COVID-19 Suppression until vaccine (18 months) recommended by new report.

report from the Imperial College in UK summarizes the results of a model utilizing the most up to date data available. Very sobering!!

Some key points.

We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half.

However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over.

For countries able to achieve it, this leaves suppression as the preferred policy option.

We show that in the UK and US context, suppression will minimally require

  • a combination of social distancing of the entire population,
  • home isolation of cases and household quarantine of their family members.
  • This may need to be supplemented by school and university closures

The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed.

We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound

Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

Certainly this is very sobering. We are in this for the long haul. Reports of some beneficial effects of drugs presently used for other purposes are providing hope for the critically ill.

Various cities and counties have instituted curfews and local ordinances, closing non-essential business under penalty of criminal charges. These measures are necessary for immediate mitigation and suppression.

San Francisco  instituted a “shelter in place” starting at 12:01am this morning in order to enforce enhanced social distancing measures. Again, a wise measure in a hot zone.

Anthony Fauci MD, Director of Infectious Disease and Allergy at NIH has sated “if someone tells you that you are over-reacting then you are doing it right”.

“Younger people should be concerned for two reasons. You are not immune or safe from getting seriously ill. Even though when you look at the total numbers, it’s overwhelmingly weighted toward the elderly and those with underlying conditions. But the virus isn’t a mathematical formula. There are going to be people who are young who are going to wind up getting seriously ill.

So protect yourself, but remember that you can also be a vector or a carrier. And even though you don’t get seriously ill, you could bring it to a person, who could bring it to a person, that would bring it to your grandfather, your grandmother or your elderly relative. That’s why everybody has to take this seriously, even the young.”

Too many in our community are under-estimating the gravity of this situation and the measures necessary to save lives. Those who ignore these recommendations increase risk for their families, friends, and society at large.

Stay at home except for necessities which include food, medicines, urgent medical care.

Immediately wash your hands with soap and water for at least 20 seconds when you come home or come in contact with anything from the outside. Soap and water more effective than hand sanitizer.

Wipe down hard surfaces with Clorox type disinfectants in kitchen, bathroom, phone, door knobs, car door handles, steering wheels, etc.

When out in public for necessities wear gloves, eye protection. Disinfect shopping cart handles before touching them AND wear gloves.

Any item brought into the home handled by other folks should be wiped with disinfectants.

Wash clothing and sheets frequently. Droplets from asymptomatic carriers of COVID-19 can remain on clothing and hard surfaces for a few days and remain infectious. If a retail worker touches their face then touches the item you purchase (or coughs or sneezes on an item) it could transmit disease.

Keep your immune system optimal:

  1.  No alcohol. Alcohol suppresses the immune system for several days
  2.  Get plenty of sleep, at least 8 hours.
  3. Follow good sleep habits.
  4.  Eat an anti-inflammatory diet.

Stay safe.

Sleep well, exercise outdoors, laugh, love, engage in meaningful work, drink filtered water, eat clean, eat whole foods, get plenty of sunshine, spend time with those you love.

Doctor Bob

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