Part 5 – Ending The COVID Shutdown

Do we have to stay at home until the last person dies? 

Is self-isolation or shelter in place for how long?

It turns out there is a way to end this crisis. 

We can do it today — yes today 

— that is how I started my podcast with this week’s episode, but there are a few points that need to be highlighted.

This Is Not Political

This has, for some people, become a partisan issue. This isn’t.  It is not Democrats saying we have to keep things locked up until we die of boredom or a vaccine comes out. Nor is it the GOP saying we should open up everything now and let people die.

There are always those who wish that to be the case. They want to paint one party into a corner to say something stupid (not difficult by the way) and show they are more reasonable.  Those who do such, no matter which side, are partisan hacks.

Many Types of Disciplines Besides Medicine Needed To Open The Economy

Science is more than virology, epidemiology, and medicine. There are other disciplines that need to have input when we talk about how to reopen the economy so it is better.

Economics is a science, and there is no doubt that economists, perhaps especially behavioral economists will provide vital input into how opening.

Business is a discipline, and if you would be opening the world in a time when we have this disease you certainly need to have business people involved in discussions. That means not only people from Wall Street but from Main Street. Not only business from the restaurants, and barbershops (please open I need you) but healthcare is a business and hospital systems need to be at the table.

There is a legal side of opening the economy. There are risks, there are parts of risk we can take, there are risks that we ought not to take, and having legal minds helps not only decipher a better way to inform citizens but develop tools so that the risk is mitigated. Simplistically, is there are role to keep business free from lawsuits of people who would claim they developed COVID19 from a business.

The Extremes Are Incorrect

We cannot keep the economy closed until we have treatment. But we also cannot open to where we will be harming people.  Risks are a part of what we calculate daily. Driving, scuba diving, breathing re-circulated air, undergoing surgery are all risks that we cannot bring the risk to zero.

It is also silly to reopen everything at once and take our chances. That is like saying, “we know driving is important to the economy so we will go ahead and make cares without seat belts, airbags, etc.” Yes, we live with risks, but we need to open to mitigate the risks.

People Want Easy and Partisan

Sometimes you cannot win with reason. I was in a discussion with someone who said that the current shutdown was not a violation of the first amendment, and that even before the founding of the republic the Continental Congress had laws about isolation and quarantine. That every time there is some public quarantine someone takes it to court and this has been adjudicated and it is in the public interest to have these laws. This person would have none of it and said even the Supreme Court could not interpret the constitution (apparently this person could).

There are some that would agree with whatever their “leaders” would tell them. They will believe memes over a peer reviewed scientific paper. By the way, the level of education a person has received, the degree a person has received, is not an indication of critical thinking skills.

These are complex topics and require complex input, rational thought, and consensus at high levels with a lot of people involved.

We are not experts at everything. But people want to think they can grasp complex issues and give a simple solution. This is why you have charlatans selling vitamins as the cure for COVID19, when it is far more complex than that. This is why you have people saying that we can pray COVID19 away, because it is too complex to grasp.

We all have our blind spots. Geology is a past time of mine, rocks and tectonic plates, and living in California I love to hear about the latest strategies to mitigate for earthquakes. But were I to look at the engineering and architects drawings I would be lost.  I am not an expert, but I am interested. I might know more about North American Plate and the Pacific Plate but get into the mechanics of subduction and I am lost.

We tend to disregard experts. They will believe a meme or a talk show host before they believe someone who has studied the field for years. We see this in medicine, climate change, anti-vaccination, genetically modified organisms.  People will believe a “logical” argument even if it is wrong before they will believe an expert.

Well, we need all the experts on board for this problem, and what we do not need is for the partisan hacks to claim victory – we need everyone to claim victory.

Some Things We Can Do Today

So when people ask for more information about what we can do to open up there are a few things that we can do today.

So instead of just saying “we need more testing”, we need a plan. Because more testing means a lot of things to a lot of people. Is it a nasal swab, is it spitting in a jar, is it blood, or is it taking a temperature

Number one  Massive screening

When most people hear this they agree and say we need to test people with those nasal swabs or some PCR test (stands for polymerase chain reaction).

This is not the PCR tests (nasal swabs) or the blood antibody tests.

By screening we mean asking some questions of people and taking their temperature.

It turns out that screening is one of the more sensitive ways we can tell if someone is sick.

So sensitive that if you have COVID screening will reveal it  about 90% of the time,

Taking a temperature and asking questions is something we can do to a lot of people quickly

And the results of that simple screening is we will have a small group of people that

We will want to get more information about – and those are a small group that we will wnat to determine

If they need the nasal swabs or PCR tests

It is an early indicator of disease 

If someone has one of these symptoms – and those are

A cough,

Unexplained body aches

A sore throat

Shortness of breath – or feeling winded for activities that you would normally not be

Chills

Diarrhea

Or a new onset headache

If someone has those, and/or a temperature greater than 100 degrees we would go to step two which is isolate them until they get a nasal swab

Which is the polymerase chain reaction – which is the reaction used to see the parts of the virus

That is the test we get from the nasal swabs – and where the majority of tests are done

Screening should be done before going into any retail establishment, workplace, and schools. 

In addition, the establishments must have hand sanitizers readily available, and all should be wearing masks.

The other tests which are important are the blood test that can detect antibody against the virus

If you have had COVID19 you will develop antibodies against the virus and if you have that you may have some immunity against the virus

We don’t know how long that immunity will last but we think it is good for two years

Antibody tests (blood tests) are important for front line workers in healthcare, police, paramedics to determine prior exposure and daily screening of first responders can provide an early tracking.

Some have suggested PCR tests of local sewage, which can give an early warning of people who are shedding – the technical issue is that RNA degrades rapidly and this would lag.

2. Contact Tracing

With tuberculosis and sexually transmitted disease once a case was discovered the state health department would work to isolate and treat the case and then spend a fair bit of time finding those people who have been in contact with the person. 

The ability to do contact tracing with cellular phones allows a more rapid response. Meaning we can see from your cell phone where you have been.

I know  – big brother government. WEll most of us are boring so no one cares.

But wouldn’t you like an alert on your cell phone if you were in an area where there was a person who is now COVID19 positive? 

And if you turned positive wouldn’t you like to be able to alert people you were in contact with that they might need to isolate for a bit and test?

This means use of the new apps being developed, as well as some of the location functions on cell phones.

We still need “boots on the ground” meaning public health care workers to follow up with contact tracing

To insure people have self isolated and that those who were in close contact do that and are tested.

It will also mean training more in public health workers – and it just happens we have people who need to be employed

3. Decontamination of surfaces/air

Surfaces in workplaces need frequent decontamination – and should be done frequently, especially in public places. 

Our local grocery store, Von’s hires people who spray and wipe down every grocery cart

That is surface decontamination. That is a great service from the grocery store

Thank you Von’s

In work areas, decontamination should be performed twice a day by the employees followed by a hand wash break.

For restaurants, this means when someone leaves

The tables, condiments, and menus need to be decontaminated

It may mean bringing back table linens or use of paper for table coverings. 

Many restaurants use to wipe down the table with some rag and ignore the salt/pepper/ketchup and menu

That will need to change to a better system to decontamination 

Perhaps individual condiments, real decontamination of the table surface and undersurface and chairs

Maybe bring back table linens or use of butcher paper for coverings

Maybe paper menus

4. Air handling systems

There was some data that a lack of air exchange systems in WuHan were the source of infections. If you are getting air filtered through your neighbors apartment then that has to changeFilters and scrub units along with UV lighting should be considered for apartmentsAnd for most business

5. Technology

If a person has been screened for a day then the ability to enter this on a cellphone application along with when the person has had any PCR testing, or if the person has had a positive antibody.Testing facilities will have the ability to change your screen on your iPhone with an appropriate application. You show your screen as you enter places to show that you have up to date screening, or testing. In that way the cellphone screen can provide identification of someone who can be in public and is not a danger – much like we would with vaccination.

6.Public Schools

Screening of kids before they go into schools is probably the best indicator of disease in a community. Every child needs to see their doctor before going to school, which is what happens with many schools. That doctor/pediatrician would either test the child for the #COVID19. 

And daily children would be screened by their teacher a few quick questions and a temperature.If the child has any symptoms, then a quick swab and test will allow early detection and can be followed up with isolation and contact tracing. Since kids are the community barometer – they are the early warning system for the community.

It is impossible to keep kids from one another – but having them tested and then isolating and sending home and having the ability to work from home is important.

In France they sent the kids back without this – and now they are having to close schools again because of new outbreaks of COVID19.

Hospitals and Medical Centers

When they have the ability the hospitals and surgical centers need to reopen to all elective cases as soon as possible. If the system is not overwhelmed then hospitals can be the center for testing in the community and screening. Currently at my hospital everyone who enters is asked if they have had any symptoms and your temperature is taken.If your temperature is normal and you have no symptoms you are given a mask and a paper and allowed entry. The paper is good for 24 hours. If someone has symptoms they are given a PCR test to check for the virus.

So let us assume you are positive. A positive person for COVID. That is the test indicates you have COVID. Then you self isolate. On your phone an app is placed and your movement is restricted. If you violate that movement it is an immediate fine, charged to your phone immediately. No exceptions. Wander too far and you are taken in. It is like the ankle bracelet for those under house arrest.

We could use those, but we don’t need to. South Korea does the app on the phone and it works.Want to enter a facility? You have to be COVID negative that week.

For those who have been exposed to COVID,  and recovered they get the special badge. They don’t need to go through testing all the time. This year Once we have the blood antibody test, we can use that test to give the all pass on the phone. This allows places to open where people who are negative can shop, can eat out, can buy things, and it effectively isolates those who are ill and watches their family members.

Leadership

According to Eisenhower:  “the essence of leadership is to get others to do something because they think you want it done and because they know it is worth while doing — that is what we are talking about. 

You want to end the stay at home. We can do that – today.

It is smarter than shelter at home. It allows our nurses, doctors, and hospital workers safety

This crisis was brought about by a virus, and exacerbated by ineptitude.

True leadership can lead us out of this problem. The investment in technology is minor. The ability to monitor people is universal. We can end the crisis and re-open the world.

Who will lead the way?

[OUTRO]

Thank you for listening to Your Doctors Orders. While I am a doctor and a virologist, I am not your doctor. And you should always seek the advice of a trusted, licensed medical provider.

But here is this doctor’s advice: Until we implement the technology, stay at home. Wash your hands a lot.

This podcast is a part of the Your Doctors Orders network and is produced and distributed by Simpler Media. My executive producer is the talented and masked Producer Girl from Producer Girl Productions. 

You can follow me for information and snarky tweets on Twitter where I am @drterrysimpson. that is d.r. terry simpson. 

Until next time, Don’t drink the water. Drink the scotch!