The Numbers are Good ..

They are .. we’re seeing progress because of our mitigation efforts. Even the hardest-hit New York is seeing a downturn.

However, COVID-19 has not changed:

  • is still highly-contagious .. droplets, aerosol and contact.
  • Transmits without symptoms .. some who have it don’t know and may unintentionally spread it.
  • Is still ~10x as deadly as the flu .. we are still trying to understand the actual denominator
  • Remains on surfaces for longer than you’d think.

The overall health situation has not changed:

  • No widespread testing.
  • No vaccine.
  • No reliable therapy.
  • With the exception of “The Resolved“, no way of knowing who has had it already.
  • Medical workers are still the front line and we must protect them.

The testing situation has not changed:

  • How do you get a detection test? The CDC has a Self-Checker that looks for symptoms.
  • How do you get an antibody test?
  • How do know if you’ve been exposed?
  • How do you know if you’re contagious?
  • We’re not doing reliable contract tracing .. This may not even be widely possible until May.

Personal protection activities have not changed:

  • Stay home.
  • Wash your hands.
  • Cough into your arm.
  • Don’t shake hands.
  • Don’t touch your face.
  • Wipe down surfaces.
  • Keep a two-meter distance from others.
  • If walking / running don’t follow too closely behind others.
  • Wear a mask to protect others from your droplets.
  • In short .. “Behave Like You Have It“.

On work:

  • Who can go back to work safely?
  • If only the Resolved, are there enough workers to justify opening offices? Stores? Malls?
  • Which workers should go back to work first?
  • Is there a way that workers could consider temporary positions in essential roles?
  • How will employers keep workers safe? I talk about this a bit in “The ‘New Normal’ .. ‘New-New Normal’?

As the weather turns, we all want to get out. We want to get back to our jobs, our parks, our bars, our restaurants, our churches as soon as we can. I’d like to go to the grocery without hazmat gear. I need a hair cut (candidly I need them all cut).

The Federal Government wants to open the country ‘with a bang’ .. but there’s simply no evidence that enough has changed for this to occur without endangering the public. Please pay attention to the science.

Stay connected. Stay safe. Stay home.

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’:

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.

What we are doing is working ..

.. So, let’s not change it. Let’s manage it.

Physical Distancing is working. The rate of detected cases are reducing, even with more testing .. even in the hot areas.

Testing, testing, testing.

Most of us are getting the right idea .. Even these guys: “A Florida county is reminding people to maintain a distance of at least one alligator between each other“.

On the other side .. There are still (eight, as of this writing) states who have not enforced social distancing. Dr. Brix doesn’t think this is a good idea: “Birx warns holdout states about social distancing“. Will they be the next post-Mardi Gras New Orleans?

Here’s the map from the New York Times: “Coronavirus in the U.S.: Latest Map and Case Count“. Updated fairly often. The CDC has an AAG that closes at 4pm daily.

Yes: some of the case counts look low .. But we must consider state population, population density and how much testing a state is doing. Given the aggressive nature of this virus, I suspect the per-capita numbers are not that far off. I am looking for these data.

We must pull together .. but by staying apart. For now.

Stay connected. Stay safe. Stay home.

“I won’t .. “

Not me .. I will. I wore one yesterday to Costco and again today to Sprouts. I didn’t feel out of place, look silly or draw any stares (well, no more than normal) from anyone.

A mask.

Not so much the guy in the White House.

I’m not going to get political, but I am going to advocate for common sense:

  • CDC  issued “Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission” today. In anticipation of this (it wasn’t actually a secret), I posted “Respect the Mask” earlier today.
  • He, his VP and those around him are getting the rapid CoViD-19 (capitalization intentional, as here is how the virus was named .. I’m going back to all-caps hereafter) test on a regular basis. I agree with this: he, his VP and critical team .. not to mention the Chain of Command being tested on a regular basis is a very good thing.
  • While a less-than N95 won’t protect you fully, it will likely protect others from you .. please recall COVID-19 can be transmitted asymptomatically .. that is, without symptoms. You may not know you have it and transmit it to others. Remember “Behave like you have it ..“? I do .. I wrote it. Nothing original therein .. Just common sense (again) when sorting a challenge with multiple unknowns.

Wear a mask or a scarf. Be careful. Stay informed.

Stay connected. Stay safe. Stay home.

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