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Thursday, February 27, 2020

Guest Post: Pandemic? Don't Panic!

by Dr. Cathaleen Madsen



Dr. Madsen holds a PhD in Bioscience with a concentration in Microbiology and Infectious Disease. The views expressed in this article are hers alone, and not those of anyone she works or has worked for. She has written this article as a favor to Erin Palette and was not paid to do it.

Picture this: you’re at work, hauling a bit more rump than usual in preparation for the Big Deadline, when your child’s school calls. They’ve got a sore throat and a fever of 101° F; can you please come pick them up?

You assent, groaning inwardly because you knew this was coming. Half your team is out with the seasonal crud already, you’ve been trying to ignore that little tickle in your own throat, and just to make things interesting, there’s a heavy snow warning for your area, because of course there is, because Murphy is a bastard and you never could get the hang of Thursdays.

But hey, this is Adulting 201 and not your first rodeo.
  1. Your first stop is your boss’s office to explain the situation and respectfully suggest they start planning coverage, because the Asia-Pacific Team / yearly inventory / Federal audit isn’t going to stop for something so minor as a bout of the crud and an incoming blizzard. 
  2. Your second stop is the grocery store, where you grab a couple of bottles of cough syrup and Tylenol, maybe a week’s worth of easy-prep meal staples like lunch meat, peanut butter, and microwaveable dinners, and some good-ol’ bleach and Lysol. You should probably pick up an extra bottle of wine or 6-pack of beer, because reasons.
  3. Third stop is the school, to pick up your child. Yes, they’re miserable, and it’s going to be a long few days of chicken soup and cold medication, but you go through something similar every year. You’ve got this.
If you’re nodding along right now, congratulations! You’ve got the right idea on how to prep for the arrival of COVID-19, aka the Wuhan Coronavirus.

But wait! I hear you ask. What about the quarantines? What about “social disruption?” The Diamond Princess? A freaking PANDEMIC?! Why are there no masks or gloves in that shopping list? What about basic infection control? 3% lethality? HELLO???

I'm happy to answer those questions, but first let me introduce myself so you’ll have an idea of where my answers come from:
  • My name is Cathaleen Madsen, and I have a PhD in Biosciences which I earned through the National Center for Biodefense and Infectious Diseases at George Mason University.
  • My dissertation was on molecular virology, and though I didn’t work on Coronavirus, I’ll be happy to geek out over viral reproduction and surface proteins with anyone who’s interested. 
  • I spent most of my electives in the Biodefense (policy) department, where I focused on mitigation of public fear and anxiety related to biological threats. So although this has nothing to do with who’s signing my paychecks these days, looking at risks and allaying fears is kind of what I do.

Let’s start with some definitions, by which I will take the sting out of some very scary words, like pandemic. In basic terms, that means a disease that has spread widely across geographic regions. It has nothing to do with how many people actually get sick, how severe their sicknesses are, or how many people die. Hollywood certainly doesn’t help here, but so far it looks like we’re facing more “swine flu outbreak of 2010” and not so much Steven King's “The Stand.”

The next scary word is quarantine. Yes, that does mean confinement of a person who was likely exposed until the incubation period has passed without them showing symptoms. But it doesn’t mean being barricaded in your home while soldiers with rifles guard the front door (at least not in the US), much less internment in some government-run sterile clean room while techs in hazmat suits pass your meals through a slot in the plastic barrier. The government is currently screening people coming off of international flights from known risk zones, or coming across the border, and then diverting the people who need it to medical facilities that can handle it. They’re not rounding up citizens to test at random and then divert to holding facilities. Aside from the complete Constitutional violation of such a thing, we simply don’t have the manpower, and anyway that ship has sailed - literally, in the case of the Diamond Princess. It’s berthed in Yokohama, Japan and undergoing quarantine there, well outside of US jurisdiction (though 14 Americans were repatriated. And then quarantined). An upgrading of the status from epidemic to pandemic means a change in tactics from “keep it over there” to “minimize its impact here.” For an excellent explanation of why this is so, please see this article.

This is where prepping comes in. Yes, you should go out and replace basic supplies you’re out of, plus a little extra - not because society is about to break down, but because you might be stuck in the house for a week feeling like absolute trash and too bombed on cold medication to drive or operate anything more complex than a can opener and a microwave.
  • Standard household disinfectants are always a good idea in crud season, and yes, bleach and Lysol do kill Coronavirus. 
  • Walking around in an N-95 filter mask and gloves is complete overkill, and will remind you forcibly of August in the South. Worse, stocking up on these is going to divert those resources away from hospitals and other healthcare workers who actually need them. Instead, practice the elbow bump instead of a handshake, push elevator buttons with your knuckle, and try to stop touching your face (you’d be surprised how often we all do this). 
  • And for the love of wellness, WASH YOUR HANDS. Under a faucet, with actual soap and running water and suds.

The other part of minimizing the impact is staying home when you’re sick. (See also: social disruption.) Sick workers are going to have a hard time filling quotas, sick plumbers won’t be able to fix your faucet when it breaks (hence the ever popular advice to stock up on water), and sick coaches may have to cancel your kids’ sporting events. In extreme situations, schools or workplaces may close under the guidance of local government or management - think snow days.

Again, this is not Hollywood-style “civil unrest” with people running, screaming, and looting while armed officers break up any groups larger than three; it’s the isolation of your favorite pizza place being closed for a week while the kids are out of school, and by the way, that toy you’ve been promising your youngest is back-ordered because it ships from China. (Now you know why I suggested wine or beer.)

Regarding lethality, COVID-19 has a reported mortality rate around 2.3% according to CDC-China. But it’s important to remember that is some very basic math; it's just the total number of deaths divided by total number of confirmed cases. It doesn’t take into account things like people who had mild symptoms and never went to the doctor so they didn’t get counted (thus making the denominator larger), elderly age or previous medical conditions, or where and when they became infected. Not surprisingly, mortality has been much higher at the epicenter of the outbreak, where things happened very fast and new patients were met with already-exhausted healthcare resources. Remember that proper medical management, even if there’s no cure, is a significant factor in reducing the death toll. Medical centers and public health workers here in the U.S. are doing quite a lot of work behind the scenes to make sure that our resources are ready to meet the challenge, which is an advantage that the first round of patients in Wuhan didn’t have.

Bottom line: what preps do you need? I would suggest the following:
  • Maintain at least a week’s worth of groceries and staples in the house, including whatever the kids or pets need. Throw some easy-prep meals in there for days when you’re too sick to cook. 
  • Staples in this case includes disinfectants.
  • Check prescription medications. If anything is about to run out, see if you can refill a little early. (Don’t bother trying to source and stockpile antibiotics. They don’t work on viruses anyway.) 
  • Do get some extra cold medicine - the stuff you have is probably an inch of orange syrup in the bottom of last year’s bottle, and you’ll need a full set if the crud (of whatever variety) hits your house.
  • Talk to work about their plans for coverage. Can they cross-train people to fill multiple functions? Allow telework if someone gets sick?
  • Ditto if you’re under regular medical or mental health care. Will your therapist allow a Skype call? Do they have a plan for making sure everyone can still get dialysis/chemo/scheduled surgery during an outbreak or a staff shortage?

Also, be sure to do the following:
  • Check on your neighbors who might be elderly, disabled, parenting small children, recently laid off, etc. No one wants their home health aides to come in with a raging fever, but it happens when there’s genuine need and/or the other person absolutely needs the paycheck, and baby formula is ridiculously expensive.
  • Don’t be afraid to cancel plans if you or a friend is getting sick. Whatever sort of sick that may be; the flu is likely to lay you out faster and harder than COVID-19.
  • Go on about your business until it’s time to stay home.

Above all, don’t panic. Go ahead and prep, but prep like you're facing a snowstorm in flu season, not like you're expecting the eruption of Yellowstone.

12 comments:

  1. I worked many years in medical admittedly in administration and not patient care but I was often in patient care areas. We got a yearly mandatory TB and the flu vaccine was strongly recommended and if you declined then you were required to wear a mask in patient care areas. The big rules stressed by corporate compliance was hand washing. Not like most people do. Recite the ABCs or Happy birthday in your head and keep washing till you get to the end. Do this early do this often, do this whenever moving from one area to another or handling equipment that has come from a different area, cover your cough with your elbow and not your hands. Even after all that we were told and it was true you are going to get sick. The first couple of years working in that environment you were going to be sick with everything that came through the doors but after that you would rarely get sick because you would have immunity and they were right it was miserable. I have not worked in any facilities since 2014, I maintain my flu shot as well as keep the same hand washing procedure and still have not caught anything more than the common cold.

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  2. I have a PhD in health policy and epidemiology, and you probably read my research papers in your biodefense classes. You are exactly right with what you are saying. It is nice to see someone else not exaggerating the risk to try to get access to more funding.

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  3. Thank you for your sensible information and giving it with a bit of humor.

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  4. A tip - to let you know exactly how often you rub your eyes or touch other mucus membranes:

    After washing your hands, handle a dried jalapeno chilli.

    The lesson is soon learnt. What is more, it will show you after the first lesson exactly how thoroughly you have to wash your hands. Or you get a second lesson, when you do it again after what you thought was a thorough wash.

    Re stockpiling - toilet paper. Pet food. Self quarantine might be 14 days or more, rather than just 7.

    Get some good books, and/or movies. Either to take your mind off how lousy you feel, or for respite when looking after others. Rest. Sleep. Drink a lot of water.

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  5. I wrote a help blog which ran to long and got long in revisions. I would say two weeks of supplies. But I think you missed something important. The regular flu has a mortality of about 1% so 3% is nothing to sneeze at? The question is rhetorical. I know people who listened to the radio man who said this is a "bad cold" - those people are not preparing. I was in Gulf One as a journalist and the last couple of days before the war began, when the last of the gas masks were being handed out, middle class women fought over plastic sheeting, duct tape and bottled water. I down played as much as I could, but did tell people to add some of nature's anti-virals. With the CDC testifying there is not enough masks and gowns for health care workers and we know there is a limited supply of prescription anti-virals and with an already large number of seasonal flu then - we need more ideas. As journalists my husband and his co-workers know personal names of people personally affected - it changes - everything. Now three cases of unknown spread. People need two weeks of supplies.

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    Replies
    1. Regular flu mortality rate is .01%

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    2. We are preppers, so obviously the more preps you have laid in the better we think it is. :)

      Regarding mortality, both of the flu and COVID-19, please keep in mind that those mortality rates are not differentiated demographically. People who are older and/or who have pre-existing medical conditions are at a greater risk, whereas those who are healthy and younger have a much greater survival rate. Please go here for a breakdown of mortality by age group; you will see that those under 50 years old have a less than half of one percent fatality rate, whereas those who are 80 or older have a 22% fatality rate -- which isn't great, of course, but another way to look at that is to see it as a 78% survival rate.

      As always, make decisions based on how things affect YOU, not how they affect an undifferentiated population.

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  6. Since many flu deaths result from pneumonia, perhaps getting vaccinated for pneumonia is a good idea. It is free from Medicare.

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  7. Thanks for your calm, practical advice. Might I suggest that if you have kids at home, you pick up a new board game, book or movie to keep them occupied if they're stuck inside? Might cut down the need for the wine. ��

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  8. YES!!!!!! thank you for this no nonsense approach

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  9. I want to know what will happen to those who need Carers? The elderly and disabled people?

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  10. Thank you for the information.

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