As fall approaches in much of the world, many people are anxious about what will happen when cold weather forces people indoors. Will the virus resurge with a vengeance, especially as people return to offices and schools reopen?
We’ve been warned about a “fall wave” for a long time, but then we had a bad summer wave. What most worries you about the fall?
I try to avoid “wave” metaphors because each outbreak is unique. New York City and Sturgis, S.D., both had bad ones, but months apart and for different reasons: New York in February because of tourists returning from Europe; Sturgis in August because of a motorcycle rally where masks were disdained.
But yes, autumn really worries me. Outbreaks are exploding at colleges all across the nation. There may initially be fewer deaths because students are young — but professors aren’t.
And soon, chilly weather will drive people indoors, where studies suggest you are 20 times more likely to get infected. By midwinter, if we aren’t careful, the death toll could head back up toward its April apex.
One notion about how we get back to “normal” is that we will achieve herd immunity — the proportion of the general population with immunity that would block the ability of the virus to thrive and spread.
The odds say that’s not very likely. Firstly, there is no certainty that immunity lasts. Like the flu, having COVID-19 probably does not mean you won’t get it again. But the second problem is the percentage of immune people required: it’s estimated to be 40 to 80%. To reach 60% the number of deaths would be between two and three million in the US alone. The Washington Post simulations below will help you grasp the problem.
A vaccine, or millions of deaths: How America can build herd immunity to the coronavirus
Can the country build herd immunity without letting millions of people die?
In the absence of a coherent plan from our Federal government, Medical professionals offer specific recommendations. Here is a summary from the New York Times with hyperlinks to sources for details.
The Association of American Medical Colleges released a “road map” listing areas for action. The groupsays its members include all 155 accredited medical schools in the United States, as well as more than 400 teaching hospitals and health systems. “If the nation does not change its course – and soon – deaths in the United States could be well into the multiple hundreds of thousands,” the preamble warns.
No. 1 on their list is remedying shortages: “Laboratory supplies (e.g., reagents, transport media, plastic trays, sample vials, swabs for testing) are a critical national need. The federal government should negotiate with plastic fabricators and chemical supply houses, using the authority of the Defense Production Act or other means, to redirect American manufacturing to urgently eliminate shortages. … The federal government should negotiate with paper companies, rubber companies, and fabricators to increase domestic production of these urgently needed [personal protective equipment]. … The government should issue large contracts to companies producing critical medications needed for COVID-19 treatment so that companies are willing to overproduce in the short term and ameliorate national shortfalls.”
The Johns Hopkins University Center for Health Security released a report on Wednesday with its own 10 recommendations. “Unlike many countries in the world, the United States is not currently on course to get control of this epidemic. It’s time to reset,” six scholars write in the introduction of their report. Like the academic medicine association, they also call for bolstering PPE and testing supply chains. Also on their list: “Close higher risk activities and settings in jurisdictions where the epidemic is worsening and reinstitute stay-at-home orders where healthcare systems are in crisis. … Conduct and make public detailed analyses of epidemiologic data collected during case investigations and contact tracing. … Scale up contact tracing and continue to improve performance. … Develop policies and best practices to better protect group institutions.”
The Florida chapter of the American Academy of Pediatrics issued new guidance on reopening schools. Education reporter Valerie Strauss reports that the guidelines sent to Gov. Ron DeSantis (R), who has pushed for schools to reopen fully, list measures schools should take to safely offer in-person learning, including: Staggering start times for students to keep the number of children low inside classrooms. Keeping kids in cohorts throughout the school day. Enforcing strict handwashing requirements; disinfecting classroom surfaces every day. Ensuring that ventilation systems for classrooms are in good working order. Keeping children and teachers six feet apart in classrooms and during outdoor activities. Barring any activities in which students face each other.
“In the absence of robust and rapid diagnostic testing for schools, the major tools for disease mitigation are personal (social) distancing, mask usage, strict hand hygiene, fomite prevention on surfaces (enhanced cleaning measures), and proper room ventilation,” says the guidance, submitted by Paul Robinson, the chapter’s president.
At least 17 of 21 states flagged as “red zones” in the latest internal report compiled for the White House coronavirus task force are apparently not following recommendations by federal authorities to slow the spread. “The report, which is sent regularly to state officials but is not released to the public, categorizes states as green, yellow or red based on their levels of new cases and rate of tests coming back positive,” Hannah Knowles reports. “A state is designated a red zone if it reports more than 100 new cases per 100,000 people or if more than 10 percent of its virus tests come back positive.”
Rep. Jim Clyburn (D-S.C.), the chairman of the House’s Select Subcommittee on the Coronavirus Crisis, sent letters on Wednesday to the governors of the red-zone states of Georgia, Oklahoma, Florida and Tennessee urging them to follow the White House task force’s advice, including requiring masks, closing bars and more strictly limiting gatherings. He also demanded states turn over documents and data to his committee. “The White House’s refusal to publicly call for strong public health measures and to ensure nationwide compliance has led to an uneven patchwork of restrictions across states, counties, and cities,” Clyburn wrote in an open letter to Vice President Pence and White House coronavirus task force coordinator Debbie Birx. “This approach is allowing the virus to spread, prolonging and exacerbating the public health crisis facing this country.”
A study released this morning by the Massachusetts Institute of Technology calls on governors in neighboring states to coordinate economic reopening plans more closely. The Social Analytics Lab at the MIT Initiative on the Digital Economy says its researchers used data from mobile phones, social media and the census to conclude that residents are worse off when reopening is not coordinated among states and regions. “When we analyzed the data, we were shocked by the degree to which state policies affected outcomes in other states, sometimes at great distances,” said Sinan Aral, an author of the study, in a statement. “Travel and social influence over digital media make this pandemic much more interdependent than we originally thought. Our results suggest an immediate need for a nationally coordinated policy across states, regions and nations around the world.”
“Florida’s social distancing was most affected by New York implementing a shelter-in-place policy due to social media influence and travel between the states, despite their physical distance,” according to a summary of the study, while “New Hampshire had a strong influence on adjacent Massachusetts, despite being a small state.”
Here’s a vivid science experiment that demonstrates the benefit of wearing a mask to reduce contagion. Although these petri dishes are not COVID-19 but rather random bacteria, they demonstrate the dispersion of droplets by speaking, shouting, and singing with and without masks. They experimenters also demonstrate the remarkable reduction in droplets as social distance is increased.
A dear friend asked for instructions on how I cook Salmon so that it stays flavorful and moist. It’s fairly simple: I brown it and finish it with steam.
Preparation
Slice the salmon fillet into serving size pieces about 1.5 inches wide. Arrange the pieces skin-side down on a plate. Salt and then spread soft butter on the top (pink) side. (It also works to melt the butter in the pan immediately before adding the salmon.)
Cooking
Select a skillet (with a lid) that’s large enough for all the salmon. Pre-heat it until water beads and dances when splashed on the dry surface (about 375 degrees). Apply a light coating of olive oil, and quickly place all the pieces in the skillet, buttered side down, skin up. Sear for 96 seconds uncovered, then turn skin-side down. The pink side will be pleasingly brown thanks to the butter. Reduce the heat a bit (300) and sear the skin side for another 90 seconds.
Holding the lid at the ready, splash in some dry sherry (1 to 2 oz) and clamp the lid on, trapping the steam as the liquid flashes to vapor. Reduce the heat, keep the liquid boiling (275), and steam for 1.5 to 2 minutes. Remove from the heat and leave covered until you serve it. The liquid remaining in the pan may be spooned over the salmon when you plate it.
This same method works well for medium-rare steaks and hamburgers. Pre-season the meat with salt, butter, and mustard before searing.
For most people, making zoom work is merely clicking the link in an invitation to a meeting. The rest happens automatically, all you do is follow the prompts. Easy?
Not always. Particularly for those who infrequently use the internet. The symbols, gestures, and words that are required to interpret and interact with a computer constitute a foreign language that’s not familiar. The glossary below demonstrates my point.
Term
Meaning
Screen
The entire surface that displays computer images
Cursor
The arrow, pointer or place marker that moves with your mouse or follows the movements of your finger.
TouchPad
A touch-sensitive surface that controls the cursor. (Sometimes the screen itself)
Window
A rectangular region of the screen that can be resized, moved about, or stacked in layers on a screen.
Web Address
The location of a particular page of information in the World Wide Web of Internet information. (e.g.: https://zoom.us) Technical name: “URL”
Address Bar
When using web browser software, the region of the window that accepts or displays the web address the browser seeks to access. This is not the “search” bar which interprets typewritten keywords and initiates a search for relevant web sites.
Enter
The act of pressing the “Enter” key on the keyboard. (This key may be marked “Return” or may have a bent arrow symbol tracing a line down and to the left.)
“Click”
The act of tapping the left mouse button to select whatever the cursor is pointing to.
“Right-Click”
The act of tapping the right mouse button to view options related to whatever the cursor is pointing to.
Drag
The act of moving a graphic object on the computer screen by pointing to it with the cursor, holding down the left mouse button, and moving the mouse.
There are many more of these terms, and many of them refer to an action originally performed with a mouse, but now refer to gestures performed on a touch-sensitive surface with the finger(s). We stroke and tap, not point and click.
It’s not realistic to think that people will take a course to learn how to use their computer or tablet to access Zoom. Coaches or guides are needed to help them acquire minimal familiarity and skills to get started.
Here is the abstract of a new study. It concludes that COVID-19 is much more contagious than we believed.
Abstract
Severe acute respiratory syndrome coronavirus 2 is the causative agent of the 2019 novel coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6–7 days and a basic reproductive number (R0) of 2.2–2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period. We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3–3.3 days. Assuming a serial interval of 6–9 days, we calculated a median R0 value of 5.7 (95% CI 3.8–8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus
High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2
Severe acute respiratory syndrome coronavirus 2 is the causative agent of the 2019 novel coronavirus disease pandemic. Initial estimates of the early …
“This is the first major medical voice to express this opinion. Dr. Shapiro is not just expressing a personal opinion, but that of the largest academic medical system in the country…over 40 hospitals (3 in Italy), 36 senior living facilities, #5 in NIH funded research, and 3.8 million insured lives in its health plans. We have a lot of data.
