what the end of containment will look like, for instance the end of contact-tracing and most quarantines.

The FAQs on the Singapore Ministry of Health webpage (https://www.moh.gov.sg/covid-19/faqs) can serve as a model that other developed countries can adapt to start talking to their publics about this now, to reduce the shock and anger when governments stop trying to contain all identified cases.

What’s working for us

We’d like to share with you some of our recent everyday life experiences in talking about pandemic preparedness with people who perceive us as a bit knowledgeable about what may be on the horizon.  Some of this overlaps with the more generic comments above.

1.      We’ve found it useful to tell friends and family to try to get ahead on their medical prescriptions if they can, in case of very predictable supply chain disruptions, and so they won’t have to go out to the pharmacy at a time when there may be long lines of sick people.  This helps them in a practical sense, but it also makes them visualize – often for the first time – how a pandemic may impact them in their everyday lives, even if they don’t actually catch COVID-19.  It simultaneously gives them a small “Oh my God” moment (an emotional rehearsal about the future) – and something to do about it right away to help them get through the adjustment reaction.

2.      We also recommend that people might want to slowly (so no one will accuse them of panic-buying) start to stock up on enough non-perishable food to last their households through several weeks of social distancing at home during an intense wave of transmission in their community.  This too seems to get through emotionally, as well as being useful logistically.

3.      Three other recommendations that we feel have gone over well with our friends and acquaintances:

  • Suggesting practical organizational things they and their organizations can do to get ready, such as cross-training to mitigate absenteeism.
  • Suggesting that people make plans for childcare when they are sick, or when their child is sick.

4.      And the example we like the best, because it gives every single person an immediate action that they can take over and over: Right now, today, start practicing not touching your face when you are out and about!  You probably won’t be able to do it perfectly, but you can greatly reduce the frequency of potential self-inoculation.  You can even institute a buddy system, where friends and colleagues are asked to remind each other when someone scratches her eyelid or rubs his nose.  As we noted earlier, someone should develop a face-touching app – instead of a step-counting app to encourage you to walk more, how about an app to encourage you to auto-inoculate less!  And track your progress, and compete with your friends, even!

The last message on our list – to practice and try to form a new habit – has several immediate and longer-term benefits.

Having something genuinely useful to do can bind anxiety or reduce apathy.  You feel less helpless and less passive.

And you can see yourself improving.

And you can work on your new habit alone, and also in a pro-social communitarian way.  Others can help you do it, and you can help them.

And it yields real harm reduction!  It is arguably the endpoint of what washing your hands is for, and it helps when you can’t wash your hands out in the world.

Like all good pandemic preparedness recommendations, it helps you rehearse emotionally, as well as logistically.

The bottom line

Every single official we know is having multiple “Oh my God” moments, as new COVID-19 developments occur and new findings emerge.  OMG – there is a fair amount of transmission by infected people with mild or subclinical cases!  OMG – there is a high viral load early on in nasal and pharyngeal samples!  OMG – the Diamond Princess, how can that have been allowed to happen!  And on and on.

Officials help each other through those moments.  They go home and tell their families and friends, sharing the OMG sensation.  And then what do they tell the public?  That they understand that “people are concerned” (as if they themselves weren’t alarmed), but “the risk is low and there’s nothing you need to do now.”

Ian, it sounds like you want to argue on behalf of preparedness.  Encouraging all stakeholders to prepare logistically should start now, if not sooner.  And you are in a position not just to encourage logistical preparedness, but also to encourage government sources and other experts like yourself to do the same.  Perhaps even more important, in our judgment: You can try to encourage emotional preparedness, and try to encourage other official and expert sources to encourage emotional preparedness – guiding people’s OMG adjustment reactions instead of trying to stamp them out.

Related:

The Organic Prepper: The CDC Warns Businesses, Schools, Communities to Prepare NOW for Covid19: “THE DISRUPTION OF DAILY LIFE MIGHT BE SEVERE.”

Pandemic Preparedness for Businesses

This post attempts to gather some resources and information for businesses to make a pandemic preparedness plan. Every business will be a bit different – what applies to a city government will not be the same for a family run espresso bar. In the case of a pandemic, you will need to deal with the possibility of quarantined employees and customers, protecting the health of employees against the possibility of infectious customers, dealing with travel restrictions, possible death of key employees, communication difficulties, and much more. It’s best to at least have an idea of what sorts of problems your business may face before it actually faces them. While the current coronavirus is not epidemic in the US as of yet, you can learn a lot about business effects just by paying attention to what is happening in China and elsewhere.

As part of the planning process you need to:

  • identify core services, and what is needed to maintain the supply chain
  • identify staffing arrangements, such as telecommuting, succession planning and cross-skilling
  • protect the health of staff
  • develop a communications strategy for employees, customers and suppliers
  • consider financial implications, such as cash flow, cost increases and insurance
  • identify contingency plans for the unexpected
  • schedule how the plan will be tested and updated.

CDC Business Pandemic Influenza Checklist (pdf)

CDC Iterim Guidance for Businesses and Employers to Plan and Respond to COVID-19

Pandemic Preparedness for Faith Based Organization (pdf)

AlertFind: Pandemic Planning Templates – several templates linked at this website

OSHA: Preparing Workplaces for an Influenza Pandemic (pdf)

FEMA: Pandemic Continuity of Operations Template (pdf)

EDEN: A Guide to Preparing a Business Disaster Plan For Pandemic  (pdf) – a powerpoint overview

Example plan: Hotel Assoc of Canada Pandemic Plan (pdf)

BizChangers: Business Risks from Pandemics and Epidemics (pdf)

Some AIHA pandemic recommendations

Singapore Manpower Ministry COVID-19 guidelines for businesses and employers.

From NuWire:

Employers Need to Prepare Now

Prudent employers will assemble a pandemic team and plan if they have not done so already. The pandemic team should develop a coordinated and efficient pandemic response plan so that the needed public health information is gathered and transmitted; the communications to managers and employees about operations, cleaning protocols, leave and benefits is consistent and effective; and anticipated disruptions managed effectively while avoiding litigation risks and panic within the workplace.

The pandemic plan should provide pre-established means of communication and planning including:

  • Operational alternatives to shift production to unaffected areas and mitigate disruptions from quarantines and high absenteeism;
  • Education of employees on basic health precautions at work and at home, not reporting to work when sick or exposed, leaving work promptly when symptoms occur, and mechanisms for tracking who is ready to return to work or obtaining employee releases to return to work;
  • Implementing increased prevention and transmission precautions by increased cleaning protocols, disposal of employee tissues and cleaning up after sick employees;
  • Selection of safety equipment for key personnel possibly including masks, gloves and cleaning supplies and equipment, and the educational requirements for its application, use, removal, and disposal;
  • Redesign of procedures and operations to limit the face to face interactions of employees in group meetings, lines at time clock, cafeteria, elevators, etc.
  • Education of management concerning employee communications, transmitting self-disclosed infection information from employees, sending employees home who want to stay at work, and communicating with employees too scared to report.
  • Develop and communicate travel restrictions to any known infected areas.
  • Specific assignments for an emergency response team should include the following in the event that further response is necessary:
  • coordinating with federal, state and local authorities in control of public health and safety in case of quarantines and inoculation efforts;
  • developing and implementing evacuation procedures if they become necessary;
  • preparing facility shutdown check-lists;
  • identifying key personnel whose presence is important to continue vital company functions; and
  • determining methods for communicating effectively with employees.

Doom and Bloom: Epidemic Personal Protection Gear

The Altons at Doom and Bloom Medical have up an article discussing the various personal protection gear that a person would need to wear if caring for a highly contagious patient.

Having knowledge of infectious diseases and how to treat them is very important, but you’ll be more effective in preventing their spread by having some supplies. Which supplies? That all depends on the nature of the disease itself and the risk that the healthy population will be exposed to it.

Before you can be a successful caregiver and heal the sick in an epidemic, you must avoid becoming one of its victims. Viruses can be very contagious (like the airborne common cold) and have a low fatality rate. Alternatively, a disease may have a high fatality rate (like Ebola) and be less contagious (it’s not officially thought to be airborne). Rarely, a really infectious agent may be both very contagious and lethal (like The Pneumonic Plague in the Middle Ages).

In a truly virulent outbreak, healthcare providers are at serious risk. During the Ebola epidemic of 2014, being a medical worker was one of the principal ways to get (and die of) the disease. In 2020, the physician who first tried to warn the world of the coronavirus COVID-19 epidemic was, unfortunately, also one of its casualties.

Because of the risk to medical workers, strict protocols regarding what items a caregiver should wear are formulated and constantly modified based on new scientific evidence. A uniform way to to don (put on) and doff (take off) equipment is very important in safeguarding healthcare providers

PROTECTIVE GEAR TO WEAR

Here is what we think you should wear if you are taking care of a highly contagious patient. First, we’ll discuss which armor would give you the most protection. You should have…

•             Coveralls (with head and shoe covers; some come with hoods and booties built-in)

•             Masks (N95 or N100)

•             Goggles or face shields (to be used with, not instead of, masks)

•             Nitrile Gloves

•             Aprons

Shoe covers and built-in attached booties alone do not give you enough protection. Rubber boots should be worn and can be sanitized between patient encounters.

ABOUT FACE MASKS

N95 non-vented mask

Medical masks are evaluated based, partially, on their ability to serve as a barrier to very small particles that might contain bacteria or viruses.  Masks are tested at an air flow rate that approximates human breathing, coughing, and sneezing.  The quality of a mask is determined by its ability to tightly fit the average human face.  The most commonly available face masks use ear loops or ties to fix them in place, and are fabricated of “melt-blown” coated fabric (a significant upgrade over woven cotton or gauze)…

Click here to read the entire article at Doom and Bloom.

 

The Medic Shack: The N95 HEPA Mask

Peak Prosperity: Coronavirus Is Worse Than You’ve Been Told

Dr. Chris Martenson of Peak Prosperity has a PhD in pathogenic biology. He’s not a practicing doctor, but he does have an understanding of viruses. In this video he gives an overview of the dangers of the coronavirus and explains why the airport screening methods in use are only security theater.

Organic Prepper: Pandemic Preparedness

Daisy at The Organic Prepper has an article up about the Wuhan Coronavirus and what you can do now to prepare. From what is currently known, this coronavirus has approximately a 2% mortality rate. That is considerably lower than some other viruses that have made the news over the years, but while it is low it is about the same as the Spanish Flu pandemic that killed millions around 1918. Should you be worrying? It’s too early to tell right now. We don’t know if containment will be achieved or how easily it may spread. But if not this one, at some point another pandemic will sweep the world causing mass casualties, so it is good to have some preparation for the event.

…In Wuhan, supermarket shelves were empty and local markets sold out of produce as residents hoarded supplies and isolated themselves at home. Petrol stations were overwhelmed as drivers stocked up on fuel, exacerbated by rumours that reserves had run out. Local residents said pharmacies had sold out of face masks.

“When I saw the news when I woke up, I felt like I was going to go crazy. This is a little too late now. The government’s measures are not enough,” said Xiao, 26, a primary schoolteacher in Wuhan, who asked not to give her full name.

Few pedestrians were out and families cancelled plans to get together for the new year holiday. Special police forces were seen patrolling railway stations. Residents and all government workers are now required to wear face masks while in public spaces. Most outbound flights from the city’s Tianhe airport were cancelled. (source)

Those who wish to be prepared should note the speed at which quarantines were put in place in China. Don’t delay placing orders for supplies, fueling up your vehicle, and adding last-minute preps to your stockpile. You may already have many of the supplies you need, so be sure to do an inventory before panic-buying.

However, if you discover you do need supplies, get them now. If you wait until a quarantine is announced, you’ve waited too long and you’ll be out there fighting for resources with everyone else in your area.

Whatever your plan is, don’t delay taking action. Otherwise, you might find yourself in the same situation as 20 million Chinese people who were suddenly quarantined.

Click here to read the entire article at The Organic Prepper.

WSJ: New Coronavirus Spreading Person to Person

Antiseptic being sprayed at Incheon International Airport

A novel (new) coronavirus appeared in China in December, 2019. At that time, it appeared to be spreading from infected animals to humans who spent time around the infected animals. Now, the virus appears to be spreading with human to human contact. There has been a total of 310 confirmed cases of the infection with six deaths. This virus is believed to be much less deadly than SARS, another coronavirus strain.

Wall Street Journal: China Virus Kills Two More Patients as Authorities Step Up Control Measures

A newly identified virus originating in China killed two more people, infected dozens of others and jumped across the Taiwan Strait, bringing the total number of confirmed cases to more than 300 and prompting authorities across Asia to step up control measures.

The coronavirus, which causes pneumonia-like symptoms, has now killed six people in China, authorities said Tuesday, since it first appeared last month in the central Chinese city of Wuhan.

It has also spread beyond the country’s borders to Japan, Thailand and South Korea. On Tuesday, health authorities in Taipei confirmed the self-governing island’s first case of the new coronavirus, a 50-year-old Taiwanese woman who had been working in Wuhan.

Chinese health authorities acknowledged Monday that the coronavirus is being transmitted between humans, heightening concerns that it could spread quickly as tens of millions of Chinese people travel across the country and abroad for the Lunar New Year holiday later this week

Medical workers have themselves been infected. Fourteen medical staff that authorities previously confirmed to have been infected came in contact with a single patient with the coronavirus in Wuhan, said Zhong Nanshan, who is one of China’s most highly regarded epidemiology experts and is leading an expert committee on the outbreak for the National Health Commission.

Wuhan will take more stringent measures to prevent transmission of the disease, including canceling what it considers unnecessary large gatherings, setting up a prevention and control center, and strengthening protection of medical staff, China’s state-run Xinhua News Agency said Tuesday.

Xinhua reported that officials in Wuhan, a sprawling city of 19 million people, would work to minimize public panic by informing citizens about the outbreak in a “timely, open and transparent manner…”

Click here to read the entire article at The Wall Street Journal.

WHO: World Facing ‘Acute Risk of Devastating Disease Pandemics’

Infectious disease doctors have for some time been worried about another Spanish Flu-style pandemic, fearing that the world is overdue for one. This article from The Independent seems a bit engineered to incite alarm, but it is still a good message. A pandemic could arise at any time, and people will probably be surprised when it does.

World facing ‘acute risk of devastating disease pandemics’ which would kill millions, WHO warns

An airborne pandemic could kill millions and wipe 5 per cent from the global economy, according to WHO scientists

An airborne pandemic could kill millions and wipe 5 per cent from the global economy, according to WHO scientists ( Getty )

The world is facing the growing risk of a disease pandemic which could kill millions, and critically destabilise the global economy, an international expert panel of scientists has warned.

The Global Preparedness Monitoring Board (GPMB), a new body assembled by the World Bank and the World Health Organisation formed after the west African Ebola outbreak, has said governments must make considerably larger efforts to prepare for and mitigate that risk.

In its first annual report, the GPMB said there is an “acute risk for devastating regional or global disease epidemics or pandemics that not only cause loss of life but upend economies and create social chaos”.

“The threat of a pandemic spreading around the globe is a real one,” the group said in a report released on Wednesday.

“A quick-moving pathogen has the potential to kill tens of millions of people, disrupt economies and destabilise national security.”

“While disease has always been part of the human experience, a combination of global trends, including insecurity and extreme weather, has heightened the risk. Disease thrives in disorder and has taken advantage–outbreaks have been on the rise for the past several decades and the spectre of a global health emergency looms large.

It added: “There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people and wiping out nearly 5 per cent of the world’s economy.

“A global pandemic on that scale would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared.”

 

Click here to read the entire article at The Independent.

Doom and Bloom: Dengue Fever – A Rising Pandemic

The Altons at Doom and Bloom Medical have an article up on Dengue Fever , its current pandemic status, symptoms, treatment and precautions.

 

  • aedes aegypti mosquito

    Singapore dengue outbreak: Nearly 9000 cases through July – Outbreak News Today

    Nicaragua declares alert over dengue fever – Washington Post

    Bangladesh grapples with country’s worst dengue outbreak – Miami Herald

    Three headlines about Dengue Fever this year? No, actually they’re all headlines just from one day: Aug 1st, 2019. Dengue fever is a true pandemic, with community wide outbreaks in various regions throughout the world. Indeed, rates of Dengue infection are thought to have increased greatly since 1960 due to encroaching civilization and population growth in warmer regions. As a resident of South Florida, I believe that the development of residential air conditioning around that time may have precipitated the explosion in potential victims.

    rash in dengue patient

    What is Dengue fever? It’s an infection caused by a virus that’s transmitted to humans by mosquitoes. If you live between latitude 35 degrees north and 35 degrees south, and lower than 3000 feet elevation, you’re in Dengue territory.

    And you’re not alone. An estimated 400 million people get infected with the Dengue virus every year. Luckily for the grand majority, they don’t even know they have it. 96 million cases, however, aren’t so fortunate and develop sickness.

    The mosquito in question is the Aedes Aegypti, but other species may possibly spread it. A mosquito bites a human with the Dengue virus and becomes infected. It doesn’t get sick, but the virus is now in its saliva for life. The mosquito passes Dengue onto the next human through its next bite.

    Just a few diseases transmitted by mosquitoes

    There are actually four different but related viruses that cause dengue fever, but the symptoms are similar. If you’re in the unlucky minority that gets sick, you can expect to see signs about four to seven days after the infectious bite…

     

Click here to read the entire article at Doom and Bloom.

Eaton Rapid Joe: Fourteen Cows – A Preparedness Story

At the Eaton Rapid Joe blog, Joe has written a series articles about a man in small town trying to get prepared and prepare his neighbors for what he believes is an imminent Ebola outbreak. The series started back in January and runs through this month, so it will take a bit of read to get through. The story is Fourteen Cows.

 And it came to pass at the end of two full years, that Pharaoh dreamed: and, behold, he stood by the river. And, behold, there came up out of the river seven well favoured kine and fatfleshed; and they fed in a meadow. And, behold, seven other kine came up after them out of the river, ill favoured and leanfleshed; and stood by the other kine upon the brink of the river. And the ill favoured and leanfleshed kine did eat up the seven well favoured and fat kine. So Pharaoh awoke.  Genesis Chapter 41

The bulletin boards and forums were on fire with rumors of Ebola having made land-fall in the continental US.

The original posts cited videos that had been quickly yanked off the internet. A typical video was of a middle school basketball game where one of the players  suddenly collapsed and started vomiting bloody fluid.

The CDC felt compelled to issue a statement that the seasonal flu sometimes exhibited those symptoms and to not panic. The CDC claimed to have everything under control.

Rick Salazar had plenty of time to track the progress of the phantom epidemic. He worked the gig economy and was currently in a lull. Also, the middle of January was a slow time on the farm. On nice days he might cut a little bit of firewood but other than that all he did was walk the dogs.

What was distressing to him was that the videos seemed to all originate in San Diego, California and St. Paul, Minnesota. If the CDC’s story was true then the videos should be originating in a semi-random fashion that was roughly proportional to population density.

It only took a few minutes of internet research to learn that San Diego and St. Paul were epicenters for refugees from Uganda and its neighboring countries. IF Ebola was going to show up in the US then it was more likely to show up in those two cities than just about anywhere else.

Rick logged off his computer and took a stroll around the property. He did not like what he saw.

There was nothing wrong with the forty acres. It was fifteen miles from “the city” of 200,000 and roughly five miles from two cities of five thousand each. Nope, the problem was not the property. It was the house and its proximity to the roads.

The house was a scant 150 feet from the road and another road pretty much “T”ed into the front yard. The house was indefensible.

Then Rick rode his mountain bike around the two square miles that contained his forty acres. After that he rode a couple of miles up the road that “T”ed into the road he lived on.

What he saw was that the landscape undulated and there was a high point about every quarter mile. He also saw the reason why the road department decided to end the one road at the T. The two square miles were bisected the long way by extensive muck bottomed marshes. Rick had heard one neighbor say that some of those muck deposits went down thirty feet. Not a desirable roadbed by any stretch of the imagination…

Click here to read at the Eaton Rapids Joe blog. At the end of each installment is a link to the next installment.

The Medic Shack: Pandemics

The Medic Shack has a short article up about preparing for pandemics, Pandemics. The Media, Food and YOU. It is not a comprehensive guide, as he admits in the article; rather, it is meant to assure the reader that the risk is real and how to get a start on thinking about preparation.

A couple of weeks ago I wrote a bit on Typhus in the US. 3 years ago it was barely on the radar. The talk of the town was Ebola. It is making a guest appearance in Congo. Oh guess what. There is a bit of a civil war going on there. What happens when war and deadly communicable disease meet? People leaving to escape the war. And bringing the little friends with them. Cat Ellis The Herbal Prepper and I talked about the dangers of modern air travel and the rapid spread of violent viruses. What we didn’t talk about then was our family car.

Right now Typhus is having a resurgence in California and in Texas. And its coming on the winter travel season. OMG DO WE NEED TO SEAL OUR STATE BORDERS TO PREVENT THE SPREAD OF THE PURPLE CREEPING FUNGUS???????ARRRRRRRRRRRRRRRRRRRGH!

OK. A little melodramatic. But a valid concern.

NO we are not going to start bouncing about in a panic like a fork dropped into a garbage disposal.

Fact is is if a pandemic is going to start there is not much in the 21st century way of life that will stop it. Until we get “Star Trek level Bio Scanners” that will screen and kill pathogens, we need to be smart about protecting ourselves and family

Last year was the deadliest flu season in decades. @ 80,000 deaths were attributed to the flu. CDC Brief on Flu Deaths 2017-2018 (Also NO I am not going to get into the pros and cons of flu shots) I’m just using it as an example of how bad a virus spread can be.

Viruses are not the only “bugs” that can kill us. For people who do not live in the desert southwest or mountain west have not heard much about Bubonic Plague. Except out of history books. My son Jake’s boss at the local blood bank in Anchorage thought he was joking when he talked about how plague kills people every year. Until he showed them the stats.

So how do we prevent the spread of disease or the start of a pandemic when things go bad if the technology of the 21st century can not do it?

Do we isolate ourselves behind walls and barriers? Or do we learn how to stop or at least slow down the spread of disease.

Quarantine.

It is one of, and in all reality the best way to stop the spread of disease. In todays world it is a “dirty word” We say that we need to quarantine Fido for a few days before bringing him to the summer retreat in Hawaii its all good. But when we say we need to quarantine a group of people from Outer LithuUnitedia because the Purple People Eating Fungus is running rampant there. People get up in arms and the cries of discrimination and racism fly though out social media and the 24/7 news outlets…

…This article is one of those that was and is tough to write. In reality it needs to be broken into a host of smaller articles detailing different facets. This one is written to provoke. No promote discussion. Please take the time to converse with me or with anyone about the different scenarios. My email is medic@themedicshack.net Facebook is The Medic Shack or Mewe at The Medic Shack

Pandemics are real. Not the product of imagination. Time is way past to learn how to protect ourselves from them. The first link of the chain, and one that is ALWAYS broken, is. Communication. There is no real, concise, and most of all believable source. But wait! What about the CDC? Yes they send out warnings. But are dependent on the national and local media. Ok so what about the local or national media? Good question. What is the general media talking about. When there is something on the news about illness it is sandwiched between politics, hate crimes and the Hollywood Who’s Who. Do a news site search for the current Ebola outbreak in the Congo. See what you find in the news.

As I said earlier. I have no intention of doing the fork in the garbage disposal routine of panic. I am just wanting to pass on information. The most powerful weapon we have is not our weapons. Its our mind. We need to employ it. And to employ it we need to arm it. Knowledge is ammunition. And used correctly it is the most powerful weapon and more importantly, the best tool for survival.

Cat Ellis The Herbal Prepper has written a book on pandemics. Its called Prepping for a Pandemic and its on Amazon. Get a copy and read it.

Click here to read the entire article at The Medic Shack.