Monday, March 16, 2020

Curve-flattening wasn't an obvious concept at first to most medical observers


Andrew Cuomo, D-NY governor, has pretty much taken the national lead on staging the strategy to “flatten the curve”.  He was on CNN today for an hour, and he is practically making himself de facto president in setting national policy.  He wants the states to be pretty much uniform so people won’t cross state lines to get out of the lockdowns.

I wanted mention his op-ed today and instruction to President Trump to use the Army Corps of Engineers to increase hospital capacity quickly.  Doing so could add confidence that the health care system need not be overwhelmed and help calm the markets.  Some hospitals are reported to have built some staging areas (like Stanford in California) for the expected rush of patients.
    
I have to admit that I only began to really ponder the “flatten the curve” idea about a week ago, as Italy’s desperate situation began to sink in.  Soon Italy may have more deaths than China, and Europe, including Spain, may.  You can combine the concept with the idea that younger healthier people are morally responsible for loose behavior that can infect others, although usually that doesn’t matter much with well-established infections.  Because the coronavirus came from China, an adversarial power, under circumstances that seem negligent and conceivably intentional, they make our hyperindividualism a vulnerability to a foreign enemy.

  
The mitigation measures for “flattening the curve” need to begin well before the curve starts to turn steep, when they will seem unnecessary to members of the public who don’t understand the math.
  
The Verily website in California is being rolled out, and it will probably exist in other cities later. Jack Andraka’s Facebook page today indicates he can help schedule other tests (at Stanford) sometimes for persons who do not immediately qualify for the test according to Verily.




I think we are approaching a point where volume testing by drive-in or for whole apartment or condo buildings will become needed, in order to learn the actual incidence of infection and actual typical severity, which may turn out to be much less than we think (but there is still the question of clusters, which could be related to more virulent strains or to larger exposures).

An Atlantic article by James Hamblin warns that the course for Covid-19 can be more dangerous than generally thought even in mild cases and younger patients. There is a tendency for a second phase or “relapse” sometimes.

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