By Grant Jacobs 23/03/2020 4


We need to be lifting our game against COVID-19.

[Edit: this was written before to the announcement of the Level 4 lockdown, and the National State of Emergency. The explanation of why we’re doing this, and general points should still be useful.]

You and I need to help those working to prevent the spread of COVID-19 while they’re trying to lift the testing and treatment efforts.

We don’t want to be playing this game running backwards. Best to play it solidly forward, from the start.

So, what you and I need to do, and why?[1]

Don’t overwhelm critical care

We do not want the health system overwhelmed.

It all comes back to this. Forget that detailed stuff about case fatality rates, R0s, whatever. If the health system is overwhelmed everyone who needs that care is affected – not just people with COVID-19.

And COVID-19 is incredibly good at overwhelming health systems.[2] That’s the story of this pandemic.

It’s best understood by starting with the worst case for hospitals, then working back to what you and I need to do to reduce the chance of that.

Running the ICU

Imagine you’re a doctor in an (uncontrolled, ongoing) outbreak of COVID-19. You’re running an intensive care unit (ICU) and cases are coming in. Each patient takes around 3 weeks to recover, if they do. A hard slog.

BUT. Every three days, about twice more patients come in than you have already. It’s an incoming mountain of cases.

If you had a full ICU on Monday, by mid week you’ve got 2 or so ICU’s worth of patients added to the ones you had. But your ICU is already full! You’re going to have a hell of a job helping them. It all breaks down, and people die.

That’s the worst case. Think Italy over the last few days.

You’ll have seen graphs of increasing case numbers. We don’t ever want to get on a steep rise of cases.

Statistically most cases don’t end up in hospital, but the more cases you have, the more that do, and the numbers rise astonishingly quickly.

Hospitals get overwhelmed if there are too many cases at once. We need to keep the number of cases at any one time way down.

Some Asian nations learnt this first-hand in 2003, during the SARS outbreak. For 15 years they’ve built up resources, and they’ve been able to respond better now.

In New Zealand we’re having to expand as we’re going along. The people doing that work need our help. If you and I help them, it buys them time to continue to put things in place.

Not a fun adventure

The government is working on things, but in very real and practical terms, what you and I do is critical. We’re not doing it well. We need to do a lot better.

Last year I read on epidemics and outbreaks. This won’t be the end of everything, forever—life will get back to normal in time—but outbreaks aren’t pretty for those at the messy end, and that can be you or people you care about.

We are going up a fast rise of cases. In setting deadlines for travel restrictions and for people to get home, we’re importing cases, bringing cases to us. Just what we don’t want – but most of those cases should be in isolation.

We’re relying on those self-isolations and physical distancing to really work, and for there to be little spread of the disease in the community.

That’s a fragile thing because our measures are voluntary.

Unlike in Asia, we don’t have a top-heavy government enforcing things (yet).

As a biologist who has followed this since from early-mid December, I am appalled at the casual ease New Zealanders think they can take it. Do it properly. If we don’t we will very quickly be like those European countries you read about in the newspaper.

Because the immediate measures are voluntary(ish), at lot of this really is up to you and I. Everyone should do the very most they can.

Where to learn the tactics

I’d run through the recommend advice, hammering it home, but you might just as well read the Ministry of Health’s page: it’s all there. There’s more from Siouxsie on this, too.

Learn the rules and tactics. Be savvy. Know every move. Become a master of the game.

The coach (me) thinks a few points on the MoH website want to be lifted up, though. Let me add a little about these to the two links above.

More ideas

This video of how to wash your hands properly may help. There’s more to it than you think!

(Michelle Dickinson, aka Nanogirl, has a way to teach your kids at home.)

Keep at least 2 metres apart, or more (not 1). Really avoid meetings. Work from home. Parties, BBQs, and other gigs: it’s not the time, not now.

If you must meet in person, keep it short—a few minutes—and avoid close contact. There’s some evidence fewer exposures are better; keep the number of times you’re out and about few.

Advice for shopping and work isn’t on the MoH website; this paragraph is personal suggestions. Please don’t all rush off and do a huge shop! Crowded supermarkets are opposite of what is needed. Shop online if you can. Don’t hoard, please. In China’s lockdown, only one person per household was allowed out to shop, once every 3 days. Appoint your shopper, and have that person take extra cleanliness measures on their return.

Older people (>70) should stay at home. It sucks, but your kids and grandkids want you. Do it for them. Get relatives or support organisations to help. The problem is that you more than most people are likely to load up the hospital system, as older people are the mostly likely group to end up there. That in turn, affects everyone else. But do it for your younger ones.

From what I’ve seen, too many New Zealanders are too casual about it. It may not literally be the end of the world, but this is a disaster. Let’s all lift our game.

In isolation

Stay at home.

In some Asian countries, all confirmed or possible/probable cases are put into government isolation rooms – no going outside. Local newspapers reported some isolation units were windowless rooms.

Point is, staying in your own home or your hotel room is a luxury, really. You’ve got TVs, stereo, and all the rest. Ride with it, it’s not that bad.

Symptoms and more

Symptoms are fever, coughing, body aches, shortness of breath, and sometimes headache, sore throat or diarrhoea. (There’s a simple online graphic course.) If you have symptoms, ring Healthline: 0800 358 5453

Healthline is apparently overloaded. For general questions about COVID-19 you’re perhaps best to start with the help links above so people with symptoms need Healthline can check if they need to be tested!

For New Zealanders, general information is here. You could ask in the comments below this post: we can’t give medical advice, but we can help with background knowledge.

Fencing it in

Containing a contagious disease is bit like a chain fence — as strong as the weakest links.

Case #31 in South Korea is an example. That member of the Shincheonji Church of Jesus twice received doctor’s advice to take a test confirming if she had a SARS-CoV-2 infection, and didn’t. Instead she carried on her social life. Thousands of cases are linked to that one lapse.

We’ve moved to nation-wide isolation, but we still can’t afford weak links, never mind half-broken ones. We don’t have a health system that can cope with that.

Every time someone heads out to the supermarket, goes for a walk, etc., they open themselves to spreading the illness.

It really is up to us. Play a solid, careful game – go easy on the flashy moves.

Do it all properly. Lift the game way up.

It can be controlled

Look at Singapore, Taiwan, Hong Kong or Vietnam. Their number of cases stay low.[4] (Even little Sarawak where I was living.) Some countries with large numbers of cases have hauled it back in with a huge push back.

But we’re not those nations. We haven’t had 15+ years building up our hospital system to cope with large outbreaks, or run practical simulations like South Korea did in late 2019.

We need to help buy time to help New Zealand to build up. There is a wide push for stronger formal control. Some modelling suggests a big push may not need to be that long, and it’s something we might try.[1]

That’s for the government and their advisors. You and I can help by lifting our game.

Please.

About me

I’m a research scientist, a biologist. I’m used to data (I’m a computational biologist). I work from the biological research literature, especially on humans and how our molecules and genetics work. I’m not an epidemiologist or a medical specialist, but I track what they suggest. Consider this an opinion piece, but one founded on the words of specialists.

I have been tracking this outbreak from early on by fortuitous accident. Last year, well before the COVID-19 outbreaks, I was researching zoonoses for a book-length writing project.[1,3] Part of that was looking out for examples of outbreaks. In early-mid December 2019, a ‘pneumonia of unknown cause’ from China drew my attention—if you’re interested in this stuff it was striking—and I’ve followed the specialists’ talk on this since.[1]

Other articles in Code for life

You could spend some of your stay-at-home time exploring Sciblogs. Check out the other writers’ work, too: see ‘Our blogs’ at the top, right.

The 2019-nCov coronavirus outbreak: all together now

1000 of these now (links to many things I’ve written, including those below)

Scientific paper has a face in a turd. Who could it be?

The sheep-leaf nudibranch 

Temperature-induced hearing loss

Book sales, frumpy readers, and mental rotation of book titles

Deleting a gene can turn an ovary into a testis in adult mammals 

Footnotes

1. Later, in another piece, I might explore what international experts have suggested, note some innovative ideas, or offer a few comments of my own, particularly on testing. I also follow comments from the public closely. There has been a lot of confusion. If it’s useful I can tackle these, too. Let me know if you’d like that.

I’ve wanted to write this and (many!) other pieces for several weeks, ideally getting them to a media outlet. Originally my focus was on clarifying the confusion with a different analogy to the “flatten the curve” notion that has become popular since. (Part of why not is is that all this was interrupted by leaving Sarawak, where lived for over a year, a short ‘breather’ in Cairns, then a visit to Stewart Island.)

2. Among other things, in Italy there has been a shortage of ventilation units, forcing doctors to consider who to intubate (or use a lesser, mask-based ventilation unit, or none). I’ve seen suggestions a hospital in Seattle is also faced with this. Ventilators provide oxygen for those struggling to breathe. From accounts I’ve read, intubation is a tricky exercise, with risks, and considered something of a black arts.

3. Particularly rabies. Why rabies is a long story! To head off the curious, one element is that in Sarawak, where I was living, around one-third of stray dogs have rabies, and around 20 people had died from the illness. Rabies is 100% fatal in symptomatic cases. Being a curious scientist, I have spent (literally) weeks exploring rabies, the public efforts tackling it, and the broader picture of zoonoses in general.

4. There are Asian nations with very few cases, some of them with land borders with China, others will strong links to China. I’m very curious about their stories, especially having lived in the area.

Featured image

“This transmission electron microscope image shows SARS-CoV-2—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S.”

Rights: CCA 2.0 Generic. Credit: NIAID-RML


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