Post by Beth on Mar 17, 2020 22:32:18 GMT
Hi all,
This is what I've shared with my networks by email
---
Context:
I've been keeping an eye on domestic and global statistics about COVID-19, and noting that even allowing for our poor testing resources (thanks in part to Donald Trump refusing the offer of test kits from the World Health Organization, and in part to failures at our Center to Disease Control), we've got new confirmed cases climbing domestically. Relative to the U.S. population -- ~330 million people -- the numbers are still very tiny, but are proportionately climbing each day. When I began writing this message, there were a total of 93 recorded deaths in the U.S., and as I'm concluding a couple hours later, 6 more have deaths have been reported (total 99). Right now, if we went just by the number of diagnosed cases -- approximately 17 out of every 1 million people in the U.S. would have COVID-19. But as this morning and this past day indicate, we're starting to see escalation.
We can't truly estimate the spread of COVID-19 in the U.S. though, again, because we're very behind in testing, and because the symptoms can be mild enough for some people that no one realizes they have it. So we don't know -- is the actual incidence 2x or 5x or 100x or 500x the current numbers. What we do know from the global dynamics thus far is that COVID-19 is very contagious, and that it's lethality, though far less than prior outbreaks of SARS or MERS, is significant enough that if it spreads too widely, the domestic death toll in the U.S. could eventually be somewhere between 1-5 million people, partly because of the danger posed by the disease itself, but significantly because our healthcare system is so poorly resourced and prepared.
Why are we in danger?:
As of today, one of the countries with the highest proportions of infected population is actually Norway. Norway's whole population is about 5.4 million people (as compared to over a billion in China), so it doesn't have the most cases by any means -- but does have a high proportion. But the total number of deaths in Norway thus far is 3. Three deaths, out of 1443 diagnosed cases, which thus far would correspond to about 2/10 of 1 percent. This percentage may increase since most people who have been diagnosed have not recovered yet, but the Norwegian survival rates are still excellent, and the likely reason is that unlike Wuhan, and unlike most of the U.S., Norway has the healthcare infrastructure to better meet the demands of a pandemic, so that people in serious or critical condition get timely care, without overwhelming their health care system.
In the U.S., unlike Norway and other countries with, thus far, very low fatality rates, we have a healthcare system that's structured around the realities of third party insurance carriers who aim to pay as little as possible for each healthcare service and resource delivered. So to manage in that economic structure, hospitals operate with just enough beds so that every one will be filled as often as possible, to maximize revenue. This already creates problems, and sometimes unnecessary deaths, even without a pandemic. It means now, that we don't have the capacity to respond if a substantial portion of our population is infected, because even though most people can recover fully at home, our hospitals are already mostly operating at close to capacity.
The COVID-19 crisis doesn't just threaten people who get the disease and become very ill. In the U.S., because we've generated essentially -- artificial scarcity -- in our healthcare system, it means that if we have too many people coming to the hospital with labored breathing, high fevers, or dehydration (all potential outcomes with COVID-19), they began to compete for beds with all of our other serious and critical cases. So we don't just risk COVID-19 deaths, but people dying unnecessarily or prematurely from heart conditions, cancer, gunshot wounds, car accidents, even asthma attacks, and other emergency needs -- because we don't have enough critical care to meet new demands in addition to the ones that are always present.
The problem isn't just intensive care beds, but a shortage of supplies (masks, etc) needed to keep our healthcare workers from getting infected and quarantined. 1 person was recently diagnosed with COVID-19 in Vacaville, CA, and over 200 healthcare workers wound up quarantined (and temporarily unable to work), in part because the disease is truly very contagious, but also because the local hospital that treated the COVID-19 case was so under-resourced and under-prepared.
So what do we do right now and in the coming weeks and months?:
Since this isn't a good time to travel, even if you were prepared to re-locate to Norway: Some of you have already been hearing the term "flatten the curve" -- which basically means, we need to slow down infection rates to try to keep from totally overwhelming our dys-functioning and under-resourced healthcare system. We need to keep in mind that predictions about time till we have a vaccine indicate it may be more than a year, so this likely won't be resolved rapidly.
But for ourselves, we also just need to maximize our own readiness in case we do get sick, or live with someone who is sick. This doesn't mean stockpiling toilet paper or bottled water. It does mean focusing on strong immunity, and thinking about our physical environment at home, and basically doing everything we can to get through this, even if we are infected, without being entirely dependent on our unreliable healthcare system for survival.
A few tips:
* Try not to panic, it won't help, and there are reasons to remain hopeful: The estimates of lethality risk for people who are in relative good health and under 60 are very low, less than 1%. Even for those of us with risk factors, based on age and other health conditions most people are recovering, with or without intensive care. One of the recent patients who recovered fully was 100 years old! And parents, again, it's good to remember that children are surviving very, very well. Panic is stressful, and stress weakens immunity -- so let it go and focus on taking great care. I know this can be especially tough for people who already struggle with anxiety or panic attacks, and this is a great time to identify anything that will help with self-soothing and stress release.
* Warm air: Initial reports indicate that this virus thrives in cool, dry environments, so keep the air in your home or wherever you're staying on the warm side. If you or someone in your household is sick, warm air, not just warm clothing and blankets, is important for several reasons. A primary relevant one with COVID-19 is that when you're breathing cold air -- cold contracts, heat expands -- so if you're becoming short of breath, cold air will tighten your airways and make it harder, and increase the need that you might need emergency care. Heaters can dry the air, so humidifiers, or even boiling down a pot of hot water, can help restore moisture. Warm means warm -- not hot. You don't need to have your whole household sweating, just keep your indoor temperature warm enough that you wouldn't need to wear layers of clothing to feel warm.
* Strengthen your core: Right now, starting today and continuing every day -- it's a great idea to begin (or continue) doing gentle exercises that strengthen your abdominal muscles (abs), and to practice deep breathing down into the belly (like when we yawn). The more formal term is "diaphragmatic breathing". If you do get sick, COVID-19 often induces a deep dry cough, which can be hell on your stomach. A hacking cough can even tear or severely strain muscles in your stomach, and if your body isn't prepared to handle coughing, this can make recovery harder.
* Keep your lungs open: Avoid tea with caffeine (it's dehydrating), but some herbal teas can be very helpful. Some prospects include mullein leaf, pleurisy root (thanks, Aurora for the reminder), astragalus, osha root (thanks Nikki C. for the recommendation), peppermint, eucalyptus, and oregano.
* Clean, non-toxic environment: There have been record sales of cleaning products like Chlorox and Lysol, and I need to stress that if COVID-19 is on surfaces in your home (or wherever you're staying), you've certainly already been exposed. So, clean environment doesn't mean heavy use of chemical cleaning products, as these can make it more difficult to breathe if you're already short of breath. But do try to keep your environment dusted, periodically swept, and mopped or vacuumed, and remove trash with some frequency, so that your air is as clean and breathable as possible. If you already have respiratory allergies or asthma, consider getting a hepa-filter, if you don't already own one -- to keep your air a bit cleaner.
* If you get a fever: Don't immediately try to lower it with over the counter drugs. If you're getting feverish, your body is doing its job by trying to burn out a virus (or bacterial infection). So let it work, and focus on staying warm, and well hydrated, and sleep as much as you can. If the fever gets high (103 or above for most people is very high) -- then it's important to try to bring it down with wet cloths on the forehead, over the counter medication, and possibly by inducing you to sweat (staying wrapped up warmly if you can tolerate it, and drinking hot water or herbal tea). If you hit 104 or above, or if you can't bring it down within a few hours when it gets past 103, emergency care will potentially be needed. You can use tele-medicine first to confirm if you're unsure, but again if it's 104 or higher, I would head for the ER. Don't try to drive; if no one is with you, call 911. If a loved one (rather than ambulance) is taking you -- call ahead and let them know you're coming, and may have COVID-19. In the very worst case scenario where your community is clearly over-loaded and people are not getting timely emergency care: it won't feel good, but an ice bath can help bring down your body temperature, and stay as super-hydrated as you're able to be. I know this is uncomfortable for most of us to think about, but you might need a diaper, chamber pot, or bed pan, if you're hydrating heavily, and are too weak to repeatedly walk to the bathroom.
* Avoid or minimize dairy, even if you're well now: Having your body produce more phlegm (which dairy contributes to) can exacerbate symptoms, and make it harder to clear your respiratory system.
* If you're having difficulty when breathing: Don't lie flat, get your back supported by pillows or a reclining chair. Drink hot water or herbal tea. Topical remedies with eucalyptus and menthol may or may not help, but likely won't hurt you. Try to stay as relaxed and calm as you can. If you're a little scared and uncomfortable, it's no fun, but you may be fine if you're patient and give your body a chance to heal. If you feel like you may black out, like you're continually wheezing and gasping, your vision or hearing are having disruptions, or you can't keep from panicking from shortness of breath -- you likely need emergency care.
* Make your household or personal contingency plans: Who needs to be notified if you're sick? What do you need packed and ready if you need to be hospitalized? If you live alone or you're the only adult, who's checking on you? Do you want and have a medical power of attorney (aka healthcare proxy or advance directive) on hand? Try beginning the sentence, "If I (or my family) develop symptoms of COVID-19, I will take care of myself/us by..." and then beyond your specific answers that complete the sentence just work on facing the possibility, working past fear or anxiety, and knowing that you have a practical and adaptable plan in place. The worst case scenarios likely will *not* happen, but don't avoid thinking of them -- consider them carefully so that you won't be under-prepared. This may also mean communicating with loved ones outside your home -- for instance, planning with others so that if you are well and friends or extended family are sick -- you know who will be dropping off groceries and supplies on their doorstep, and vice versa.
If someone in your household has COVID-19, can you avoid exposure?: In essence, the answer is very likely that you were already exposed. COVID-19 has a longer average period than the flu (average 5, as compared to 2 days) from exposure to first symptoms, but is already very contagious once it's in your system. So if someone you live with is sick, you've probably already been exposed for several days. Again, this doesn't mean you need to panic, just stay home, and take the best care of yourself possible. It's possible that you won't even become symptomatic, and if you do, this is why we plan ahead!
If you recover from COVID-19, how long do you need to stay quarantined?:
If you have the social privilege and resources to stay in a safe place without severe economic hardship, try to get extra rest for at least several days, and ideally a week, after you are fever- and symptom-free. Being infected with COVID-19 and recovering does not mean you are subsequently immune -- you can get sick again (and this will likely remain true until there's a vaccine), so it's vital to recover thoroughly, for your own health, and to be sure that you don't rush back into the world while still contagious.
What do we need to learn from this, and to keep on doing beyond the immediate moment?
We urgently need to mobilize for deep change in our healthcare systems. Fairly consistently already -- we're seeing patterns that in nations and regions where there's a strong social safety net, and where hospitals that are well-resourced in terms of space, beds, supplies, equipment, and human staff -- COVID-19 fatalities are low. Though it's early in the U.S. (including its colonized territories), we're seeing indicators already that our lack of decent protections and infrastructure will induce a death toll, beyond what this virus would otherwise generate. This is going to be traumatic, and it's important that we keep speaking, learning, and reaching out to each other, both to work through that trauma, and to make sure that as many people as possible understand what we would need to do in order to create health and safety in the future, and how we wound up in this position.
Thanks for reading, and please pass this on as it's helpful.
This is what I've shared with my networks by email
---
Context:
I've been keeping an eye on domestic and global statistics about COVID-19, and noting that even allowing for our poor testing resources (thanks in part to Donald Trump refusing the offer of test kits from the World Health Organization, and in part to failures at our Center to Disease Control), we've got new confirmed cases climbing domestically. Relative to the U.S. population -- ~330 million people -- the numbers are still very tiny, but are proportionately climbing each day. When I began writing this message, there were a total of 93 recorded deaths in the U.S., and as I'm concluding a couple hours later, 6 more have deaths have been reported (total 99). Right now, if we went just by the number of diagnosed cases -- approximately 17 out of every 1 million people in the U.S. would have COVID-19. But as this morning and this past day indicate, we're starting to see escalation.
We can't truly estimate the spread of COVID-19 in the U.S. though, again, because we're very behind in testing, and because the symptoms can be mild enough for some people that no one realizes they have it. So we don't know -- is the actual incidence 2x or 5x or 100x or 500x the current numbers. What we do know from the global dynamics thus far is that COVID-19 is very contagious, and that it's lethality, though far less than prior outbreaks of SARS or MERS, is significant enough that if it spreads too widely, the domestic death toll in the U.S. could eventually be somewhere between 1-5 million people, partly because of the danger posed by the disease itself, but significantly because our healthcare system is so poorly resourced and prepared.
Why are we in danger?:
As of today, one of the countries with the highest proportions of infected population is actually Norway. Norway's whole population is about 5.4 million people (as compared to over a billion in China), so it doesn't have the most cases by any means -- but does have a high proportion. But the total number of deaths in Norway thus far is 3. Three deaths, out of 1443 diagnosed cases, which thus far would correspond to about 2/10 of 1 percent. This percentage may increase since most people who have been diagnosed have not recovered yet, but the Norwegian survival rates are still excellent, and the likely reason is that unlike Wuhan, and unlike most of the U.S., Norway has the healthcare infrastructure to better meet the demands of a pandemic, so that people in serious or critical condition get timely care, without overwhelming their health care system.
In the U.S., unlike Norway and other countries with, thus far, very low fatality rates, we have a healthcare system that's structured around the realities of third party insurance carriers who aim to pay as little as possible for each healthcare service and resource delivered. So to manage in that economic structure, hospitals operate with just enough beds so that every one will be filled as often as possible, to maximize revenue. This already creates problems, and sometimes unnecessary deaths, even without a pandemic. It means now, that we don't have the capacity to respond if a substantial portion of our population is infected, because even though most people can recover fully at home, our hospitals are already mostly operating at close to capacity.
The COVID-19 crisis doesn't just threaten people who get the disease and become very ill. In the U.S., because we've generated essentially -- artificial scarcity -- in our healthcare system, it means that if we have too many people coming to the hospital with labored breathing, high fevers, or dehydration (all potential outcomes with COVID-19), they began to compete for beds with all of our other serious and critical cases. So we don't just risk COVID-19 deaths, but people dying unnecessarily or prematurely from heart conditions, cancer, gunshot wounds, car accidents, even asthma attacks, and other emergency needs -- because we don't have enough critical care to meet new demands in addition to the ones that are always present.
The problem isn't just intensive care beds, but a shortage of supplies (masks, etc) needed to keep our healthcare workers from getting infected and quarantined. 1 person was recently diagnosed with COVID-19 in Vacaville, CA, and over 200 healthcare workers wound up quarantined (and temporarily unable to work), in part because the disease is truly very contagious, but also because the local hospital that treated the COVID-19 case was so under-resourced and under-prepared.
So what do we do right now and in the coming weeks and months?:
Since this isn't a good time to travel, even if you were prepared to re-locate to Norway: Some of you have already been hearing the term "flatten the curve" -- which basically means, we need to slow down infection rates to try to keep from totally overwhelming our dys-functioning and under-resourced healthcare system. We need to keep in mind that predictions about time till we have a vaccine indicate it may be more than a year, so this likely won't be resolved rapidly.
But for ourselves, we also just need to maximize our own readiness in case we do get sick, or live with someone who is sick. This doesn't mean stockpiling toilet paper or bottled water. It does mean focusing on strong immunity, and thinking about our physical environment at home, and basically doing everything we can to get through this, even if we are infected, without being entirely dependent on our unreliable healthcare system for survival.
A few tips:
* Try not to panic, it won't help, and there are reasons to remain hopeful: The estimates of lethality risk for people who are in relative good health and under 60 are very low, less than 1%. Even for those of us with risk factors, based on age and other health conditions most people are recovering, with or without intensive care. One of the recent patients who recovered fully was 100 years old! And parents, again, it's good to remember that children are surviving very, very well. Panic is stressful, and stress weakens immunity -- so let it go and focus on taking great care. I know this can be especially tough for people who already struggle with anxiety or panic attacks, and this is a great time to identify anything that will help with self-soothing and stress release.
* Warm air: Initial reports indicate that this virus thrives in cool, dry environments, so keep the air in your home or wherever you're staying on the warm side. If you or someone in your household is sick, warm air, not just warm clothing and blankets, is important for several reasons. A primary relevant one with COVID-19 is that when you're breathing cold air -- cold contracts, heat expands -- so if you're becoming short of breath, cold air will tighten your airways and make it harder, and increase the need that you might need emergency care. Heaters can dry the air, so humidifiers, or even boiling down a pot of hot water, can help restore moisture. Warm means warm -- not hot. You don't need to have your whole household sweating, just keep your indoor temperature warm enough that you wouldn't need to wear layers of clothing to feel warm.
* Strengthen your core: Right now, starting today and continuing every day -- it's a great idea to begin (or continue) doing gentle exercises that strengthen your abdominal muscles (abs), and to practice deep breathing down into the belly (like when we yawn). The more formal term is "diaphragmatic breathing". If you do get sick, COVID-19 often induces a deep dry cough, which can be hell on your stomach. A hacking cough can even tear or severely strain muscles in your stomach, and if your body isn't prepared to handle coughing, this can make recovery harder.
* Keep your lungs open: Avoid tea with caffeine (it's dehydrating), but some herbal teas can be very helpful. Some prospects include mullein leaf, pleurisy root (thanks, Aurora for the reminder), astragalus, osha root (thanks Nikki C. for the recommendation), peppermint, eucalyptus, and oregano.
* Clean, non-toxic environment: There have been record sales of cleaning products like Chlorox and Lysol, and I need to stress that if COVID-19 is on surfaces in your home (or wherever you're staying), you've certainly already been exposed. So, clean environment doesn't mean heavy use of chemical cleaning products, as these can make it more difficult to breathe if you're already short of breath. But do try to keep your environment dusted, periodically swept, and mopped or vacuumed, and remove trash with some frequency, so that your air is as clean and breathable as possible. If you already have respiratory allergies or asthma, consider getting a hepa-filter, if you don't already own one -- to keep your air a bit cleaner.
* If you get a fever: Don't immediately try to lower it with over the counter drugs. If you're getting feverish, your body is doing its job by trying to burn out a virus (or bacterial infection). So let it work, and focus on staying warm, and well hydrated, and sleep as much as you can. If the fever gets high (103 or above for most people is very high) -- then it's important to try to bring it down with wet cloths on the forehead, over the counter medication, and possibly by inducing you to sweat (staying wrapped up warmly if you can tolerate it, and drinking hot water or herbal tea). If you hit 104 or above, or if you can't bring it down within a few hours when it gets past 103, emergency care will potentially be needed. You can use tele-medicine first to confirm if you're unsure, but again if it's 104 or higher, I would head for the ER. Don't try to drive; if no one is with you, call 911. If a loved one (rather than ambulance) is taking you -- call ahead and let them know you're coming, and may have COVID-19. In the very worst case scenario where your community is clearly over-loaded and people are not getting timely emergency care: it won't feel good, but an ice bath can help bring down your body temperature, and stay as super-hydrated as you're able to be. I know this is uncomfortable for most of us to think about, but you might need a diaper, chamber pot, or bed pan, if you're hydrating heavily, and are too weak to repeatedly walk to the bathroom.
* Avoid or minimize dairy, even if you're well now: Having your body produce more phlegm (which dairy contributes to) can exacerbate symptoms, and make it harder to clear your respiratory system.
* If you're having difficulty when breathing: Don't lie flat, get your back supported by pillows or a reclining chair. Drink hot water or herbal tea. Topical remedies with eucalyptus and menthol may or may not help, but likely won't hurt you. Try to stay as relaxed and calm as you can. If you're a little scared and uncomfortable, it's no fun, but you may be fine if you're patient and give your body a chance to heal. If you feel like you may black out, like you're continually wheezing and gasping, your vision or hearing are having disruptions, or you can't keep from panicking from shortness of breath -- you likely need emergency care.
* Make your household or personal contingency plans: Who needs to be notified if you're sick? What do you need packed and ready if you need to be hospitalized? If you live alone or you're the only adult, who's checking on you? Do you want and have a medical power of attorney (aka healthcare proxy or advance directive) on hand? Try beginning the sentence, "If I (or my family) develop symptoms of COVID-19, I will take care of myself/us by..." and then beyond your specific answers that complete the sentence just work on facing the possibility, working past fear or anxiety, and knowing that you have a practical and adaptable plan in place. The worst case scenarios likely will *not* happen, but don't avoid thinking of them -- consider them carefully so that you won't be under-prepared. This may also mean communicating with loved ones outside your home -- for instance, planning with others so that if you are well and friends or extended family are sick -- you know who will be dropping off groceries and supplies on their doorstep, and vice versa.
If someone in your household has COVID-19, can you avoid exposure?: In essence, the answer is very likely that you were already exposed. COVID-19 has a longer average period than the flu (average 5, as compared to 2 days) from exposure to first symptoms, but is already very contagious once it's in your system. So if someone you live with is sick, you've probably already been exposed for several days. Again, this doesn't mean you need to panic, just stay home, and take the best care of yourself possible. It's possible that you won't even become symptomatic, and if you do, this is why we plan ahead!
If you recover from COVID-19, how long do you need to stay quarantined?:
If you have the social privilege and resources to stay in a safe place without severe economic hardship, try to get extra rest for at least several days, and ideally a week, after you are fever- and symptom-free. Being infected with COVID-19 and recovering does not mean you are subsequently immune -- you can get sick again (and this will likely remain true until there's a vaccine), so it's vital to recover thoroughly, for your own health, and to be sure that you don't rush back into the world while still contagious.
What do we need to learn from this, and to keep on doing beyond the immediate moment?
We urgently need to mobilize for deep change in our healthcare systems. Fairly consistently already -- we're seeing patterns that in nations and regions where there's a strong social safety net, and where hospitals that are well-resourced in terms of space, beds, supplies, equipment, and human staff -- COVID-19 fatalities are low. Though it's early in the U.S. (including its colonized territories), we're seeing indicators already that our lack of decent protections and infrastructure will induce a death toll, beyond what this virus would otherwise generate. This is going to be traumatic, and it's important that we keep speaking, learning, and reaching out to each other, both to work through that trauma, and to make sure that as many people as possible understand what we would need to do in order to create health and safety in the future, and how we wound up in this position.
Thanks for reading, and please pass this on as it's helpful.