Coronavirus Tidbits #33 4-12-20

Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Tidbits will likely be a bit shorter and a little less frequent for the next little bit. I have been immersed in it and I need to spend a little more time on self-care, which for me means seeing the spring flowers emerge and digging in the dirt. Pesach is always a bit rough anyway, so I will turn to more nature.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

News 

Urgent: Contact Congress to Save the Post Office

As I wrote yesterday, Trump and Mnuchin refuse emergency aid for the USPS. See more here or at Resistbot.

Trump has long wanted to privatize the Post Office, apparently to hurt his perceived enemy, Jeff Bezos/Amazon, and to enrich his cronies.

One other, more nefarious reason, it to stymie states efforts to expand voting by mail.

Killing the Post Office will particularly hurt rural and elderly.

Please contact your Congress people either by calling, emailing, by Texting Resistbot on iMessage or text USPS to 50409. Either will help get your message to the appropriate person.

To Call your House member & 2 Senators: 202-224-3121 HOUSE: 202-225-3121  Also demand provisions for VOTE BY MAIL! while you have them.

 

Smithfield Foods plant temporarily closed d/t Covid outbreak; 

they produce 4-5% of the country's pork. Cargill and Tyson have also had to close plants.

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Recommended article: Pandemics and the Food Supply:

"With the adoption of “Just-in-Time” supply practices, most U.S. grocery stores carry only a three-day inventory of food. When demand surges, as during a public health emergency, stocks may be quickly depleted with long delays before replenishment.

There is much we can do to offset these vulnerabilities. We can reduce our dependence on foods from distant locations by buying from nearby sources and supporting and strengthening local farms and food producers. We can donate to local food banks and meal sites and encourage the expansion of regional, government-managed emergency food stockpiles. We can store more essential foods in our own homes before an emergency hits; a two- to four-week supply of staples should provide an adequate cushion. We can grow our own. Even the least green thumbs should be able to produce a decent supply of easily stored potatoes on a small plot. Most important, we can look after our neighbors and the most vulnerable among us during times of crisis."

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Farmers are dumping up to 7% of milk produced 

while in San Antonio, 10,000 families lined up for boxes from a food bank.

"Dairy Farmers of America, estimates that farmers are dumping as many as 3.7 million gallons of milk each day. A single chicken processor is smashing 750,000 unhatched eggs every week."

Similarly, millions of pounds of produce are being plowed under.

NYTimes has a reasonable explanation, including that factories are not equipped now to ship food in different packaging, as food shifts from school meals or restaurants to home. Logistics of distribution is also a problem. Sickening, nonetheless. https://www.nytimes.com/2020/04/11/business/coronavirus-destroying-food.html

 

Diagnostics:

still an incredible, negligent last of testing.

I was a little surprised at this strong caution about antibodies:

Presence of antibodies does NOT equal immunity. We just don't know yet.

More from IDSA on #COVID19 diagnostics in their podcast: bit.ly/2wyiq5m

Drugs:

Remdesivir: Big for #COVID19 therapy: the compassionate use results for remdesivir in 53 patients looks very encouraging, especially in very sick patients on mechanical ventilation with 18% fatality (only, expect > 50%) and overall 68% improvement.

I'm not bothered that this was not a randomized controlled trial; it wasn't intended to be. Compassionate use is just that--an act of desperation that might give an inkling or direction for further trials.

Devices:

Epidemiology/Infection control:

Excellent video on Handwashing and Soap

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Good article by Marc Lipsitch, Harvard epidemiologist

https://www.nytimes.com/2020/04/13/opinion/coronavirus-immunity.html

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Masks:

Another reminder about how to use and care for homemade masks:

https://www.self.com/story/homemade-coronavirus-mask

especially about putting them on and taking them off safely.

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***NOTE Temperature of the laundry water isn't critical; it is the soap that disrupts the virus' envelope. Many advise temps > 160 F based on lab data.

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A video on why Soap works: https://www.youtube.com/watch?v=K2pMVimI2bw It's a chemistry explainer. Once you are beyond the language, the illustrations are good.

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Face Shields:

are being promoted by three epidemiologists at U Iowa as an alternative for the public:

https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2020/04/07/coronavirus-covid-19-ppe-iowa-doctors-mass-produce-face-shields/2952532001/

This makes sense because the shield protects the eyes, nose and mouth from droplets.

Iowa Dept of Public Health says (for HCW): "Face shields should always be used in conjunction with homemade face masks. Face shields must be used in direct patient care to cover the mask so the same mask can be used when providing care to multiple patients."

Some infectious disease specialists I contacted suggest the public use both a shield and cloth mask when going shopping or in a public area, as the shield provides better protection against droplets, but air/small droplets can readily get around the shield. Plastic face shields are a good barrier and can be readily decontaminated.

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

 

Good article on Grocery Shopping safely and do you really need to disinfect groceries?

https://www.npr.org/sections/health-shots/2020/04/12/832269202/no-you-dont-need-to-disinfect-your-groceries-but-here-s-to-shop-safely

Again, the experts NPR spoke with emphasized hand sanitizing over everything.

They say it is not necessary to disinfect groceries: "If you follow good hand-hygiene practices — washing your hands after unpacking your groceries, before cooking and before eating — then, she says, your risk is probably "very, very low."

If something (like canned goods) are going to be set aside, you can just leave them for 2-3 days and don't need to wipe them down.

And these infectious disease experts disagree with the Michigan doc of the famous YouTube, saying to just rinse your produce in cold water.

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From pediatrician Dr. Daniel Summers:

I tell parents they’re off the hook for trying to accomplish anything beyond the necessary. If they don’t have the bandwidth to potty train or work on getting their toddler to sleep through the night in their own bed, they can hit the COVID button as many times as they need. There will come a time when trying to get your picky child to tolerate cucumbers will once again seem worth tackling. Now is not it. Bring on the macaroni.

We are all daily facing stressors that surpass anything many of us have experienced before. We are facing loss of jobs, of security, of the capacity even to leave our homes for the indefinite future. We are facing illness and the potential of death. We are facing the catastrophic failure of many of our leaders, starting at the very top, to address this crisis with competence and forthrightness. We are facing new struggles and hardships every day.

That is enough to deal with. It is enough that I cannot smile at the small, nervous patients in the way that so often I was able, to help them feel just a little bit better in the scary place. That is challenge enough right there.

Every challenge that can responsibly wait can be put off for the day we can safely get haircuts and give hugs again.

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Breathing exercises:

Are increasingly being recommended. This article is a reasonable summary and is worth a read.

https://www.dailykos.com/stories/2020/4/8/1935532/-Doctors-and-nurses-demonstrate-breathing-techniques-proven-to-help-with-coronavirus-symptoms?detail=emaildksp

While binge-watching Netflix or whatever, it may be worth practicing these to become comfortable with them. Some are similar to those given to patients with COPD or pneumonia pts, given an incentive spirometer.

Focusing on the breath is an anchor in meditation and some forms of yoga. You might find these helpful in reducing your anxiety as well.

Politics:

Trump retweets call to fire Anthony Fauci after the coronavirus expert says earlier measures ‘could have saved lives’

https://www.washingtonpost.com/nation/2020/04/13/trump-fire-fauci-coronavirus/

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Paula Reid @CBS was remarkably persistent yesterday at Trump presser:

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Heartbreaking and infuriating indictment of our "preparedness":

 

Comic relief:

Perspective/Poem

From Nick Kristof:

"Journalists have rarely been allowed into hospitals in this crisis; reporters and photographers found it much easier to be embedded in Army units in Iraq or Afghanistan than to embed with doctors fighting Covid-19. Hospitals worry about HIPAA privacy rules, the dangers of infection and the possibility of embarrassing stories. Unfortunately, the shortage of gritty on-the-ground coverage means that to many Americans, the coronavirus remains distant and unreal — so they plan a large Easter dinner or gather friends for a game in the park...

The death rate from Covid-19 has been more than 50 per million inhabitants in the United States, versus four per million in South Korea, one in Singapore and 0.2 in Taiwan..."

While many hospitals don't allow health care workers to use their own PPE (Personal Protective Equipment) some do.... Goggles for Docs has been helpful in providing ski goggles.

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From Dr. Leana Wen, on Giving Birth in a COVID-19 Pandemic

My providers never wavered in taking exceptional care of me — just as they did two years ago. But just as I saw them as potential asymptomatic carriers, they saw me as one, too — someone who could make them ill and endanger their loved ones.

And that, sadly, is the deeper shift at work in our health-care system. Covid-19 is forcing a change in the provider-patient relationship and creating a tension that must be navigated with empathy, by caregivers and patients alike.

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Quite disturbing:

Prepare for the Ultimate Gaslighting*

The Great American Return to Normal is coming.

Bits of beauty:

Two views of Maine from Mary Baudo.

 

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