Monday, March 2, 2020

What a public health agency should be doing now for COVID-19

1.  Diagnostic information.  Describe the specific features of the disease in the US (symptoms and signs) so doctors will be able to clinically distinguish most COVID-19 cases from other respiratory infections like colds, influenza, pneumonias, allowing them to isolate, quarantine, treat respiratory infections more sensibly.  CDC and NIH say they will publish articles on this soon.  

Excuse me, but CDC and NIH leaders are not academics whose job is to publish in academic journals:  they are public servants with government websites devoted to dealing with COVID.  As soon as they find information useful to professionals or the public, it should immediately be posted on their websites.  And state health departments say the necessary information has been made available to CDC.

This poster, used by health systems throughout the US to distinguish influenza, colds and pertussis, is exactly what practitioners need -- with an extra column for COVID-19, so we can quickly differentiate likely and unlikely COVID cases.

2.  Decontamination.  Tell us how to clean different surfaces and how to eliminate virus on fomites.  With other coronaviruses, virus was viable after a week on some surfaces.  NYC says they will give schools a "deep cleaning."  What method will they use and who said it was effective?

CDC has P4/BSL4 labs where environmental studies can be safely conducted to answer this question.  The answer is crucial.  Yet the CDC website, even as of today, March 2, includes no information in its COVID infection control section (or anywhere else I could find) on environmental decontamination.  I was also unable to find this info, specific to COVID, on the WHO website.

3.  Testing.  Why did CDC restrict testing to under 1000 people total in the US through the end of last week?  It seems they did not trust their test, and restricted testing to people who had an extremely high risk of having the virus.  Which would presumably give fewer incorrect results.  This tactic led to lowballing cases.

Yet WHO had another test it shared with countries; China had tests; commercial and state labs wanted to develop tests.  Until the evening of 2/28/20, only CDC's test was allowed to be used in the US, and only if the patient met very restrictive clinical criteria and had a strong China connection. 

Being unable to test kept the US numbers down, for a time.  But it allowed cases to go undiagnosed and to spread within the community.  This no doubt has caused a much larger problem--undiagnosed cases--so we do not know where in the US there are current "hot spots" and Americans have been slower to respond vigorously.

We need real time rtPCR tests, antibody tests to determine prior infection, information on viral cultures and animal models to speed research.

4.  Treatment.  CDC and the rest of the federal establishment know that remdesivir may work, chloroquine phosphate may work (both used in China) and other drugs may be able to be repurposed for COVID.

We have been told 1 US person received remdesivir and others are being offered it in the US.

Why isn't the US conducting joint clinical trials with other nations (those who have tested and diagnosed many more cases) to explore the many possible drug options?  Where are these drugs made?  What efforts are made to get them into rapid production, especially remdesivir?  Where do the raw materials come from, and can they be produced in the US?  Apparently China is trialling over 200 drugs in small trials, as well as antiserum.

5.  Overwhelming of the medical system.  If cases continue to rise exponentially, we will exceed the available hospital beds, ventilators, doctors, nurses, masks, gowns, etc.

Coming up with a plan for how to respond at that future time is what we need from public health agencies and government.  Right now, we have enough of everything.  Is the US trying to rapidly manufacture masks, gloves, other PPE, ventilators, ECMO devices, train staff, and otherwise prepare for a medical armageddon?  To me, this is the real role of the public health system.

If so, what is being discussed behind closed doors?  What are the feds planning in terms of increasing healthcare resources?  In terms of rationing healthcare?  

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