I wrote a thing for facebook

I often try and stay off facebook, and I definitely stay away from talking about health topics, but I know some people I’m friends with (particularly on here) will trust that the US president will give them good advice on managing the current crisis. For your protection: He won’t.

He’s concerned about numbers. The numbers are starting to look bad. Not the number of deaths, or the numbers in hospital. We’re not at the point where those things are near as bad as they will be yet. No, for him, it’s worrying that the economic numbers are bad (https://qz.com/1823251/coronavirus-could-leave-30-percent-of-us-workers-jobless-fed-pres-says/). And we know from history that bad economic numbers are bad for re-election. That worries him, and I think it honestly worries him more than the numbers of people who experts say will become sick or die because of inaction. It’s likely he’s going to say “meh” to social distancing soon (https://www.washingtonpost.com/politics/trump-signals-growing-weariness-with-social-distancing-and-other-steps-advocated-by-health-officials/2020/03/23/0920ea0a-6cfc-11ea-a3ec-70d7479d83f0_story.html). Why should you ignore that and try your best to keep social distancing? Why am I going to be standing at least 3, and ideally 6 feet away from all of y’all?

First, a bit of a rant, feel free to skip on down. But I feel this is important to understand why we’re in the situation we’re in.

Back in 2012 and 2015 (yes, under Obama), there were warnings that a pandemic was an increasing risk in the globalised modern world. Obama, in response to criticisms of the Ebola response, created the Pandemic Response Team (https://www.usatoday.com/story/news/world/2020/03/18/coronavirus-did-president-trumps-decision-disband-global-pandemic-office-hinder-response/5064881002/).

Then in 2016 – Trump’s transition team was briefed on the probability of a pandemic and that the US was underprepared for it: https://www.theatlantic.com/politics/archive/2020/03/pandemic-coronavirus-united-states-trump-cdc/608215/).

Handily, at that point, the US had a pandemic response team – so there could be planning around how to manage a pandemic and a unified response to it. The US no longer has a pandemic response team, instead we have Mike Pence, who’s record on managing public health risks is terrible (https://www.politico.com/news/magazine/2020/03/02/how-mike-pence-made-indianas-hiv-outbreak-worse-118648, https://www.bmj.com/content/350/bmj.h1708.short). What happened to the pandemic response team? Trump and his team disbanded it. He may claim now that he knows nothing about it, but despite his protestations, he himself sung the praises of dissolving the pandemic response team back in 2018. He may not remember, but video does: https://www.independent.co.uk/news/world/americas/us-politics/coronavirus-video-trump-pandemic-team-cut-2018-a9405191.html. That means that we’re without the people who would have spent years prepping for this and who could give us a carefully planned response.

Okay, so – we (the US) knew it was likely to happen, then we got rid of the people who could have told us what to do.

But that was all in the past, people keep saying to me that he’s doing a good job now.

Well… no.

As international concern grew, as it became clear from China and Europe that this would be a major pandemic. Instead of leaping into action, Trump wasted precious weeks on claiming it wasn’t a problem (https://www.youtube.com/watch?v=NezEbDx4B9A). At the same time, both GOP members of congress as well as a Democrat (no one’s hands are clean here), having access to briefings about how bad it was going to be, decided to sell their shares (https://thehill.com/homenews/senate/488593-four-senators-sold-stocks-before-coronavirus-threat-crashed-market). You know it’s bad when the well off start moving money out of markets.

Then the government in the US decided that everyone else’s testing kits weren’t good enough and decided to develop their own (https://www.newyorker.com/news/news-desk/what-went-wrong-with-coronavirus-testing-in-the-us). Which is why we don’t have enough kits to test everyone, and it takes days to get a test resulted here, and in South Korea they’ve just developed a 10 minute test.

Why should we be testing everyone? Surely we only need to know for sick people?

For me, as a healthcare provider, dealing with an individual patient, yes, that’s broadly true. I need to know whether Bob, who’s sick and coughing, has COVID-19, because I need to protect other patients, and I need to protect myself to avoid catching or spreading it to my other patients. And the precautions I’ll take are different for different diseases. Of course, because the testing in the US takes days to come back, I won’t know until long after Bob has gone to the ward, or ICU, or has gone home and I’ve been at work for days more.

But, while it matters even in the healthcare environment that we test others – because this disease has a median incubation period of 5 days (but up to 11.5 commonly, and over 14 is a possibility: https://annals.org/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported) so I will have worked my full set of shifts, and may even have come back to work a week later, and still not know I’m sick. 

It matters much more in general, because in the US, there are very strict criteria for who can be tested for COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html) so we’re missing a lot of cases (https://www.washingtonpost.com/outlook/2020/03/23/coronavirus-count-confirmed-testing/). We can’t identify hotspots, and isolate those people. We can’t look for patterns to try to control it. Instead we’re stumbling blindly and effectively having to try and isolate everyone. 

In Iceland and South Korea, they’ve basically been testing everyone and their dog. (https://www.government.is/diplomatic-missions/embassy-article/2020/03/15/Large-scale-testing-of-general-population-in-Iceland-underway/) And what they’ve found is that there are massive numbers of people with little to no symptoms who are not just carrying the disease, but are spreading it (https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf). So, in the absence of testing, distancing for everyone is the safest response. 

This disease is way more infectious than flu. Every person with flu infects roughly 1.4 people; every person with COVID-19 infects roughly 3 people. Doesn’t sound like much, right? But humans are curiously bad at maths and stats. So… https://twitter.com/C4Dispatches/status/1241803403619172359

Other countries didn’t get as much time or warning about this. We squandered the time we could have been training temporary technicians to at least help manage ventilated patients, and we could have helped nurses, techs and doctors who don’t regularly manage ventilators update their skills and knowledge. We lost the time we could have got factories churning out basic cheap ventilators, PPE, and could have had lots of time with social distancing to slow the impact.

We have two tools left in our armory. Hand washing / good hygiene practices and…. Social distancing.

Why does that help? https://covidactnow.org/

I know it’s tough, as an introvert who lives with a wonderful partner, I’m lucky. I like spending all my time with Kathryn. Many people aren’t so lucky. Some are in the hell of living with abusive partners, some have mental health challenges that will make this time especially hard, and for many it’s just tough. 

I can’t offer a great deal for that other than my sympathy, but the advice in this show was pretty good. https://www.npr.org/2020/03/19/818432205/special-episode-a-social-distancing-survival-guide

But it’s important. And with any luck it’s going to feel like it’s not worthwhile. Dr Landon explained this the best I’ve seen:

https://www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/emily-landon-speaks-about-covid-19-at-illinois-governors-press-conference

And now I’m going to go back to my regularly scheduled silence because I think facebook is the spawn of satan, interspersed with the odd photo of our house to keep friends updated on the fact that we still do a hell of a lot of DIY.

PS: If you’ve hoarded N-95s, please donate your N-95’s to your local hospital / EMS service so we don’t end up doing this: https://wwwnc.cdc.gov/eid/article/12/6/05-1468_article#tnF1

PPS: If you’ve hoarded toilet paper:

https://ruinmyweek.com/wp-content/uploads/2020/03/coronavirus-toilet-paper-15.png