“Shared expectations lead to predictability.”
- Testing problems continue unresolved
Q: Why are people in states with high caseloads not able to promptly get tests?
A: With increased number of cases being identified, the public is requesting tests in ever expanding numbers. Without an organized national testing program, supplies for many of these tests are hard to locate and expensive for states to purchase. In addition, the lack of national coordination has placed excessive demand on large laboratories that do the testing. This presents an overwhelming number of tests for some laboratories to manage resulting in long delays – up to 7 to 10 days – for results to be returned. Finally, under the false but stated assumption that more testing results in increased number of cases, the president has been promising to close down several large testing sites the federal government has promised. All these issues could be resolved by developing a national testing policy – but that seems unlikely for the time being.
- Circulatory system effects
Q: If coronavirus-19 affects the respiratory system, how come so many younger COVID-19 patients are having strokes?
A: Initially, this infectious virus was referred as the novel coronavirus-9. It was identified as within the coronavirus family (spherical with multiple spikes protruding resembling a crown-like object). Bur there was little known about how this virus affects the human body compared to and contrasted from other corona viruses – such as the ones that cause the common cold. Studies and evaluations would be needed to identify its unique or novel characteristics. It was recognized early that a common manifestation of the COVID-19 disease was difficulty breathing. It was spread to others through exhaled and inhaled respirations. Later studies of how COVID-19 affected children found a significant number of cases where inflammation of body organs was found. Another finding in younger adults was an infrequent but significant number of patients suffering strokes caused by blood clots. The immediate impact of this added knowledge was to consider and later approve for treatment the steroid dexamethasone that reduces inflammation, and of blood thinners such as Heparin. Investigators have now been drawn to examine more closely how the coronavirus-19 affects other organs and systems.
Earlier studies in April at Mount Sinai Hospital reported finding blood thickening and clotting in some patient organs. A more thorough examination by autopsies of COVID-19 patients has recently been concluded at the Department of Pathology, New York University at Langone Medical Center. Amy Rapkiewicz, M.D. chairman of the Pathology Department stated that clotting “was dramatic because though we might have expected to find it in the lungs, we found it in almost every organ that we looked at.” Autopsies also revealed large bone marrow cells called megakaryocytes that are common in bone and lung tissues were located throughout the body in multiple different organs. “Notably in the heart, megakaryocytes produce something called platelets that are intimately involved in blood clotting,” Rapkiewicz stated,
From these findings, it is speculated that many who have recovered from COVID-19 may have hidden organ damage. Examples include kidney and liver damage, and a host of other conditions. There is much more yet to be learned about this novel coronavirus!
- EMS resources stressed
Q: How are ambulance resources holding up with increasing COVID caseloads?
A: Ambulances have always been paired with the transportation of the sick and injured to a hospital. In 1968, the national Emergency Medical Services (EMS) program was established. EMT training, vehicle design and equipment on ambulances were all standardized nation-wide. For over a decade, with the wide acceptance of defined medical care being performed at the scene by paramedics, there have been proposals to allow paramedics to practice their skills in the field without transporting the patient to a hospital. An example would be at a school clinic. But this remains an aspiration for many. Current funding of all EMS services depends heavily on the patient being transported. Even in a municipal service, EMS is able to bill health insurance companies. However, they do not reimburse for calls unless the patient is moved in the ambulance. Thus, the major impact on EMS during this pandemic is financial. If the community is overwhelmed with COVID-19 calls, the call volume can increase. However, if the hospital and medical officials decide to request that no CPR and transport be given to all patients who are found to be in cardiac arrest at the scene, that EMS response takes time away from other calls, and later cannot be billed. Likewise, if the ambulance must wait in the hospital parking lot for 4, 6, or in one case 10 hours before the patient can be brought into the emergency department, there is no billing allowed for that waiting time. If EMTs contract COVI-19 while on duty, any overtime paid for others to cover their shifts cannot be billed. To counter all this, there is one offsetting resource available. FEMA has the ability to mobilize ambulances from outside the disaster area to travel to the areas where added EMS resources are needed. But even then, as this pandemic disaster widens to cover more of the nation, this pooling of shared resources becomes more difficult.
- Classic epidemiology: science and politics
- Why is it so hard for people to follow proven recommendations of public health experts?
- A. Epidemiology is the science of managing contagious diseases. Standard strategies have evolved to control such threats. A basic strategy to control an epidemic is “test-trace-isolate-and-treat” those affected. Accurate testing can locate infected people. For each person testing positive, they can be asked to identify who they have recently been in contact. These new contacts are then located and tested for the disease. All who test positive are then quarantined or isolated to prevent them from coming into contact with others. Each recently tracked person is tested. If their test is positive, they are asked to identify other contacts and over time, the chain of continued infections can be stopped. This strategy has evolved into an accepted policy for managing infectious diseases.
This series of FAQ has been focused on the science of managing coronavirus-19. But it appears that politically, it is increasingly important to reopen the economy and ignore the science. the current situation may be better illuminated by trying to understand what is behind the political discussions overtaking this issue:
In a new book “The Imposters” written by Steve Benner, many examples are cited with explanations showing that the Republican Party has been turning away from developing policies based on expertise, analysis and research. Policies that could result in debates leading to compromise. This shift began long before Trump ran for the office of the president. As far back as May 2009, GOP leaders were concerned after losing back-to-back election cycles. “The House GOP conference chairman (who was Mike Pence) advised his colleagues to start getting rid of legislative staff – aides responsible for writing and scrutinizing policy proposals, giving the party its capacity to govern – and start hiring aides who would focus exclusively on the media.” “Kentucky’s Mitch McConnell was often candid about how he approached his responsibility. …the GOP senator settled on a strategy of maximal partisanship, demanding total Republican opposition to Democratic proposals” (p.7). Trump entered office with his own unique deficits of leadership, but has been supported and enabled by the newly-refocused Republican Party. Each of the chapters in his book focuses on one of eight different policy issue being managed including health care, immigration policy and climate change. It is well researched and annotated. This book, perhaps can serve to better understand why so many people in the country appear to be unable to understand and sensibly react to the many rational policy options being discussed. The full title of the book is “The Imposters. How Republicans Quit Governing and Seized American Politics”.
- Confusion reigns
Q: I’m confused. Should I send by 4th grader to school?
A: Everyone is confused! The lack of a national pandemic policy focused on reducing the infection rate using standardized mitigation steps creates a confusing situation for the public. As a result, Americans are divided and state and local leaders are creating conflicting strategies to contain the surging COVID-19 cases. In Georgia, the governor Brian Kemp sued Atlanta’s mayor to prevent her from mandating masks. Medical professionals are angry over all this because more than 1,200 of them, 161 being nurses have already died from this disease. Many people say they won’t wear masks because it violates their freedom. The Trump administration is demanding that all schools fully open this fall – or he will cut their federal funding. Educators and many local officials are objecting because of the risk – to the students, staff and older people living back home. Thirty of California’s 58 counties are on the state’s watch list and their schools may remain closed. The CDC was ordered to revise their reopening school guidelines to make them less restrictive. Now the CDC has decided (or has been ordered) not to provide their revised standards to the public. Anger and angst are the expected result of all this chaos!
