COVID-19 – A Letter to the Future – Part 6

From WHO. Global pandemic deaths.

This is a continuation from Part 5 of a letter to students in 2035.

The COVID pandemic that started in 2019 is still going strong in June 2022 with subvariants of Omicron. According to WHO the number of deaths worldwide is at 6.2 million.

The United States passed the grim milestone of 1 million deaths, the highest number per capita in the world. Yes, it’s awful and made worse by the laissez faire attitude of most Americans that it’s not worth taking precautions. Fortunately, the death rate in the summer of 2022 is low due to a 75% vaccination rate and a high number of infected, but not dead, unvaccinated individuals.

The big picture of COVID-19 infection in 2022 is one of multiple waves of mild infection with less virulent mutations. Thus, the pattern is looking a lot like the end of the 1912 influenza pandemic. Vaccine makers are planning for new vaccine “boosters” targeted at the circulating variants. Given Earth’s population of seven billion, the rate of new viral mutations might be so high that vaccines may not be terribly effective. The mRNA vaccines do have an advantage of rapid development, but suffer from a cost that is unaffordable for poor countries.

The reason the United States has such a high number of deaths is a matter of debate. A highly mobile population (as evidenced by numerous cases in tourist destinations), an elderly population living in retirement communities, and 25% of the population that refuses vaccination, are major factors.

A warming planet with more hurricanes, more tornadoes, more ice storms, more heat waves, more food insecurity, more mass shootings, and wide-spread droughts are the backdrop of this pandemic. Stress from the pandemic and climate have pushed world leaders to take wild and dangerous actions. In Sudan, war and crop failure forced mass migration. The American president attempted a coup. The Russian president attacked Ukraine and threatens nuclear Armageddon. Conflicts have reversed global efforts to reduce carbon emissions that cause global warming. If the viral threat isn’t bad enough, political destabilization may turn out to be worse — try to make a mathematical model of that!

Sorry, students of 2035. If humans can’t be more cooperative and reasonable, you might be reading this in your underground shelter. Hopefully, part seven will be more upbeat.

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COVID-19 – A Letter to the Future, Part 5

Omicron

This is a continuation from Part 4 of a letter to students in 2035.

The COVID pandemic started at the end of 2019. It’s still going on in February 2022 with the emergence of a new more-contagious, less-lethal “Omicron” variant. Unlike the 1918 Influenza pandemic, we do have a very effective vaccine. 75% of the US population has had one shot, 25% with a third booster. That booster makes death from COVID 100 times less likely.

After two years of pandemic, the US Army finally decided that soldiers who refuse orders to take the vaccine will be discharged. However, the population at large is getting weary of the virus, the bad news, new variants, and masks. Above all, masks (rationally, it should be deaths). Business owners hate masks, dislike disputes with customers who don’t wear them, and cringe at angry complaints from customers who do wear masks about those who don’t. It’s the business community who have the ear of weary governors and legislators. Leaders have backed away from public health responsibilities with a shrug and a whisper, “It’s over.”

But, it’s not over. The death toll continues to rise, now at nearly 900,000 in the country with the highest per-capita death rate, the U.S. The world’s population is 65% vaccinated with one shot. Only 35% of Africans have had one shot. The poor vaccination rate makes humans a breeding ground for more coronavirus mutations. Omicron shows that vaccinations are not quite as effective as evidenced by rising numbers of mild “break-through” infections . According to John M. Barry, a scholar at Tulane University, the late-in-pandemic lassez- faire attitude also happened during the 1918-1920 Influenza pandemic:

Nearly all cities in the United States imposed restrictions during the pandemic’s virulent second wave, which peaked in the fall of 1918. That winter, some cities reimposed controls when a third, though less deadly wave struck. But virtually no city responded in 1920. People were weary of influenza, and so were public officials. Newspapers were filled with frightening news about the virus, but no one cared. People at the time ignored this fourth wave; so did historians. The virus mutated into ordinary seasonal influenza in 1921, but the world had moved on well before.
— John M. Barry

One bright spot, beyond the vaccine, is the invention of an effective oral antiviral medication. It’s still in short supply, but world-wide distribution should help. A late-in-the-game realization for the public is that higher quality N95 masks (they filter out 95% of aerosol particles) are more effective than cloth or paper masks. Building engineers now realize that better air filtration, especially in schools, may help control outbreaks of many types of air-borne viruses.

How long will the pandemic last? Looking back at all the pandemics in recorded history: Cholera (6), Plague (3), Influenza (5), and Corona virus (2). They usually last between one and three years. That gives some hope as we enter our third year.

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COVID-19 – A Letter to the Future, Part 4

Source: World Health Organization

This is a continuation from part 3 of a letter to students in 2035:

In July 2021, the US population felt the pandemic had resolved and stopped getting vaccinated with about 70% having received one vaccine dose (two doses would be recommended). Unfortunately, children less than twelve have not been not vaccinated and those 13-16 years old are starting to be vaccinated. The Delta Variant turned out to be terrible since it spreads like wildfire and kills the unvaccinated in large numbers. Southern States in the US are the hardest hit with frequent reports of the last words of those infected: “I didn’t think it was real.

The tendency of patients not to follow doctor’s advice, “non-compliance”, has always been been a problem. The numbers of “non-compliant” individuals became crystal clear: about 25%. The more officials pushed the more the 25% resisted, claiming it was their right. History says otherwise. George Washington was much in favor of smallpox vaccination for his troops. TB sanitariums were the norm for individuals infected with TB in the 1800s. And, polio was virtually eradicated in America in the 1960’s by the Sabin-Salk polio vaccine taken on a sugar cube. The idea that population safety trumps individual preference is actually an American tradition, which has been abandoned in the pandemic.

Those who study the lack of concern for public health place blame on many political and religious leaders for not supporting vaccinations and masks. Plus, a new problem, social media where news, opinion and falsehoods mix to create a storm of dis-information. The term may survive to 2035 or it may not, but at this time dis-information means the conflation of observations with a claim of relationship. For instance, placing huge emphasis on someone who took horse de-worming medication and didn’t contract Covid. That dis-information resulted in considerable sickness and a few deaths. Likewise, the widely held view that healthy adults could not contract Covid certainly caused thousands if not hundreds of thousands of deaths. Valid information is actually easy to obtain, but many simply did not look for it or believe it.

A famous country-western singer, Dolly Parton, added lyrics to her song “Joline” in the hope fans would pay attention. As widely reported here are few lines:

“Vaccine, vaccine, vaccine, vaccine. I’m begging of you please don’t hesitate. Vaccine, vaccine, vaccine, vaccine. ‘Cause once you’re dead that’s a bit too late.”

Dolly Parton, age 75

Several reporters commented on how much the public learned about how science deals with uncertainty. First, that scientists live in a world of statistics and often think everyone else does too. Second, that science is “iterative”, meaning that collection of data leads to preliminary conclusions which leads to collection of more data, new conclusions, etc. etc. A scientist who says more study is needed is not hedging some hidden truth; the scientist is simply saying that certainty is a long way off. A scientist who says they are not sure masks will be effective is perfectly within bounds to later say, after study, that masks are effective. This is not a “flip-flop”, this is scientific progression. Strangely, medical doctors are well aware of this progression and perhaps did not emphasize to patients how science works. Doctors are well aware of telling patients today “this is the best treatment” and tomorrow “something else is the best treatment.”

Who is to blame? As a rule in quality management, “it’s not the people, it’s the process (or the lack of it).” So, to restate the question: what was wrong with the process?

Here is a short list:

  • Pandemic drills and preparations were not accepted at the highest levels of government. Drills should include those highest levels.
  • Vaccines were not purchased for the entire world (7 billion people). Obtain more. Pandemics don’t recognize borders.
  • Scientists misunderstood that viral mutations would increase with increased infections — and that increased infectivity is a major endpoint. The sooner a virus is controlled, the fewer lives will be lost, seems like a simple lesson.
  • Education about public health in schools was lacking along with the importance of individuals acting to protect everyone. Educational preparation is like any other preparation.
  • Voters too easily accept platitudes from candidates. Voters should make sure the experience or education of a candidate includes some science and public health.
  • The wheels of justice turn slowly. That can not be allowed in a health emergency. Officials need to act on the best scientific recommendations at the time and be willing to tailor the actions as more and more data become available. The anticipation of a disaster is enough to act — the legal preference to wait till the disaster has happened is inappropriate. The legal system and those that make laws need to be sure the rules are different when lives in a pandemic are at risk (likewise for climate change). Law suits in the middle of a pandemic, against leaders doing their best, serve no purpose and confuse everybody. Although, leaders who endanger citizens must be stopped quickly. Lawyers are not often focused on public health — they should be in a pandemic.
  • The rules for reporters need to change. In an emergency, the majority opinion of what needs to be done should receive 99% of reporting. The 1% crazy and misguided opinions should not be given equal time, perhaps no time at all. Crazy is not a human interest story, and it confuses people. “It’s so confusing,” has been repeated so many times it’s sickening.

What’s next? We don’t know. Given enough time, a new variant may emerge which is resistant to the immunity from current vaccines. 650,000 lives lost and counting.

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Covid-19 – A Letter to the Future, Part 3

WHO data July 5, 2021

This is a continuation from part 2 of a letter to students in 2035:

In July 2021 the world realized vaccinations worked. Where countries purchased and administered vaccines, like in the United States, the pandemic began to ease. Unfortunately, the effect of viral evolution became more clear: new variants emerge which spread more rapidly and tend to be slightly more lethal. A terrible “Delta” variant swept across India, killing hundreds of thousands, and marched across the world. Some call this the “third wave”, and many fear it is the precursor to many waves which will eventually require “booster” vaccinations.

In Western countries like the U.S. and the U.K., restrictions (masks, business closure and social distancing) have been lifted. As far as the citizens there are concerned, the pandemic is over — time to celebrate. Unfortunately, millions of people in those same countries still have not been vaccinated. The “anti-vaxers” who refuse the shots claim they are concerned about possible side effects. Psychologists postulate the group is generally distrustful, poorly educated in health matters, and simply can’t connect statistics to personal risk. Whatever the reasons, un-vaccinated people may serve as a reservoir for Covid-19 lasting for many years. Australia, due to its geographic isolation and excellent disease control measures, mostly escaped the pandemic until now. The Delta variant slipped into the country — whether the control measures are going to be effective, where vaccination is rare, is yet to be seen.

Grieving is a process eventually leading to acceptance. However, one of the first steps for humans is looking for someone or something to blame. During the past year, leaders have blamed bats, China and politicians. Turns out, humans infringe on bat territory much more than the reverse, lots of bats live in China and politicians are always suspect. The final word on blame has not been written, but at this point, the innate behavior of Coronavirus to mutate and infect humans is the likely explanation for the pandemic.

In areas where restrictions have been lifted, economic recovery is happening. Of course, businesses often pushed political leaders to reduce restrictions too soon, causing considerable loss of life, illustrating that human life is not priceless. The exact price of a human life has not yet been calculated for the pandemic, but it certainly will be. This is a dark side of the pandemic, but it has been a dark time. The world is coming to the realization that humans “dodged a bullet” since a more lethal virus could have killed all of us. Record temperatures this summer drove home the impending problems of climate change — people seem more concerned. Overall, humanity is getting poor grades for averting disasters.

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COVID-19 – A letter to the future, part 2

This is a continuation from part 1 of a letter to students in 2035:

Russia and China were the first to produce COVID vaccines although they were criticized for possibly skipping some testing steps to ensure safety. In the West, 2020 was the year of the mRNA vaccine pioneered by Karikó and Weissman. The new mRNA vaccine was 90-95% effective in preventing both mild and lethal disease. Wealthy countries purchased massive amounts, squeezing out poorer countries. The US started vaccinations in December 2020. No vaccines were given in all of Africa until a month later.

Vaccine production at millions of doses per day sounded wonderful but pesky math got in the way. Large countries with hundreds of millions of citizens were looking at months or years to complete vaccination of the population. In order to vaccinate the most vulnerable, many countries opted to give the first doses to the elderly, although other countries started with working-age people. Not surprisingly, politicians were near the front of the line as self-designated vital workers.

In late January of 2021 viral evolution put a stop to vaccine euphoria. A viral mutation resulted in a new strain that was resistant to one of the less effective vaccines being used in South Africa. The UK was overwhelmed by a different mutation that was more transmissible — it spread like wildfire to other countries including the country with the highest death toll, the United States (500,000). It was slightly more lethal and slightly resistant to mRNA vaccines, stemming from more “spike” proteins on the surface of the virus. The idea of “herd immunity”, either from wide-spread infection or vaccination, lost some luster. By the first week in February 2021, Israel, the UK and the US had vaccinated 60%, 20% and 10% of their citizens.

Scientists lectured that viral evolution was enhanced in an environment of widespread infection. The millions of infected people allowed trillions of replicating viruses inside them to experiment with different mutations — sure enough, survival of the fittest virus prevailed. Vaccine manufacturers responded by starting the process to make improved vaccines — could they respond fast enough? The great fear was COVID-19 was evolving from a transient pandemic to a permanent endemic virus. Futurists envisioned the virus displacing cancer and heart disease as enemy-number-one for the elderly.

Smug survivors of COVID learned that mutated viruses could re-infect them so they still had to wear masks. Others hunkered down at home, continued to wait for a vaccine shot and became more vocal about slow manufacturing and unfair distribution plans. In February2021, the infection rate in many countries was declining — what was going to happen? Time would tell.

…to be continued…

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COVID-19 – A Letter to the Future, part 1

Dear students of 2035,

Fifteen years ago, possibly before you were born, the world experienced a deadly pandemic with a virus we called “Covid.” You undoubtedly have heard the word, but it’s unlikely you received an explanation of what happened. Those of us born in the 1950’s, heard the words “World War II”, but no one explained that either — a previous generation expects you to know such things by a data download from your mother’s brain directly to your brain at birth. By the way, that method of learning does not exist.

In the last few months of 2019 a virus popped into existence in Wuhan, China. We believe it was a zoonotic infection that jumped from local bats to humans. The virus spread from China to the rest of the world over the course of about six months, despite efforts to stop it.

Many millions of people were infected, and over a million died. In fact, statistics revealed about 3% of the infected died. We faced the daunting task of protecting people from the virus while inventing a vaccine for the seven billion people living on Earth.

As strange as this seems, it took many months for humans to believe a pandemic was attacking. Although scientists warned the public very early in the disaster, the leaders and general public were skeptical of science (not a new phenomenon when bad news is involved).

The recorded history of the 1918 pandemic fell on deaf ears. Years of health department plans to fight a pandemic were discarded in the belief that things would be better 100 years later — we had evolved, our science was better, our drugs were better and our hospitals were better. Lack of a drug against Covid was an inconvenient detail.

Covid spread by the air in tiny particles exhaled or coughed by a victim. Consequently, infectious disease experts told the population in no-uncertain-terms to wear masks, avoid crowded indoor spaces, keep a six foot distance from other people and restrict travel from regions with outbreaks. Well, some listened, many did not. The pandemic simply would not stop given the inconsistent efforts to protect people from spread. We blamed everybody and everything and no one took responsibility.

Older people were very sensitive to the disease. 90% who died were over age 65. Strong isolation measures caused high unemployment in working-age people, and the economy faltered. Many leaders adopted a strategy of reducing health restrictions to allow younger people to work while older people isolated themselves. Older people were cautious, resisting airline travel, cruises, vacations, and restaurant dining — the strategy did not repair the economy or reduce deaths.

An old concept of “herd immunity” was touted by some, although scientists emphasized that seeking such immunity would lead to vastly more deaths. Nevertheless, Sweden championed a laissez-faire strategy causing hundreds of unnecessary deaths, compared to strict measures in neighboring Denmark. The rest of the world was somewhere between.

Governments supported vaccine companies with cash and promises of high profits later. In record time, multiple vaccines were invented and manufactured. However, the task of making enough for seven billion people was a big problem.

As the first experimental vaccines came from the pharmaceutical production lines in late 2020, scientists demanded testing to prove that an effective vaccine would be delivered, one that prevented death from Covid. But politicians just wanted something, anything, jabbed into angry citizens clamoring for “a vaccine.” At the same time, “anti-vaxers” were frightened of the vaccine and refused to take it. As the debate about vaccines flared, people continued to die, hospitals were stressed, and grave diggers worked overtime.

~~ TO BE CONTINUED~~

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Why Test for COVID-19? – is testing always needed?

Los Alamos National Laboratory

This post is about a simple idea that came to us from Reverend Thomas Bayes (b. 1701) who studied statistics (now called Bayesian Method) . Here is the basic idea:

If a disease is very common, the test for it can be very simple.

If a disease is very uncommon, the test for it needs to be very accurate.

In regard to the 2020 COVID-19 pandemic in the U.S., the virus is very common. So, at this time the easiest and most accurate test is a simple questionnaire. In this questionnaire if you have two or three of the symptoms then you likely have COVID-19. If you have been in contact with someone with known COVID-19 and have any symptoms, then you likely have COVID-19. Is testing a symptomatic person absolutely needed? No. But, that’s not the end of the story, see the connected issues below.

☐ Fever or chills
☐ Cough
☐ Shortness of breath or difficulty breathing
☐ Fatigue
☐ Muscle or body aches
☐ Headache
☐ New loss of taste or smell
☐ Sore throat
☐ Congestion or runny nose
☐ Nausea or vomiting
☐ Diarrhea

So, if this simple check list is so great, why do some people need the nasal or oral swab testing (PCR viral test)? Because the virus sometimes causes no symptoms — early or late in the disease and sometimes never. Note that the check list did not have “ No Symptoms” as a selection. That makes sense, there is no way a person would think they are sick if they feel fine — yet they may be spreading virus to many other people.

The concern about “silent spreaders” is a huge problem. Once a person is known to have COVID-19 (diagnosed or suspected) then that person needs immediate quarantine for 14 days and must get in contact with the health department to start tracking down contacts that MAY OR MAY NOT have symptoms. Those contacts without symptoms should have the nasal or oral PCR testing if available. As they wait for the results (which can take hours to days) they must be quarantined.

Some silent spreaders can be tough to track down: taxi drivers, doormen, receptionists, grocery clerks, and bus drivers. Essentially, people who have huge numbers of contacts that people often forget to mention. Here is a scary thought: if people around you are getting COVID-19, maybe you are the silent spreader.

The Health Department has a huge job, and they need everybody’s help. Do what they say, don’t waste their time, and become informed by reading about the disease online. The 130,000 deaths so far in the U.S. is very serious business.

Someday COVID-19 will be uncommon (that would be nice), then we will need a very accurate test for the disease. That very accurate test sadly does not exist right now (PCR currently has about 30% false negatives — meaning the test is negative, but you actually have it).

When the vaccine is available, take it ,and in the mean time, wear your mask and practice social distancing.

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Covid-19 – the simple truth

You will need to wear a mask outside home and avoid close contacts until two weeks after receiving a Covid-19 vaccination. That’s the simple truth.

A vast amount of information in the media currently is irrelevant, misconstrued, politically motivated or wrong.

What we know about Covid-19 in June 2020:

  • It is extremely contagious and is spread person to person
  • 2 – 3 percent of people who catch the virus die
  • It is spread by inhaling small particles in the air and to a much less amount by touching objects then touching your face.
  • Masks reduce the chance of contracting or spreading the disease
    • N95 masks are best (KN95 masks are adequate)
    • Two-layer cotton masks are pretty good (flannel over muslin) — try to obtain a good fit over the bridge of the nose and below the chin.
  • Social distancing is very helpful, especially outdoors
  • Washing hands frequently with soap and water or 60% ethyl alcohol hand jell is very helpful
  • Tight spaces or large gatherings increase the spread
  • The best measure of its presence is the number of people who require hospitalization (multiply by 10 to know the number of people who have the disease but did not require hospitalization.
  • If you are in a location where the disease is active (a hot spot) and have symptoms of fever, cough, muscle aches and headache you have the disease. (i.e. “the symptoms”)
  • If you have no symptoms, or minimal symptoms, you might still have the disease (this is a real nightmare for tracking the disease and why virus testing is so important).
  • If you have active Covid-19 disease, a PCR throat swab will be wrong 30% of the time. And, two negative tests will be wrong 9% of the time. Don’t endanger your loved ones based on the test — if you were exposed, stay in isolation for 2 weeks.
  • You can be 95% sure a positive PCR throat swab test is accurate if you also have the symptoms.
  • Tiny mutations happen to the DNA inside Covid-19 which help researchers trace the path of the virus through the population. The mutations are not changing the infectivity or lethality of the disease, so far. If a major mutation happens it is likely to make the virus less powerful (nice thought, but it has not happened).
  • Surviving the disease means your body made antibodies to fight the virus. Some studies show marked reduction in natural antibody production a couple of months later. Hopefully, vaccinations will do better.
  • Antibody level tests done several weeks after infection (at least 2 weeks) are not very accurate as of July 2020.
  • Infected persons are usually non-infectious 10 days after symptoms subside. Unfortunately, elderly persons may be infectious longer so in that group two negative tests a day apart are advised before ending isolation.
  • Current projections suggest vaccinations will be available for healthcare workers in December 2020, for high risk individuals in January 2021 and for the general public (in the US) later in 2021.
  • The world population will need 7 billion vaccinations

Nasal swab technique

Time and time again, photos in the media show patients having their noses swabbed to obtain a sample for virus testing — usually incorrectly. The swab is inserted perpendicular to the face, into a nostril, to a depth equal to the distance from the nostril to the ear canal. See article in the New England Journal of Medicine.

Why does it matter? Because an incorrect swab placement will fail to obtain an adequate sample and lower the chance of an accurate test (and hurt like crazy). Many negative tests in people with Covid-19 are due to poor technique done by poorly trained health workers.

Cruise Ships

According to environmental engineers at Perdue University, cruise ships use 50 percent recirculated air from other cabins and other rooms to ventilate passenger and crew cabins. Since Covid-19 is carried in the air, viral filters (not just dust filters) are needed. Unfortunately, ships so far don’t have them. Caveat emptor.

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Biologic Readiness Condition – BIOCON

Imagine the following:

After a morning full of conferences and even a meeting with the Canadian Prime Minister, the President closed the door behind him as he headed for his desk. A diet cola, french fries and two hamburgers sat on the desk, thanks to his faithful secretary. He plopped into his chair with a smile and took a sip of his drink. Before he could eat a french fry the blue phone started to beep, slowly at first then louder and faster. Why today, why now, why was the CDC calling on the emergency line? He answered the phone, his smile gone.

“Sir, this is director Smith, I must inform you we have initiated BIOCON 4. Please confirm.”

The President wiped beads of sweat from his brow. “I confirm BIOCON 4. What is going on?”

Smith stuttered slightly. “Sir, we have reports of numerous virus infections in Laos, at over one hundred dead. Our team will be parachuting to the site as soon as the supersonic transport arrives on scene, probably in a couple of hours.”


The scenario sounds like science fiction — is that because a rapid response is not possible? Would the military fail to respond to DEFCON 1? Unlikely.

In 1962, three years after Alaska became a state, NORAD issued details of the plan to respond to a nuclear missile attack. They were very serious and ready. Included on page 41 of the report was a plan for a biologic warning system – not much happened.

HISTORICAL SUMMARY, JANUARY-JUNE 1962 . Page 41.
1 NOVEMBER 1962, Directorate of Command History Office of Information . Headquarters NORAD/CONAD (declassified)

In 2005 President George W. Bush became concerned about viral pandemics, particularly Influenza. His administration issued a call to be prepared — not much happened.

Around 1960 the US military developed the DEFCON (defense readiness condition) strategy to inform the military and the nation about an impending attack.

In the 2010’s several organizations developed bio-threat plans similar to DEFCON, but none at high levels in the government.

>> BIOCON <<

The DEFCON system appears to have survived where biologic emergency plans have failed. It is logical to have a similar system for pandemics or bio-terrorism. Below is such a readiness scheme.

Readiness
condition
DescriptionReadiness
BIOCON 1Infection spreading in the USShelter at home. Institute financial stabilization measures. Delivery vehicles and drivers to wear PPE.
BIOCON 2Outbreak involves multiple countriesClose borders. Make 300 million test kits and distribute. Notify hospitals to prepare for pandemic cases. Open reserve ICU beds.
BIOCON 3Outbreak spreads over over 50 milesDistribute stockpiled PPE, ventilators and medications as appropriate. Make at least 1 million test kits and distribute to states.
BIOCON 4Outbreak involves over100 peopleObtain DNA sequence. Start vaccine production. Notify all Dept. of Health each State. Start vaccinations if available. Manufacture test kits.
BIOCON 5Limited outbreak in foreign countrySend team to investigate. Stop all travel from that country. Quarantine all travelers who otherwise arrive from region.

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2020 Coronavirus — the Chinese Experience

China has run the gauntlet with the novel Coronavirus. They do not report any new cases now and the population is cautiously and gradually returning to normal activity. China has reported on the number of cases and deaths despite very difficult times. One problem they have had as will other countries is how to report deaths that did not happen in a hospital or without testing to verify the presence of COVID-19.

The main question currently in the United states is when will the population be free from restrictions to stay at home? As mentioned in the previous post the experience from china gives some clues. The following are two graphs; the first shows an overview of number of new cases over time (left axis) and the number of deaths (right axis)[1]. The data becomes erratic at the peak of the curve when the hospitals and healthcare workers were overwhelmed. The bell-shaped red is a fairly good fit[3] to the number of new cases. The yellow curve is from a similar effort at fitting a curve (see below) to the numbers of deaths per day.

The disease started sometime at the end of December 2019 and spread. Millions of people were confined to their residences finally leading to no new cases about 2 months later. The peak of cases happened around February 8 while the peak of deaths was about 1 week later. The deaths subsided about 2 weeks after the peak, marking continued hospital overload and a reservoir of virus that could escape and threaten the population again.

China has been criticized for the reporting of deaths, and the irregularities are easy to see around the peak of deaths probably related to a saturation of the health care system. Patients likely died at home since admission to hospitals was not possible and furthermore an exact diagnosis based on PCR testing was lacking. Nevertheless, the picture is sufficiently clear to be a guide for other countries regarding what to expect.

In a region such a one of the States in the US several milestones should be reached before social distancing is eased[2]:

  • No new cases in a State
  • Borders to the State remain closed if adjacent states still have active cases (people could leave states but would likely need 2 weeks of quarantine if they return).
  • Hospitals only have a few remaining cases of COVID-19 patients and have the staffing to receive emergencies if needed (this could take about 2 weeks from the last new case).
  • The State Health department has the capacity to rapidly trace any new cases and institute strict quarantine.
  • Adequate and rapid viral testing is available to the health department and physicians.

Social distancing allowed many persons to avoid infection, associated illness and death. A resurgence of COVID-19 is easily possible in the populations of uninfected individuals.

Healthcare workers and any other workers who have survived the illness could return to work at any time, even now. They are at very low risk due to the immunity developed to clear the virus from their bodies. At some point, a test for immune status based on antibodies present in the blood would be helpful because a large number of persons were probably infected and not diagnosed at the time with PCR testing (the mouth or nose swab). Persons with adequate antibodies also could safely return to work now.

So what does the crystal ball suggest: many people will be returning to work toward the end of April, 2020. There will be states that lag because the virus started in those states later — that’s going to be a difficult pill to swallow. Predictions about what will happen are subject to lots of unknowns. With time, the end-game will be more clear.

References:
[1] https://www.worldometers.info/coronavirus/
[2] https://www.nytimes.com/2020/04/06/upshot/coronavirus-four-benchmarks-reopening.html?smid=em-share
[3] http://www.nlreg.com/

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