Updated: Apr 6, 2020
This week has been the institution of highly recommended or legally enforceable strict social distancing across much of the US. 14 states have ordered that all residents stay home except for essential business (which includes obtaining food, fuel, and prescriptions)
- California, Connecticut, Delaware, Illinois, Indiana, Louisiana, Massachusetts, Michigan, New Jersey, New Mexico, New York, Ohio, West Virginia, and Wisconsin
Why these measures?
The full cycle from being infected, to becoming infectious, to developing symptoms, to becoming no-longer infectious, lasts in most people around 14 days.
- Since there is for all practical purposes no non-human host, if there was 0 human to human contact for 14 days, the virus would simply die out and stop circulating because no one infected would contact anyone not infected before they became non-infectious
Of course, that would be in a perfect world, as there are rare cases where someone remains infectious for more than 14 days, and there will inevitably be some person to person contact, so at least some transmission will occur, but if we can eliminate almost all transmission through this method, then we can use testing, contact tracing and continued emphasis on reasonable personal and facility hygiene and continued, but more limited social distancing to keep this in check until a vaccine is available.
Another big development this week:
An increasing number of reports are showing significant benefits from the use of the anti-malarial Chloroquine and its relative Hydroxychloroquine. There is not enough data yet to say that these are game-changers, but many are optimistic about seeing its benefits.
- Importantly, these will NOT stop the epidemic – that will not happen until 70-80% of everyone in any given region is immune through either infection or immunization. What these may do is change the risk calculations if the chance of death or severe disease is greatly reduced.
Over the next two weeks, we’ll have a good idea if we are at the beginning of the end.
Other key points this week:
- More than 50% of the cases are occurring in New York, Washington, and California, with more than 50% of all cases in just 10 counties. Some of this is an artifact of testing. The heavier hit areas are more aggressively testing, so it is logical that they are seeing high numbers of cases.
- Through March 19, using very stringent screening criteria for symptomatic persons, more than 96,200 people have been tested in the U.S.; approximately 11.4% were confirmed as positive. As of March 19, in South Korea—using very broad criteria—more than 307,000 people have been tested; 2.8% were confirmed as positive.
- Internet stories that have been flying around this week are that people taking certain blood pressure medications or standard over-the-counter anti-inflammatory drugs (including Ibuprofen and Naproxen) are at higher risk of serious disease and should stop taking their medicine. The facts do support either of these conclusions. Groups are continuing to monitor, but do not change routine use of either of these groups of medicines
- The World Health Organization has published a new recommendation that contact tracing for confirmed or high-risk cases of COVID-19 extend to 2 days before the development of symptoms. Previously there was no guidance, and many were going back as much as 14 days before.
- Asymptomatic transmission among household contacts appears increasingly important, and quarantine of all household contacts is emerging as an important mitigation strategy. Contacts should only be tested if they are symptomatic.
- Australia, New Zealand, Singapore, and the U.S. Department of State are now advising travelers to AVOID all international travel.
- A new study from the U.S. National Institutes of Health showed that at 21-23°C (69.8-73.4°F) and 40% relative humidity (RH), SARS-CoV-2 remained on surfaces for up to 72 hours on plastic and stainless steel, for 24 hours on cardboard (simulates packaged products), and for 4 hours on copper. Viruses in artificially generated aerosols (nebulizer, mimicking medical settings) remained viable throughout the 3-hour duration of the experiment.
Corporations should be mindful:
- Employees with confirmed or suspected COVID-19 should not return to work until they either test negative for COVID-19 (at least 2 negative consecutive nasopharyngeal specimens collected ≥ 24 hours apart) or are free of fever and other symptoms for ≥ 72 hours without the use of fever-reducing or other symptom-altering medications (e.g., cough suppressants) and ≥ 7 days have passed since symptom onset.
- Symptomatic persons with a negative test or who do not meet testing criteria may return to work once they have been asymptomatic for ≥ 24 hours. Asymptomatic persons with a positive test may return to work when ≥ 7 days have passed from the date of the positive test and they have remained asymptomatic.