Let’s Give The Medical & Nursing Communities A Fighting Chance To Help Us

An entity so small that you can get a sense of its size only by saying how much smaller it is than the smallest thing you can see, is causing global disruptions of unimaginable scales

Countries where COVID-19 cases have been reported — size of bubble is proportional to number of cases

There’s no dearth of graphs and cool data visualizations illustrating the spread of the COVID-19 virus across the globe. You’ve also listened to and watched countless scientists, physicians, researchers and politicians talk about where we are, and where it looks like we are headed with respect to COVID-19.

Science is inferential. Medicine is inferential. You notice trends, and then interpret them based on an existing body of data, information, and knowledge. With time you might need to adjust your inferences and conclusions based on new data. Consider the case of measles — by some accounts, the disease was known as early as the sixth century, but it wasn’t until the 18th century when Francis Home, a Scottish physician, recognized the mode of transmission of the disease. He attempted to develop a vaccine and recommended isolating those who had contracted the disease (for an excellent article on Francis Home’s contributions, the reader is referred to an excellent paper by the Nobel laureate John F. Enders who created the first measles vaccine). Measles is one of the world’s most contagious diseases. It is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. Even after all these years, we don’t have a treatment for measles, but we have a very successful preventive measure — the measles vaccine. In the last couple of decades there have been a few measles outbreaks across the world, most of them in areas where children were not vaccinated because of non-compliant parents.

Despite all the good data showing measles vaccines prevent the disease, poor judgement contributes to measles outbreaks.

Fast forward from measles to 2002 when the SARS virus emerged and grew into an outbreak by 2003. Once we learnt it was a virus that caused the disease its method of transmission, epidemiologists, scientists, and physicians leaned on past experience to treat patients. Mortality was high for SARS and with recommendations for social distancing and quarantine in place, the virus essentially ran out of hosts and the outbreak subsided. Experience with MERS in 2012 closely resembled this. In both situations, medical establishments in the nuclei of the outbreaks were severely burdened with the rapid spread and severity of the diseases, and consequent unforeseen demands on resources. This led to new guidelines on how to handle future outbreaks, and the necessity for a good sentinel system.

Back in January of this year, Professor Lauren Gardner and colleagues developed models to determine which countries would be most affected by the novel coronavirus outbreak. In the maps below, Gardner and colleagues projected which countries would be most affected from the outbreak in China, which airports across the world would be at highest risk, and which cities in the US would be at highest risk. While listing a number of limitations to their modeling, if we consider the current state of global COVID-19 affairs, their estimations from more than 7 weeks ago were spot-on.

It appears that most political appointees may have callously disregarded findings put out by scientists like Gardner, choosing instead to resort to hubris and falsehood, leading to a chaotic situation that is testing the limits of our medical systems. Although this modeling study came from barely 40 miles away from the seat of the US government, it was not until the end of February that Donald Trump thought it worth putting together a task force. Since the time of its institution, the task force has been providing regular public briefings, and the calm, realistic, and sage words of Dr. Anthony Fauci and Dr. Deborah Birx are always welcome — between them they have an enormous wealth of experience and knowledge dealing with viral diseases and epidemics. With the situation changing from day to day, we learn of new expectations of the public, to curb the spread of COVID-19 and the phrase “flatten the curve” has entered common parlance.

Yet, as the maps above created using data from the WHO illustrate, the number of cases and deaths continue to increase in most countries — it appears to plateauing in China.

Perhaps the most important thing we’ve learnt is that social distancing goes a long way in flattening the curve. Daily exhortations from the task force and various government agencies about how to wash your hands, the number of people who may assemble, the distance to maintain between individuals, the kind of symptoms to be alert about, what to do when these symptoms surface, and so on, seem to have made little if any difference to the trajectory of the disease. Because many are not abiding by the recommendations. For the most part, these are not complicated recommendations that have been made — indeed, the issue of losing a paycheck is hardly insignificant, but the photographs and clips that one sees are of young people treating this time as a college spring break.

With increasing evidence that asymptomatic individuals can test positive for COVID-19, it’s hard to underscore the importance of social distancing even for all seemingly healthy individuals. Ultimately, it is those who have underlying health conditions who are most heavily affected by this virus requiring levels of acute medical intervention at an unanticipated scale.

The pace at which the virus is spreading is matched only by the spread of false and unsubstantiated information, including offers and suggestions for quick fixes should you come down with COVID-19. We are living in an era when science has made enormous progress and we have a better understanding of diseases and disease processes. But we don’t know everything, and we can only get to the next level of understanding by learning from past experiences — such as lessons learnt from SARS and MERS.

How can we hope to be saved from, or escape the wrath of, COVID-19 if we don’t follow the most recent set of recommendations? Our healthcare professionals are at the bleeding edge of this chaos and working tirelessly to help COVID-19 patients; even if they developed superhuman capabilities to work with no breaks in the day, we would still come short on COVID-19 if we don’t heed the recommendations, simply because of the numbers involved. Flouting and ignoring the recommendations isn’t fair to those with underlying health conditions, and it isn’t fair to our healthcare professionals. Let’s do our bit in this mess we find ourselves in, and not contribute to it — wash your hands with soap and water as often as you can; stay home if you can; maintain a distance of six feet between you and the next person if you have to go out; pay attention to the science; don’t share unsubstantiated science because you’ll be contributing to the infovirus/infodemic. This is a developing story, so let’s not be alarmed at or scoff at moving goalposts — they’re being changed for the greater good.

We don’t have a cure yet, we don’t have a vaccine yet, but let’s hold on to clear thinking and make it through this — with a lot of help from scientists, and healthcare professionals. It’s all hands on deck now — which means if you aren’t a healthcare professional or involved in planning for and mitigating COVID-19, your job is to stay home, and most importantly, don’t panic!

Deepti is a scientist & now, a research analyst at Yale University. She runs Tilde Cafe, a forum to demystify science & make it accessible (www.tildecafe.org)

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