On Fri, 13 Mar 2020 at 10:08, Rick Moen via luv-main <luv-main@luv.asn.au> wrote:
Quoting russell@coker.com.au (russell@coker.com.au):
Outstanding single-stop resource maintained by a qualified expert: https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-tec...
Hi, I would like to offer some additional information that I read today on a non-public Australian discussion board. I haven't sought permission from the author to quote due to timezone differences, but I hope they won't mind me sharing this anonymously. Quote of the other (I AM NOT the doctor who wrote this) person's text begins here: Okay, for a bit of background, I’m a former medical doctor who worked for around five years in medicine (3 in emergency department), who quit biomedical medicine to go into population health and have finished my Masters of Public Health a few months ago. In my opinion based on my assessment of reports coming out of China, Italy and elsewhere, the Australian government is, if anything, underplaying the problem. While on an individual level for the majority of people the symptoms are similar to the flu, the coronavirus is proving to have a mortality rate that is much higher than a normal flu - around 0.5% with gold-standard treatment. Children seem to be safe, and risk is much higher the older you are, and the more co-existing health problems you have. The virus is spreading through a global population that has no prior immunity, and is already widespread in countries all around the world. Epidemiological “best-guess” projections by experts of who will be infected, absent heroic social measures, are around 40-70% of the global population this year - an order of magnitude higher than infection rates from the flu. For those who are infected, approximately 20% have severe cases needing hospitalization for monitoring, supplemental oxygen, and potentially adjunctive treatments. Of those hospitalized, about a quarter have critical cases which need ventilatory support in the intensive care unit with 1-to-1 nursing using very expensive - and rare, machines, sometimes for up to three weeks at a time. Without this support they die (and with this support their chance of dying is decreased by a factor of ten). That is to say, if intensive care beds with ventilators run out, the number of deaths rises approximately tenfold. There are a few major problems with this. 1) The infection rate rises exponentially. A back of the envelope calculation would put Australian hospitals at the point of running out of hospital and ICU ventilator beds in somewhere from 2-6 weeks from now. This is based on estimating the number of undetected cases currently circulating within Australia right now spreading the virus, and the rate at which the virus spreads in normal conditions (based on what happened in China, Italy, South Korea, etc). When the beds run out, the mortality rate rises to about 4% of cases. If the infection infects 40-70% of the population, that means around 2 million to 3.5 million needing hospitalization this year in Australia, and 400,000 to 700,000 Australians dying. 2) If hospital beds fill up with Coronavirus cases, the capacity to treat other problems (emergency surgical conditions, chronic diseases, heart attacks, etc) is diminished. This means a rise in mortality and morbidity for other health issues. 3) The risk to medical and nursing staff is much higher than to the general population. High numbers of deaths of doctors in Wuhan and Italy strongly suggest that medical staff are vulnerable due to receiving higher viral loads (number of viruses in their initial infection) when they are infected. This means an already stressed health system undergoing a sudden drop in its capacity due to staff deaths. This is compounded by 2 week quarantines of staff. 4) Stockpiles of basic medical supplies are nowhere near enough to sustain the Australian health system through the epidemic. At the peak of the epidemic, the health system would likely use all of the protective masks in Australia within a few days. Most of our masks are made in China, which has had its factories shut down for the last month. It has been commonplace in Wuhan and in the north of Italy for medical staff to spend as much time as possible in their protective gear to avoid throwing them out after use, with some collapsing from dehydration. This is just one medical resource which will have its capacity tested by the pandemic, and which will put Australians at higher risk. Numbers 2-4 add to or compound the number of deaths given in number 1. These factors all add up to us facing something akin to the Spanish Flu of 1918, something of grave importance which we should not dismiss. Fortunately, there are things that can be done to limit the impact. You may have seen discussion recently about “flattening the curve” this is about slowing down the spread of the virus so that the caseload can be kept closer to the capacity of the health system - because more people die, the more people there are who can’t access healthcare. This goal also allows supply chains of medical goods to catch up, allows for time for medical and nursing staff to return from quarantine (and allows time for training of auxiliary staff to help with the epidemic). The experience with the social distancing measures in Wuhan have showed a strong ability to reduce the spread of the virus and reduce the number of simultaneous cases. This Medium article [1] estimates that a single day delay in implementing social distancing measures in places experiencing uncontrolled transmission results in 40% more deaths. These measures have been brought into play in Italy in recent days, and my best guess and hope is they will be brought into play in many other countries including Australia. [1] https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3...