On Restrictions

I get it:

• We want and NEED to get people back to work. The toll on the individuals and the families who cannot work from home is nothing short of catastrophic.
• We want to go to the park, to concerts, to sports.
• We want to get out .. I know I miss my haunt, but while I cannot go there, I’m able to support the business and the staff through curbside pickup (remember to tip the staff!).

Walking and running, being mindful of physical distancing are necessary substitutes, but nothing like the old days. I get this .. we all get this.

We have to respect this. COVID-19 attacks the respiratory system and it attacks rapidly. The outcome? At best, we have mild symptoms and get well. But, a critical case needs oxygen .. the worst cases, a ventilator.

Asymptomatic spread is the biggest risk to us all. Combined with the lack of testing, spread makes us really blind to where the virus is now, and to where it’s spreading. You can be spreading and not even know it. There is an upside: if the less-vulnerable (several definitions for this) are spreading the virus to other less-vulnerable, they may gain levels of immunity. But we have to ask ourselves: are the risks to more vulnerable worth spreading the virus .. given we do not know who has it today?

They’re not. They’re just not. Without testing .. without knowing who has self-resolved or who is currently testing positive, we need to continue and be diligent with our precautions: “Behave Like You Have It ..“, because you might.

Don’t get me wrong: We’re seeing a plateau. A plateau is good .. but it’s a plateau, and in itself, not a decline. It indicates that fewer cases are coming into the top of funnel .. tragically, too many cases are exiting the funnel by passing on. Too many people dying, too many impacted families.

But the saddest part? The deaths are the only number in the funnel that we absolutely recognize, because we lack testing capabilities. Disconnects between manufacturing the tests, delivering the tests and processing the tests are severely impacting our ability to truly understand our status.

The restrictions imposed on us are there for all of us. Your following them protects both you and me, and those you and I both love. Not following them will likely lead to a second wave, which could exceed the severity of our situation now.

We must avoid a second wave.

Stay connected. Stay safe. Stay home.

Bottlenecks

Long one today .. I’m guessing I am the bottleneck .. lots of things happening (and I’m still a day behind).

Regardless of whom is responsible for the virus, the response(s) or any of the other chatter .. It doesn’t matter at this point. Let’s face forward and get through this. We can do it.

On bottlenecks. First, it was testing kits. Then, beds .. then, ventilators. Then, PPE and Healthcare Staff.

• Happily, the Fed got engaged and converted convention centers to hospitals, sailed two hospital ships to hotspots, pushed companies to produce equipment and deployed military hero doctors to augment our healthcare heroes (oversimplified for brevity).
• The States rallied their resources, and after lots of contention, managed to reduce the spread, why responding, albeit in crisis mode.
• More happily .. the American people stayed home. It doesn’t matter who told us to do it (there were a lot of things being said by a lot of leaders) .. ultimately, we followed logic and common sense. We stayed put .. we got smart, if not for ourselves, for the ones we love. We stayed put and respected in-public guidelines for necessary trips.

Then, the curve shifted. Projected deaths (worst-case, of course), fell from 2.2 million to ~100,000 .. still a horrifying number, to be sure. Hospital admissions and intubations are all down. I covered off on this in “The Numbers are Good ..“. On that:

• We didn’t need all the beds. Excellent. Resources could be deployed elsewhere.
• We didn’t need all the ventilators. Even better: we can share with other countries who are not as well-equipped as we are.
• After managing in crisis mode, we were able to relieve the healthcare heroes with military hero doctors.

We still need testing kits .. while there are a lot of them out there, there are lots of variants, spread about in a lot of places. This still needs to be centrally-managed, as does how, and who can receive a test.

We still need ways to test everyone who needs a test .. I’ll detail below, but who “needs” a test needs to change dramatically. A quick summary (for more detail, please see “Testing, Testing, Testing“) .. some new, and some adjusted terms:

• Diagnostic: A point-in-time test that returns Positive / Negative for COVID-19. Typically administered to people with symptoms and critical asymptomatic individuals.
• Antibody: Detects antibodies in your system which will be present if you’ve had COVID-19, and may be immune to reinfection. Typically administered to people who have recovered, but could be expanded to individuals who think they’ve had a mild case at a point in the past.
• Sentinel: Broader test methodology that administers Diagnostic tests to asymptomatic individuals. This test looks for positive results that will identify groups for Contact Tracing to uncover more positive results. This will help to identify the spread.
• Contact Tracing: This methodology retraces the steps of a person who tested positive to determine with whom they interacted. Tracing helps to determine who may need to receive a Diagnostic test. This tracing will reveal suspect clusters that may be geography, social, workplace, school and so on.

Then, the test flow:

• Take the test .. requires a swab of nose or throat, saliva or blood (depending on the test).
• Process the test .. requires a lab.
• Lab processing requires reagents (chemicals that facilitate detection), as well as other materials.
• Get results.
• Act on the results (typically quarantine).

Again, lots of variants of these tests from different manufacturers .. variants on processing capabilities and capacities in various labs, but overall, tests can be processed.

So .. who should be tested (besides EVERYONE)? The science suggests:

• Folks with symptoms should be tested using the Diagnostic test.
• Folks without symptoms should be tested with the Diagnostic test as Sentinels. If positive, invoke Contact Tracing. Note that asymptomatic people are reservoirs for the virus .. they store it and spread it, and evidence is suggesting they are at their peak contagious levels before they show symptoms.
• Folks who have gotten over it should be tested with the antibody test.

Some good testing news: “Hundreds of Detroit cops back from COVID-19 quarantine” .. because they were tested. These are officers and firefighters who were quarantined because they were exposed .. We need this in all 50 States and territories straight away.

But now, bottlenecks remain:

• Is the test kit you need available in your area?
• If it is can you get it?
• Can the test be processed in a practical amount of time?

Kits and capacity. But even if the kits exist, the capacity to process the tests at an industrial level simply isn’t there. Yes: you can get a test, but you may not be able to get it processed.

For now. We’ll get this sorted with the proper levels of management and coordination between The States and The Fed.

Stay connected. Stay safe. Stay home.

The Numbers are Good ..

We Are All Heroes ..

.. we are.

• Healthcare Workers are Heroes.
• First Responders are Heroes.
• Drivers, the Delivery Folks, the Stockers, the Cashiers, the Curbside, their Managers, their Franchisees, their Support Staff ..
• Employers who tell their staff to work from home ..

.. everyone who stays home, keeps us home, keeps us healthy, diagnosed and referred .. keeps the supply chain open .. paychecks flowing .. documents for the assistance to companies from the Federal Government and many, many more.

I’m a Hero .. You’re a Hero .. anyone who stays home and restricts our outings to only the most necessary. Anyone who orders in and over-tips to support the restaurant and the drivers. Anyone who watches the marks on the floor at the Costco, Trader Joe’s, Whole Foods and their ilk .. are Heroes.

Be a Hero. We are doing the right thing.

Stay connected. Stay safe. Stay home.

Back to Basics

So .. we need a vaccine. Something that is preventative .. a prophylactic.

This may look like a flu shot, where data drives what’s in it, and data that advises for how long it will last. This is the ultimate assurance that the population is protected.

From the NIH (Dr. Fauci’s organization), look at how vaccines have changed the world: “The contribution of vaccination to global health: past, present and future“.

Winner, winner, chicken dinner. This gets us back to normal.

On the not-so-basic side:

• We need to know who is immune and cannot infect others. It’s especially important that they not transmit the virus, which is unknown at present.
• We need to know that regardless of our status, have we been exposed? This is unlikely something that can be tested, but Apple and Google are working on a Coronavirus tracking tool. From The Verge: “How you’ll use Apple and Google’s coronavirus tracking tool“. My concern: if I’m in the same place (like a store) as someone with a positive status, will this produce a false positive for me?
• Last, therapy. Where if you catch it, there is a treatment to help you get over it. Which in turn, gives you the antibodies to provide yourself immunity (the top bullet).

Vaccines are 12-18 months out. Serology may happen ‘this week’, but initially, only for critical workers. Apple and Google will likely be pretty fast, but a lot of unknowns therein at the moment. Therapy doesn’t really exist yet.

Our current solution is avoidance .. and it is working. Plateaus are visible. We need to keep it up.

Stay connected. Stay safe. Stay home.

The ‘New Normal’ .. ‘New-New Normal’?

One might even say: “Nanu-nanu“.

We know the ‘New Normal’:

• We practice “Distancing .. Physical, not Social (please)“
• We “Behave like you have it ..“
• We practice “Stepping Up“, helping each other
• We “Respect the Mask“.

At this point, we must recognize “What we are doing is working ..“. Not just to continue, but to double-down on our efforts. We can see “the progress confirms the strategy is working” from NYC Mayor Bill de Blasio.

Once “Testing, Testing, Testing” is widely available, what does the ‘New New Normal’ look like?

Well, until a working vaccine is available AND we verify “The Resolved” aren’t carrying the virus with them, before going out they must (an abbreviated list):

• Take their temperature when they awaken and again when they get to work.
• Wear a mask to work.
• Wear a mask at work, unless in a confirmed private office.
• Wear a mask to the restroom.
• Consider keeping the mask on in their confirmed private office.
• Take their temperature.
• Don’t congregate with other employees.
• Wear a mask back to home.
• Take their temperature when they arrive.
• Shower.
• Wash their day clothes.
• Change into night, ‘home only’ clothes.

Employers must provide better ventilation, improve filtration and manage public facilities, perhaps as far as separate kitchens, restrooms, areas of the building or pathways.

I’m sure the CDC will do a significantly better job than have I.

The limited opening in Wuhan (I’ll talk about this later) may be fueling our irrational exuberance to return to normal .. I hope for expert heads to make these decisions.

Oh .. if ‘The Resolved’ can carry and shed the virus .. will we have a ‘New New New New Normal’?

Stay connected. Stay safe. Stay home.

Testing, Testing, Testing

It’s not just ‘the’ test .. the one that confirms whether you have the virus (‘tested positive’) or not (‘tested negative’).

I started this thought in No Magic Bullet .. six days ago (sheesh .. has it only been six daze?) .. let’s work through it.

It gets pretty granular:

• Diagnostic Test: Referred to, above. It is a Point in Time test, ideally, performed often (before or after encounters, activities, going outside and so on). It gives you a positive or negative result only at that point in time. Technically, you’d have to re-test any time you changed places (work to home to the grocery store to anywhere), encountered someone new (or someone you encounter regularly encounters someone new), etc., etc. The most common use today is to test healthcare workers prior to their shifts. It’s not really practical for the rest of us. While reliable, the risk of the time between exposure to incubation (and therefore, detection) is still unknown.
• Antibody test: This is for the “The Resolved“. Those who have contracted the virus and survived it. Far fewer of these folks out there, but knowing who has recovered opens possibilities. These folks can provide a serum containing their antibodies and / or potentially be immune and return to work. Questions still exist: if they’re truly immune, or if they can shed virus if they’re further exposed, and so on.
• Broader tests .. tests everywhere, even for those who are not showing symptoms.

The bits above give us optics into our actual status, giving us a larger denominator when calculating mortality, providing more granular geographical and demographic data, and more.

Testing (testing and testing) is the key to considering how we can get from the ‘new normal’ of WFH (now) to the ‘newer normal’, where therapy encourages recovery, creating more Resolved, and the Resolved enable businesses to safely consider non-WFH operations.

For now, we continue physical distancing. We’ve done well with this (so says the news), but we must continue.

Stay connected. Stay safe. Stay home.

The Resolved

Folks who’ve had it, survived and have gotten well. Are they:

• Immune to re-infection?
• Still contagious without new exposure?
• Contagious if they’re exposed to an infected person (or tiger)?
• How do we know?

The last answer is obvious: testing, testing, testing. This gets pretty granular; I’ll cover this in another post.

At the least, a Resolved will have antibodies that can defeat the virus with which doctors are doing serum testing. This is not a new treatment strategy (1889-1895), so I’m hopeful. Further, a Resolved could potentially go back to their jobs, helping to soften the blow on our economy and our companies .. if they meet the criteria (and others, I’m sure) from the list above.

Until you have had it .. and gotten over it, none of this applies to you or to me. “Behave like you have it ..“

Stay connected. Stay safe. Stay home.

A Ray of Hope .. and a Scary Image

I don’t agree with the light at the end of the tunnel statement bounced around .. not yet, anyway, but I am hopeful. Note that even though you can see the light, you’re still in the tunnel.

Nor am I with “game changer” statements .. through distancing, we are making progress on transmission, but not on therapy, non-proximity prevention, a vaccine or a cure. With that said, I’m a fan of treating symptoms if it gives the patient enough time to defeat the virus.

New York notes a possible flattening of the curve over the last few days. Italy and Spain as well. This means the physical distancing is working.

Then, there’s this bit from China: “The great crawl of China: Tens of thousands of Chinese tourists are stuck at a jam-packed tourist attraction after it reopened amid coronavirus pandemic“.

Stay connected. Stay safe. Stay home.

“The Virus Is Unpredictable ..”

.. I disagree. I heard it on the news today .. I’m not even sure who said it.

It’s not. It’s quite predictable, actually:

• It is deadly, more so to the ‘at risk’ population, but potentially to all.
• It transmits person-to-person, with or without symptoms.
• Staying at home will reduce transmission .. this is the one weapon in our arsenal that can make real change right now.

We have enough data to model effectively, now referring to outbreaks as ‘waves’. These waves have predictable progress, crests (which impact health asset utilization in an area) and outcomes. Some of these data are impacted by age and population density, indicating we should all be cautious. Lessons learned in one wave can help planning in others.

One commentator likened to our present experiences to watching ‘a slow-motion car crash’. This does sound familiar: we can see the predictive, data-driven outcomes unfold before our very eyes. Unhappily, it feels like the lack of coordination, confusing messaging and general bickering are running the risk of making this worse for all.

What can we do? Well:

• Stay on target .. The Queen just addressed the UK (and the world).
• Limit our contact with others.
• Six feet apart.
• If we do have to go out, wear masks in public to reduce (not eliminate) the risk to ourselves and others.

Most important: stay home. Regardless of when the stay-at-home orders were implemented, Cities and States who have locked down are seeing slower growth of transmission by the metric of fewer cases.

We can only control ourselves. We can only contribute to the greater good by doing the right thing.

Stay connected. Stay safe. Stay home.