Consulo Indicium - 3/16/20

Information for your Consideration…

 Happy Birthday Maine – March 15^th was our 200^th birthday celebration as a member of the United States of America.  We are thankful or, at least most of us…

Spreading the Word – The Seattle Times recently published two good graphics that you should share with friends and family.  I did not find a copyright so share away... 

Anthony Fauci, MD Speaks – Dr. Fauci was recently interviewed for an article in this week’s NEJM entitled “Talking with Patients about Covid-19”. When Authony Fauci speaks – we should listen!

Basic Covid-19 Facts – Amidst the cacophony of information, here are some basic facts you need to know that are published by the World Health Organization:

• The World Health Organization has calculated the doubling time for Covid-19 and up to and including 8th March 2020 it as follows:
  • If China is included = 20 days
  • If China is excluded = 4 days
  • Why? The difference is attributed to the fact that the total number of daily cases has declined following the lockdown of China.
• The predictive value of the doubling time is unreliable since how each country responds will be different PLUS the doubling time is calculated based on a fixed amount of time for the period. However, it can be used as a reminder of the exponential nature of the growth in incidence of the disease.
• To give you a sense of what exponential growth means, if you take 500 cases and double it over time, it will become 1 million cases after 11 doubling times. And, if you add 10 more doubling times to that block of cases, the world would be experiencing 1 billion cases.
• In the USA, it appears that the cases are doubling about every 2 – 5 days depending on geographical location and origin of the outbreak. The average doubling rate for the USA (as of March 14, 2020) was 3 days – and, that’s a very rapid growth rate with 1,678 cases reported as of that date [SEE “Country by Country Growth” at Our World In Data].
• The current rate of hospitalizations of cases in China are classified as:
  • 18% severe
  • 15% as hospitalization only
  • 3% result in death 
• In comparison to the N1N1 respiratory or “common” flu, the death rate among severe cases is 5.8% for N1N1 and 13% for Covid-19. 13% of severe cases result in death as opposed to about 5.8% for H1N1.
• It is two times plus more dangerous for hospitalized cases than the “common” flu in circulation in 2020.  This is in no way a prediction for the number of cases we need to expect; it is simply a reminder that exponential growth leads to very large numbers very quickly even when starting from a low base.

Johns Hopkins Leading the Way – The Johns Hopkins University website on the coronavirus is now universally considered one of the best available resources for monitoring and managing the Covid-19 outbreak.

TP Madness – In the midst of madness, it’s a time to also step back and consider a bit of humor. Dark humor can help us get through the tough times but taking us to the edge of reality.  This morning, I learned that a colleague stopped at the gas station on the way to church only to discover that toilet paper was selling for $1 per roll. Somebody out there is sitting on a gold mine! 

Unmasking America – It is times of crisis that we often unmask other significant issues in society.  The list for the USA keeps growing.  Here are just a few examples

• New York City may not totally represent the USA but – it does represent a problem we have in the country that has been unmasked by Covid-19. In “the City”, 1 in 3 children live below the poverty line.  The very sad part of this statistic is that these children rely upon the school system to provide them for adequate nutrition where they often receive three meals a day – breakfast, lunch and dinner plus a backpack full of food for the weekend.  With the imposed cancellation of schools, these kids will NOT get adequate nutrition!
• Anecdotes abound about “what’s a parent to do”. Working Moms and Dads can’t afford to stay home because without pay, their bills mount up and quickly overwhelm them. 
• It’s become clear to all of us that the USA lacks a “national” public health system. We rely entirely upon local and state governments to respond to national health emergencies like the Covid-19 pandemic.  Unfortunately, the “distributed” model of public health in times  of needs reveals the very disjointed nature of our response.  Unlike China – which has an entirely different, mandatory, no-exceptions-to-not-following-the state-mandated (which I am not advocating) approach – the USA public health model is a free-for-all.  Surely, there is a more coordinated approach that can be developed and deployed.  Not surely, actually there are models…
• We knew the pandemic was coming. It was only a matter of time.  In fact, the national office established as part of our national security apparatus was funded and in place through multiple generations of political parties until Trump took over.  The dismantling of our response system for the expediency of building other things has thwarted our efforts to adequately respond as a nation. 

DO THE FIVE… 1   HANDS Wash them often, 2   ELBOW Cough into it, 3   FACE Don't touch it,       4   FEET Stay more than 3ft apart; and, 5   FEEL sick? Stay home

Cognitive Decline Accelerates Among Widowers – A recent report appeared in JAMA Open Network reporting that researchers discovered over a three year period following the death of a spouse, the surviving spouse had cognitive declines that were 3X faster than a population of comparable married couples.  The decline was apparently independent of beta-amyloid levels – a major marker used for monitoring Alzheimer’s. The implication was that losing your spouse accelerated your cognitive decline regardless of biometric markers that were measured.  So, message received.  Keep your spouse healthy!  Lots of fruits and vegetables. And, wash your hands, keep your distance, cough into your elbow, don’t touch your face and if you feel sick – stay sequestered in the bedroom.  And, I’ll add another one – no heavy kissing :-)  . 

Diet Is Important – In a separate study reported in JAMA Internal Medicine, it was noted that the low-carb and low-fat diets which have become the rage actually only contribute to a longer life if followers maintain a healthier intake of foods, in general. So, what does that mean?  It means a diet consisting of more plant proteins (think legumes), unsaturated fats and high-quality carbohydrates like fruits and vegetables (see above) and whole grains.  The 20-year study followed nearly 40,000 participants. It noted that “people who got the most calories from unhealthy foods were 16% more likely to die during the study…” BTW, unhealthy foods means fast foods (in general), high fat, high carb loading type foods.

Testing for Covid-19 – Qiagen is a company that most everyone had never heard of except in the nether world of genomic testing until the past few days.  Why it did it become so prominent?  It seems that Qiagen has been designated by the CDC as the only listed source of “RNA Extraction Options” to be used in Covid-19 testing.  There are a few other companies out there but Qiagen is the one designated for testing by the CDC. The end result is that the company is boosting its production of a chemical that is essential for the testing and that has been “challenging” according to a company press release.  They are ramping up production at their factories in Germany and Spain – which are also in the midst of a Covid-19 outbreak. The problem is that the chemical produced by Qiagen is a key element used in the RNA extraction kits and without it, there is likely to be a delay in coronavirus testing across the USA or, we will need to find an alternative.  BTW, Thermo Fisher Scientific Inc announced last week that it had agreed to acquire Qiagen in a $11.5 billion deal. Nothing like a pandemic to seal a deal…