Coronavirus: what everyone should read
I read today what for me was the best and most informative article on Coronavirus (Tomas Pueyo). The article has been translated into 27 languages.
The original article is very well illustrated and with many references, which make it a solid piece of work.
The only problem is that the article cited is very long. Its reading on Medium is estimated at 26 minutes. So my role is to summarize the most important ideas of the article in a schematic way. Reading time is only 4 minutes
For brevity, there is no reference here other than the original article.
1) The actual number of cases at any given time is always much greater than the number detected by statistics, under any circumstances. Active cases are the total number of people who can transmit the disease to other people, and it is estimated that about 1/4 of the contagions occur before symptoms occur. Thus, even a place, like Brazil, with a still low number of cases, hides a very different reality.
2) Around 20% of detected cases require hospitalization. 5% of cases require admission to the ICU and 2.5% require extremely intensive care such as ventilation and/or oxygenation ECMO (extra-corporeal oxygenation)
3) The problem is that ventilation and ECMO cannot be easily manufactured or purchased. Some years ago, in the USA, there were about 250 ECMO machines, for example. In ICUs, many of these patients need ventilators or ECMO at the same time, but it is not possible to share. So doctors need to decide which patients will use them. This means choosing who will live or die. This was all the fatigue and the contamination of the health workers themselves. All of this contributes to the hospital becoming a chaotic environment.
4) Therefore, the collapse of the hospital system is the most important factor that explains the high mortality rate of the Coronavirus standardized by age and not the disease itself, treated in the best way. This explains why death rates differ so dramatically from country to country.
5) The transmission rate R is the number of people that each infected person contaminates. As long as this factor is greater than 1, we have an exponential growth in the number of cases. And in this case, after a certain level, there is inevitably a collapse in the hospital system.
6) Countries that act quickly can reduce the percentage of deaths by a factor that can reach 10, in addition to dramatically reducing the peak in the number of cases.
7) In relation to contagion, coughing and sneezing from a distance of less than 2 meters can be dangerous. The virus can live for hours on objects touched by contaminated people (examples are bars in public transport, food package in markets, chair arms, money, etc.), people who touch these objects, then secondarily contaminate their own objects such as a wallet or cell phone. At some point, this direct or indirect contamination reaches one of the mucous membranes (lips, inside of the mouth, nostrils and eyes).
8) In this way, it would be necessary to thoroughly clean hands and personal objects when arriving home, assuming that nothing is contaminated there. From the description it is easy to understand that this is rarely done perfectly. You can’t count on that. Only a small percentage of people are successful in these measures. Of course, hygiene on the street and at home is still essential, but this is not enough for the population as a whole.
9) So the only solution that works is strict social distancing. People need to avoid different types of environment for a while in order to drastically reduce the transmission rate (R), from R = ~ 2–3, where the virus progresses uncontrolled, to something below 1, when eventually the disease disappears.
10) In other words, it is necessary to stop crowding in confined or even open spaces, whenever possible: shopping malls, certain public transportation, some workplaces, popular street commerce, beaches, churches, cinemas, theaters, shows, events, parties and funerals. All of this, depending on the density, can constitute a time bomb.
11) Poor countries have additional problems, because there are deficiencies in public health not mentioned in the article in question. Crowded public transport are very dangerous. It is necessary for the state to ensure that the need for transportation is reduced in order to avoid high density of people, without the transport companies reducing the offer of transportation to the point of generating dangerous agglomerations even with low demand.
12) Social distancing depends on several levels: attitudes of companies, culture and education that reflects the average attitude of people towards the problem and the governmental decisions and rules. Temporarily, home office is the big deal when possible.
13) Countries that have been successful in fighting the disease have all taken very tough measures. This happened in some eastern countries like South Korea, China, Taiwan etc. Italy has also adopted very tough measures, we need to wait for the results. There is a distance between measurements and effects, by the distance between contagion and detection and also the willingness or possibility of the population to follow them..
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Vaccines and drugs are being researched intensively, but none of this should stop the necessary measures against the coronavirus.