Category Archives: Uncategorized

Social distancing, surge capacity and the new normal: COVID-19 Sitrep March 18, 2020

It’s been a week and boy, what a change. It’s fascinating to me that the clear message that needed to be sent to the general public 10 days ago was “Take this situation seriously”–that’s what I focused on in my blog post. I talked about flattening the curve and basic preparedness. Now the reality is becoming clear–we are in for a battle, and according to a recent White House report, it will be a long one. The US has joined countries around the world in implementing extreme social distancing measures including closing down schools, restaurants, bars, and gyms and sheltering in place. These kinds of measures are extreme and sure to invoke a lot of concern. Today’s article by Brian Resnick in Vox features quotes from several public health scientists who describe a difficult new normal: We will have to implement social distancing measures for months, even a year or more, to limit deaths and the disruption to society caused by coronavirus.

Right now having a plan for keeping up with the new normal and understanding all these changing recommendations should be a priority for every citizen. My institution, the Johns Hopkins Bloomberg School of Public Health, ­­is doing a great job of gathering reliable information from its experts about social distancing and other public health measures. I’ve also been working hard on answering public questions about the pandemic in real-time or near-real time in a public Facebook thread and through my Twitch stream, so feel free to join in on those if you want.

Here’s the brief sitrep of what I think is important today.

Surge capacity is the term that should be on everyone’s minds going forward. Why do we flatten the curve? Let’s say it together: “To save lives and prevent hospitals and critical infrastructure from becoming overburdened.”  OK, perhaps that’s too long for a catchy slogan. Communications experts, help me out.

The CDC describes surge capacity for healthcare settings as “the ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the present capacity of a facility.” This is already showing up in the US as shortages of consumer and healthcare goods. We don’t even have that many cases yet, but cities that do are already in danger of running out of blood, surgical masks and respirators, and other personal protective equipment (PPE) vital to preventing the spread of disease in hospitals and emergency care settings. The US Centers for Medicare & Medicaid Services (CMS) has recommended that evaluations for up-to-date mask fit tests are suspended because a mask is wasted. This means that masks may not fit as well, increasing risk to the providers who wear them.

The CDC has updated infection control practices for healthcare settings. The main change is to approve the use of face masks (surgical masks) in the care of people with COVID-19 if the supply of respirators (N95 masks) are running low. Surgical masks can prevent large droplets from entering the nose and mouth of healthcare providers, e.g., if they get coughed on. But for those providers who do things that make the droplets tiny (aerosolized) like my husband the anesthesiologist, N95 masks are still recommended. I hope he will be able to use them consistently. The FDA yesterday authorized use of out-of-date respirators if they have been properly stored.

Healthcare practitioners are, indeed, being infected. A WHO report from February 24 points out that more than 2000 healthcare workers in China have been infected, and 22 (0.6%) have died. A news article in a Chinese paper points out, however, that a press conference that same day mentions another 1070 clinically diagnosed cases and 157 suspected cases. This shows again to the importance of understanding that public health reporting of cases will always be a little behind the true situation.  Healthcare workers are more vulnerable to infection. They are in frequent close contact with sick patients. They might not know who is infectious or have the right PPE to protect themselves. They’re exposed to the virus in larger amounts over a greater period of time. They will also be put in settings where they will have to act quickly to save lives, making it more likely that strict infection control procedures will slip.

When healthcare workers are sick – or even if they are exposed – they can’t provide health care. Hopefully the worst-case scenario is clear in everyone’s minds: Thousands of the sick in hospitals, thousands of doctors, nurses, and other healthcare workers not able to work. We must do whatever we have to in order that supplies like masks, gowns, gloves and eye protection is available to protect our frontline workers. And we don’t want to get to the lowest level of CDC recommendations-when everything runs out, it may be necessary to make masks, but these aren’t likely to protect much.

I just finished watching President Trump’s news conference, and I’m relieved he will shortly invoke the Defense Production Act to ramp up production on critical supplies. The military will send resources. CMS will recommend no elective surgeries or dental procedures immediately to conserve PPE. Thank goodness. Testing production has just ramped up, which is good, but it means that in the next week we can expect to see a huge rise in cases as the number of tests processed increases. So don’t be surprised.

The bad news is that there are apparently data from Italy and France that millennials are developing serious illness at rates greater than expected. I only thing looked for about 15 minutes because I wanted to finish this post; I found something reassuring: While 24% of cases in Italy were between 19 and 50, no one under 29 has died there out of 1625 reported deaths. During the news conference Deborah Birx said some kind things about millennials, calling on their ingenuity to help defeat the virus while at the same time suggesting that maybe because they’re still out partying, probably getting lots of exposure to the virus, and likely spreading it everywhere. If this continues, numbers will not be leveling off as quickly as we want.