Please circulate this letter to the medical and legal community
I have been asked by many to write a brief article discussing the implications of the novel COVID-19 virus, how it affects us in our communities and if everyone needs to stock up on home essentials before the stores run out of them and how doctors, lawyer and judges can help reduce the spread of the virus.
.
I have worked at the RAND CORPORATION in Health policy analysis prior to going to medical school and have some insight into the current situation that has come from this new infectious disease.
Before discussing all the implications of the virus, there is a key take-home message that everyone must understand before reading any further- social distancing for the next couple of months is essential to beat this virus. Every viral timeline has an inflection point as to when the increase in the incidence of the virus reduces and starts to plateau. At that inflection point, the worry goes down in terms of the continued exponential spread of the virus, and the community can then start to get back to their normal social gatherings.
Let us start to understand this pandemic with a math lesson. This will help us understand how quickly this virus will grow and when the turning point ( the inflection point) will occur and when this virus will actually die out. The virus starts with exponential growth. So what is exponential growth? Going from one day to the next, it involves multiplying by some constant. In the data the I have reviewed the constant is about 1.25 of the number of cases from the previous day. What causes new cases are the current existing cases. If you multiply the number of current cases on a given day with the average number of people exposed to an infected person that day, and then multiply that number by the probability of each exposure becoming an infected person, you then have the exponential growth factor constant to describe the viruses contagiousness . Using this mathematical formula, we now need to look at the current data we have as to how many infections have been diagnosed over how much time and then correlate that with the next set of data over the next period of time. Outside of China it took 20 days to go from 100 to 1000 infected. It then took 13 days to go from 1000 to 10,000 infected. If you do a regression analysis, we are growing by a multiple of 10 every 16 days. If we follow this regression analysis, we will hit 1 million in the next 30 days and 10 million 17 days later and 100 million in about 30 more days. At this rate, the entire world will be infected in about 6 months! Obviously this cannot be true as the entire world has never infected with every virus that has spread in the past Therefore, there needs to be an inflection point that turns the tide where this starts to slow down and eventually stop (just like the Corona virus sars, and other Corona viruses have burned out over time). So when does this happen, Well if you look at the formula above, we know that one of two of the factors needs to go down. Either the number of people someone is exposed to each day needs to diminish or the probability of exposure to the virus needs to reduce.
Hence, the governments and the CDC, to reduce both factors, have instituted rules to limit people's exposure to one another and to reduce the probability of one infecting another. They have done this by reducing the number of people in a room at any given time and by limiting the handshaking, cleaning of areas being touch by people and wearing masks, to name a few. This is also the reason why we are now seeing schools shut down, synagogues closed and gatherings canceled. By the population following these steps, they will create this inflection point at a much faster rate and the virus will have nowhere to go except burn itself off. Until we develop a vaccine, which will take a minimum of 1 year until the drug companies pass the animal and then human tests and then get clearance for mass distribution, we have no other means, except for the above, of reducing this virus’s virulence.
Unfortunately, we have hysteria in the populace because people really do not understand that this virus will die out within the next few months with the unprecedented steps that are being taken. It will destroy certain economies that rely on lots of people being in one place at one time ( concerts, amusement parks, travel, etc. ) These economies will resurge in the future, and people need to be calm about what is actually going on around them. I f we don’t take these extreme steps that are necessary, it will not be the economies that die out. During the Spanish flu ( very much like this novel flu) 50 to 100 million people died, and back then we did not have the kind of world travel in 1918 that we have today- leading to an exponential spread of the virus. The world population back then was less than 2 billion. It is scary to do the math on the amount of deaths this novel virus ( that is just as contagious)can cause with a word population is close to 8 billion.
Whenever a new microbial killer emerges, we go through each of these stages, starting with denial as government officials insist that there is no outbreak. Not surprisingly, denial from the Chinese Government did little to reassure the population of Heyuan, a city of nearly 3 million, who emptied pharmacies of antibiotics and respiratory medications. Thus denial led to panic as denial always leads to panic. If you haven’t seen the populous rushing to Walmart yet for stocking up on 2 years of toiletries, purell and other essentials, you need to look at YouTube videos. It is beyond comprehension.
According to Cirium, an aviation-industry consulting firm, more than 200,000 flights in and out of China have been canceled, a 60 percent decline. In 2003, in the midst of SARS, global air travel was down 25 percent. There is true delusional pandemonium all over the world that is causing infectious hysteria that is unfounded and unprecedented.
Fear dissipates eventually, replaced by a more realistic sense of the risks. An epidemic, even one as seemingly easy to transmit as COVID-19, while burdening public-health systems and potentially deadly for the elderly and those with compromised immune systems, is eminently survivable by the majority of the population. This fact becomes obvious as people become sick, yet recover; doctors and nurses get a better handle on treatment, and most people go about their lives and never succumb. Which brings us to the last stage of epidemic grief: rational response. After denial, panic, and fear, we can finally get down to the business of basic sanitary measures and infection protocols.
We never did develop a vaccine. With SARS, infections peaked sometime in May 2003, at about 9,000 cases. By then, the daily rate of new infections had dipped below the number declared cured or dead. That is the inflection point of any outbreak, the point at which the worst is over. Why did the rate of transmission slow? Part of the answer is seasonality: The Northern Hemisphere’s virus season tends to run from winter to mid-spring, perhaps because people aren’t clustered indoors and so are less contagious, or because viruses might weaken in lower relative humidity or direct sunlight. (Nobody actually knows.) In the case of SARS, the battle was won one hospital ward at a time. In the antibiotic era, infection control has been largely delegated to IV drips rather than sanitary cordons. With respiratory diseases like SARS, MERS, and COVID-19, 19th-century medical techniques and equipment—masks, gloves, galoshes, sealed wards, quarantines, and ventilation—are what comprise a rational response.
The only issue that no one is really talking about is the fact that if this virus spreads at such a rampant rate, we will not have enough resources, staff, hospitals, respirators, doctors, nurses, and medical supplies to take care of everyone all at once. Therefore, the only thing everyone needs to do at this point in time is to stay away from others as much as possible and limit theirs and others' exposure. If people do not take this seriously, then we will see mass casualties and riots in the street because of lack of resources to care for patients.
My prediction is that if we follow the rules of social distancing, we will see an inflection point within the next 2-3 months. No need to stock up on 2 years of supplies. The COVID-19 will be gone as quickly as it came and everyone will just remember it as a thing of the past where everyone in the world was hysterical because of an unrealistic fear that the world was ending.
If you want to panic, go right ahead. Humanity has so far survived every microbe that has penetrated the human barrier, and we will survive this one. But I ask everyone to do one thing for the next 2-3 months-. Stay away from others and implement as many of the following guidelines as feasibly possible so that you do not contribute to the spread of this disease.
IMPLEMENTATION OF HYGIENE IMPROVEMENT STRATEGY TO QUELL THE TRANSFER OF
INFECTIOUS DISEASES IN MEDICAL AND LEGAL INSTITUTIONS
Doctors, Hospitals and Courthouses or any facility that handles the general population:
All people prior to entering your facility needs to be checked for their temperature. This takes less than 3 seconds with a $3 digital thermometer scanned on a person’s forehead. If their temperature is 101 or higher, they should not be allowed into the facility- THIS INCLUDES DOCTORS, NURSES, JUDGES, CEOS, OWNERS , ETC. -A ZERO TOLERANCE RULE. This is already being implemented in several hospitals. EVERYONE is required to be temperature-scanned without exception. If the temperature is elevated, they should be sent immediately to a testing facility and NOT be allowed to enter the building. There should be a hotline to reschedule their appointments or cases- or those individuals should be allowed to be seen via telemedicine or via cell phone or skype, court call, or any other virtual method..
Lines outside of offices or court rooms or facilities should not be allowed. Lines of people undermines the entire process of social distancing. People should not all come in at once to check-in. There should be a digital check in system and possibly a virtual means of swearing-in litigants with digital signing and filling out of forms. Most medical practices already have EMR systems that allow patients to fill out and sign forms prior to their arrival. Everyone has a cell phone and should be able to access these types of digital systems with ease. Appointments need to be given out that are not all at the same time of arrival.. People assigned to their timeslot should be required to come in at their scheduled time. Alternatively, cell phone numbers can be used to text the individual that the facility is ready to handle them while they wait outside the facility so as not to congregate within the facility. Text messages would be sent, or calls should be made 15 minutes prior to their scheduled appointment. This will limit the amount of people in any given area to three sets of individuals ( the ones already seen and leaving , the ones being seen, and the ones to be seen. This process will allow for the recommended 6 foot distance to be kept without difficulty and reduces the person to person interactions to a minimum.
Individuals who are not living together need to be separated 6 feet apart as much as feasible. This doesn’t mean that there needs to be a physical barrier . Interactions between people are allowed when needed. All workers should be wearing masks . The masks are not necessarily going to protect one from the virus that might be in the air, rather they will protect one from touching their mouth or nose inadvertently- which is the route to acquiring the infection. There needs to be a sanitizer pump on everyone’s desk and it should be used every time one enters or leaves a room. All people entering any of the facility should be required to sanitize their hands prior to entering and again prior to leaving any room. All staff should hand sanitize every time before and after interacting with any individual. All railings, elevators tables, and any other objects that are touched by people need to be wiped down by personnel after every encounter.
Any item transferred to a worker should be wiped with an alcohol swab or disinfecting disposable towel by the person transferring the item and then wiped again by the individual transferring the item back. As an example, if a cell phone is given to a doctor to look at images of an x-ray that is on their phone, before it is given to the doctor , it should be wiped down with an alcohol wipe by the owner of the cell phone. The person who is handling the item should again wipe it down with an alcohol prior to returning it to that individual.
I hope these procedures are considered and implemented to keep everyone safe and healthy.
Jonathan Nissanoff MD
Orthopedic Surgery
Advanced Orthopedic Center
