Saturday, May 2, 2020

The feds have failed us; but we can solve some of the basic questions about COVID-19 at the state and local level

My state has had 1156 positive COVID cases, 0.1% of the population, and 30 new cases in the last day.   Twenty-two percent of cases have been in healthcare workers.  New cases peaked in early April.  My county has had only 10 diagnosed cases, though we don't know how many people who have second homes here, and are sheltering in them, are affected.  They are not counted in our totals.

In any event, the case numbers are small enough for Department of Health employees to do case finding, trace contacts, and maybe identify some asymptomatic spreaders.  Is this happening? This is the basic way public health professionals respond to many infectious diseases, for example tuberculosis, syphilis and hepatitis.  

Mapping out the spread of the disease at the individual level would be extremely useful.  There are so many basic questions that need to be answered, and this would help provide some answers.  What were the risk factors in each case?  How many people were infected through close contact?  How many by touching infected surfaces? How many by simply breathing the same indoor air as someone else?  Would opening windows help?  What are our highest risk behaviors?  Does wearing a homemade mask, never tried before, reduce cases? Are surgical masks acceptable for healthcare workers' safety?

What treatment did each case receive, or administer to themself?  Were vitamins, supplements, medications used? How long did the illness last?  Did early treatment prevent hospitalizations? Shorten the course? Did any recovered cases spread the disease to others?  Is there actual evidence of reinfection?

These data could be collected by employees with minimal training.  They would be useful in my state, even with just 1156 cases.  But think how valuable they would be if collected, as much as possible, throughout the country.  Throughout the world?  

Our federal experts are clearly failing us.  They present us with no safe off ramps, except for that faraway and elusive vaccine.  (See final paragraph for info on what happened the last time the federal government rushed into a vaccine program for all.)*

Perhaps generating our own data, at the state or local level, is something we can do, now, to help us find our way out of the maze.

The lockdown should have bought precious time, during which we could figure out how to resupply needed medical and protective equipment, identify drugs that were useful and plan how to obtain them in sufficient supply.  We could have learned what countries with low death rates did right, and try to emulate them.  We could have figured out which tests were accurate, approved them, stopped the rest from being used, and expanded the production of the good ones.

But these past weeks seem to have been squandered.  There is still not enough PPE, so how will there be enough if we have a second large wave of cases? Testing is an unregulated jungle.

And instead of identifying and resolving the issue of effective drugs, our top COVID doctor (Fauci) greenlighted a scheme to alter the endpoints of NIAID's clinical trial of remdesivir, not just once but twice, to make the drug appear to have a little efficacy.  Meanwhile, he railed against hydroxychloroquine.  Subsequently, over thirty states have limited hydroxychloroquine prescribing, most commonly restricting the drug to severe, hospitalized cases. Yet 3 of 4 hospital systems in San Diego, for example, are using it. Is Fauci playing us, claiming we need better data before it can be recommended, but then refusing to fund any trials to obtain that data, when the stakes could not be higher?  And offering a nothingburger instead.

Since hydroxychloroquine reduces viral load, it should be given as early as possible.  Didier Raoult, France's most famous infectious disease doctor, says it does not work when its use is delayed. With over 1 million diagnosed cases, why are the American people still in the dark about almost every aspect of this pandemic, and especially about how the treatments that have been used, have done? 

It's past time to start gathering our own detailed data, at the state and local level.  Encourage your governor to participate and be a hero. Time to light a candle in the dark, and dig our own way out. 

Update May 8:  It looks like some states have gotten serious about contact tracing.  Maine would be a very manageable state to do it. No new cases diagnosed in my county for a week! Hallelujah.

*The WaPo tells us today about the disaster that occurred the last time the federal government decided to produce a vaccine at warp speed.  But for a much better understanding of that fiasco, read Maurice Hilleman's JAMA article, or take a detailed peek behind the curtain of the federal health bureaucracy in this study of the 1976 swine flu program, produced by the National Academy of Sciences. 

1 comment:

emmap said...

Also - I want the demographics of every case and every death from SARS COV2 - age, what chronic illness they were suffering from; in addition to what vitamins and supplements they were or were not taking.