Just got home and spent some time catching up on the thread. I had to go help out with my mom today, since my dad was in an emergency room getting checked out for a couple of hours. He is home now and doing okay.They are both 85 years old - my mom has been on a ventilator for almost 20 years, due to deteriorating health associated with muscular dystrophy and my father has diabetes, can barely see and hear. They are not in a nursing home and pay for help to come in a couple of times a day to help out. I have avoided going to see them for the past several weeks, so I would not risk infecting them, but today I had to go.
Here are some comments on what I have read in the thread and other things I have learned recently (sorry for the length, but I had a lot of time to think while driving for four hours total):
1. Several times in this thread I have clearly laid out a way for NC (and the US for that matter) to get out of the lock-down. I will not go into detail except to say Test-and-Trace. This is what South Korea has done and they have avoided doing lock-downs nation wide. Most people who have examined this agree this is the best approach to lift the lock-downs.To implement Test-and-Target, we have to continue to increase testing capabilities (more on this in another point), but it does not require us to test everyone. It does not require significant portions of the population. It is highly targeted testing, focused on people who deal directly with the at-risk populations and people who exhibit symptoms. Once people are found to be positive, you quarantine them (means they do not leave their house for 14 days minimum) and you find everyone they came in contact with and test them.
2. There are two types of testing that should be done - molecular testing and antibody or serology-based testing.
- Molecular is what we currently have available and it can either be rapid (in the case of the Abbott Labs tests) or it can take several days. We currently have approximately 18,000 of the Abbott Labs test machines available. We have done over 56,000 tests in NC so far and most of this has not involved the Abbott Labs testing. The non-Abbott tests are very accurate, but we have suffered with test material and PPE shortages that have impacted doing more.
- The Abbott Labs test has the advantage of only taking 15 minutes to get results, but the test machines are not readily available in NC. Even though there are reportedly 18,000 in the US, NC reportedly only has 15 machines. Abbott Labs says they can make about 400 per week of these test machines and NC needs more. The Abbott machine can do about 4 tests per hour, so current capacity running 24/7 is 1,440 tests per day. If NC is able to increase its supply of machines to a total of 85 (this is based on a 3% allocation of six week's production), capacity could be increased to 8,160 tests per day.
- Currently a FDA approved anti-body test for Covid-19 does not exist in the US. Many companies and universities are working on this test, but currently none are in broad use and are only going through clinical trial at the moment. Some companies in other countries (China for example) are offering tests that reportedly test for Covid-19, but these are not approved and Dr. Birx has stated that we do not know if they are reliable, so they should be avoided. The anti-body tests will test for two types of immunoglobulin, IgM and IgG. IgM is the immunoglobulin first produced by the body when it begins to fight the virus. IgG eventually replaces IgM as the body fights the virus and becomes the predominate anti-body in the body. The anti-body tests need to be able to test for IgG to be effective.
- Once the anti-body test is available, it can be used to survey the population to determine to what extent people have already been exposed to Covid-19 and they should no longer be at risk. There is a lot of debate currently with regards to how long the virus has been present in the US and the extent that people had the virus months ago (or even recently) and were able to fight it off. There are some studies with limited numbers of people in the study from Oregon and California (less than 50 in each study) that seem to indicate it may have been present in late-November or December. The belief is that these states see a higher percentage of travel from China, so they may have been exposed to the virus earlier than other parts of the country.
- Anti-body testing is likely to be more effective in those states and areas that have seen the largest number of cases (NY, NJ, California, Washington, Louisiana, etc). The theory is you will find much higher numbers of people who have been exposed and now have the anti-body. In the states with less cases and exposure (NC is a perfect example,but others such as Wyoming, Montana, etc) will not benefit as greatly from these types of tests. It is still important to do the testing in these less-effected states to gain a general baseline for the existing exposure level, but it is likely wishful thinking to believe that a large portion of the population already has immunity.
3. It is way to early to be playing the blame game, particularly as it relates to political parties. Current evidence indicates leaders from both parties have made mistakes and have been slow to act. I could summarize many instances where leaders have provided bad advice to the citizens of particular states (NY and California are good examples), where leaders did not put in place strategies to adequately protect high-risk populations (NC is a good example) and were slow to put more broad travel restrictions in place (particularly where Europe and Iran are concerned). The time to have a full retrospect lessons-learned analysis is next year when the virus is hopefully more under control. Right now, the focus of our leaders needs to be solely on how we get the virus under control and get the economy open.
4. Dr. Fauci is not wrong about there being a second wave. He has been very clear on this and most virologists are of the same opinion. Dr. Fauci has also been clear that the very drastic measures we have taken over the past several weeks and will continue to take over the next several weeks most likely will NOT be required when the second wave hits. His view is by the time the second wave hits, we will have a few things going for us now that we did not have in February:
- We will have effective tests available -both molecular (slow and fast results) and anti-body. We did not have a test available in February, so the US was severely limited in this regard and it significantly contributed to the need to lock down. The reason for the lack of a test has been clearly documented and it has less to do with being slow to react and more to the point that the original test submitted for approval by the FDA failed. So a new test had to be developed and this took until March to be developed and approved.
- He believes we will have some effective treatments to the Coronavirus available to us when the second wave hits. We do not have them now. Last I looked, there were over 300 clinical trials underway and there is some optimism a few will be successful. While hydroxychloroquine and azithromycin are getting a lot of press and I agree it should be tested in clinical trials, I am not as optimistic about its ultimate success. There is also optimism about remdesivir (developed to fight Ebola) and there are some promising early results. We need clinical trials to validate the success of all of the proposed treatments. There are lots of people now working on various treatments and I am optimistic some things will be found that help. However, it will be a few months before we know for sure.
- We will have better strategies for testing and tracking breakouts of the virus and better able to lock down select areas instead of locking down the entire economy.
5. Some people are suggesting we cannot open the economy until a vaccine is available and quite frankly, this is not a rational strategy. Additionally, is it not rational or reasonable to keep the economy locked down until there are zero deaths and zero cases of the virus. Most people I have seen suggest lock-downs can lift when two things happen:
- The number of daily new cases drops for 15 days straight and,
- Testing capabilities exist to conduct Test-and-Trace
6. Lock-downs were put in place to reduce the number of deaths and to lower the chances our healthcare capacity will be exceeded. I do believe the lock-downs have achieved both of these things and in many states (California and Washington) the success has exceeded expectations. In other states such as NY and NJ, they have experienced heart breaking levels of death, but I truly believe it would have been worse without the lock-downs. I will also note that for the most part in these states, they did not run out of critical ventilators or hospital/ICU beds. They have experience shortages of PPE, but I truly believe the government has done the best they could to insure PPE as available.
7. North Carolina has NOT been severely hit when compared with other states in the South and for the most part has been very lucky. If trends continue to hold, NC will not exceed its healthcare capacity for beds, ICU beds and ventilators. In fact, I believe NC has enough ventilators (based on current trends) to send some ventilators to other hard hit areas if this is necessary. I have provided statistics in earlier posts on this thread to backup this statement and I stand by my assessment. I firmly believe the lock-down measures being taken can begin to be lifted by the middle of May at the latest.
8. If current trends hold and even with the large increase in cases that have hit nursing homes, I believe NC will peak in the number of deaths per day a the end of next weekend. I do expect this week to be the worst week of deaths in NC, but I expect cases this week to begin to drop by the end of this week. I will say the large increase in cases in the nursing homes (where the majority of new cases are coming from) really pisses me off and the leadership of NC should take some time when this is done to figure out what they could have done better. I personally believe the NC leadership should have focused testing of nursing home workers and I also believe many nursing homes should have locked-down their facilities to all outside visitors (anyone who does not work in the facility) much earlier than they did.
9. The media and others need to get over the fact that lock-downs can be lifted starting in early May. There are many states that due to their low population densities, have seen limited impact from the virus. With Test-and-Trace, these states should definitely begin to open up at the end of April. Dr. Fauci has been clear (apparently some chose not to listen) that some states will be able to open up before other states do. I believe states such as NY, NJ, Michigan, Louisiana will be some of the last states to open up. Other large states like Washington and California could open up before some of the more hard hit states. States like Wyoming, Montana, Maine, North Dakota, etc, could open up end of April.
