Back to Work Part I: Understanding the CoVid 19 Enemy
Review SARS-CoV-2 Characteristics - Function & Contagion
As noted in my last report, we've moved from emergency management to crisis management. That is simultaneously the good news and the bad news. I expect the crisis in one form or another will be with us for some time to come. But forecasting what the future looks like is at best a precarious endeavor.
Everyone is now trying to figure out a way back to the new normal, which means living with a incurable virus in our midst, until such time as therapies, cures or vaccines are found and proven to be successful.
So what does the path forward look like?
The image at right was created by Brooklyn artist Craig Ward of bacteria he collected on the subway and made into artistic renditions.
Governor Cuomo Begins Sketching a Back to Work Plan
For starters Governor Cuomo extended NY Pause through May 15th. NY Pause is the directive to close social gathering places and venues, schools and non-essential businesses. Within the past week Mayor de Blasio said the NYC Public School system would not reopen this school year.
Governor Cuomo laid out a sketch of a conceptual plan, which likely came from one of the consultant groups, as it looked a lot like the growth share matrix devised by Boston Consulting Group. The growth share matrix was designed for companies to use to evaluate the businesses they are in, to determine whether to continue investing in them or to begin cashing out of them. The divisions in high growth businesses that are profitable are the ones to keep backing, while the companies in the low growth low profitability businesses are the ones to sell, close or grind out every last dollar.
Governor Cuomo's matrix axes [plural for axis] has high and low infection rates along the y axis and more essential / less essential along the x axis. The more essential and less potential infection the quicker you're back to work. The less essential and the higher the potential infection, the longer before you're back to work.
- CLICK here to read the rest of our report on Understanding CoVid 19 characteristics, symptoms, spread / contagion, mitigation, therapies, cures / vaccines, so we can get back to work.
Back to Work Part I: Understanding the CoVid 19 Enemy
Review SARS-CoV-2 Characteristics - Function & Contagion
Trump's 'Plan' to get America Back to Work
Meanwhile, back at the White House, the Donald outlined what he called a plan to get America back to work. This is a summary of an ABC News report of the plan. They reported that the Donald's three step plan includes:
- Doing mostly of what we're already doing: social distancing, telework and shelter in place for vulnerable populations. Additionally pave way for an opening of smaller venues with sanitation and social distancing in place, and allow elective surgeries as hospital capacity becomes available. This step assumes a downward trajectory of infections and testing for those infected and healthcare workers.
- Opening non-essential services like bars, gyms and larger venues can open with moderate social distancing and sanitation in place.
- Returning back to the new normal.
Getting Back to Work - Start with the Science
The first place to start in getting folks back to work is with a review of the science of viruses in general, and the Corona Virus in particular. This should provide clues to how to keep this beast in check until the bright scientific minds of the world come up with a cure and / or vaccine.
Short Course on Viruses from Wikipedia
Viruses are organisms, which have many properties similar to life like genes, but since they do not have some of the key life components - such as cell structure, their own metabolism or the ability to replicate without a host. Thus they are not considered living entities, but rather agents "... living at the edge of life ...". Wikipedia also says that there are 5,000 known species of viruses, which live in any and all ecosystems, and that there are millions of viruses on the planet.
Wikipedia also describes what a virus is when not replicating itself inside a host cell. They state,
"... viruses exist in the form of independent particles, or virions, consisting of: (i) the genetic material, i.e. long molecules of DNA or RNA that encode the structure of the proteins by which the virus acts; (ii) a protein coat, the capsid, which surrounds and protects the genetic material; and in some cases (iii) an outside envelope of lipids..."
Viral Agent Transmission - On Surfaces, in the Air & Older People
Thus virions are the vehicle for viral transmissions and as current studies of the Corona Virus indicate, the virions of CoVid 19 can remain operational for up to three days on some surfaces. Keep this factoid in mind, as its implications for ridding the nation of the virus is key, as it implies we all need to step up our cleaning regimens.
Also note that the reason older people are more prone to dying from viral infections, is that older people's cell walls diminish in size and strength as people age. Thus the cells of older people are more susceptible to viral infections as the virion can more easily penetrate and replicate within an older person - and like a computer virus - bring the whole system crashing down. Keep this in mind as it has implications as to who should be quarantined / protected.
There are six phases to a viral infection. They are: 1) attachment to a host, 2) penetration of a cell, 3) uncoating which releases the virus, 4) replication, 5) assembly [which can be mutations] and 6) release [explode the cell wall or replicate with the cells].
Virus Category - SARS, MERS & CoVid 19
SARS - Severe Acute Respiratory Syndrome, MERS - Middle East Respiratory Syndrome, CoVid 19 - Corona Virus 19 and the common cold all come from the same family of viruses. This viral family, Corona Viruses, is believed to date back thousands of years and is carried by birds and bats. The Corona Viruses were named as such for their 'crown' like appearance, which has some connection to the fact that they're RNA viruses.
Two 21st Century Viral Originations From China, the First Since Xi Jinping Became Dictator
Since the turn of the millennium, two of the major viruses named above appeared to have originated in China. According to a Wikipedia chart on the 2003 SARS virus, China had the lowest mortality rate. This leads one to ask the conspiracy question of whether Xi Jinping's China is developing selectively targeted bio warfare agents that have gotten out of control. It seems a fair and important question - but it's a question not a statement.
The other options are that China managed containing and mitigating the virus better than the other nations that caught it. Or that the Chinese government did a Rupert Murdoch style Fox Fake News, and published only what they seem to want folks to know, possibly omitting key facts to aid their narrative.
CoVid 19 is Now Called SARS-CoV-2 - A Flu Variant
The Corona Virus or CoVid 19 has been renamed to SARS-CoV-2 and it's described as an influenza variant. Thus it seems logical to look to the flu for guidance regarding SARS-CoV-2 transmission, which must be mitigated in order for us to safely return to work.
The flu can be transmitted in three ways: 1) direct contact with an infected source, 2) indirect transmission by touching a surface that has the organism and 3) aerosol transmission.
The Atlantic did a good early story on this vis a vis whether to wear masks on April 1, 2020 entitled "The Corona Virus Airborne. Should We All Wear Masks?". But the New England Journal of Medicine just completed a study which they published on April 16, 2020 [yesterday] which compared / tested for the Corona Virus which is now being called SARS-CoV-2. You can look both of these up and read them for free.
Characteristics of SARS-CoV-2 Transmission
A March 23, 2020 Washington Post report says respiratory viral agents infect and replicate in three areas - the nose, throat and lungs. A virus like CoVid 19 can replicate itself 10,000's of times and within days by millions. A person may become symptomatic after a day or two, but can also become contagious at that time or before.
The spread of a respiratory virus like CoVid 19 comes from droplets from within the lungs, which can be transmitted directly onto someone, or become airborne, or left on a surface. On smooth surfaces CoVid 19 can last up to three days, while on cardboard it lasts an estimated day. If it is frozen, it can reactivate when it thaws since it's not an organism per se [see above].
The April 16, 2020 New England Journal of Medicine report pretty much confirms the what was published in the Washington Post story above.
The Aerosol Debate & Masks / See the Atlantic report. See NE Journal of Medicine report. Coming later Monday.
SARS-CoV-2 - Therapies & Cures
Vaccines aren't likely for 12 - 18 months, assuming things go well. It's important to put a caveat here as the virus mutates as it's replication process co-opts / intertwines with the host cell. That's how scientists were able to trace the origin of the Corona Virus into the U.S. through Europe.
There are other potential palliative techniques.
One is using the blood plasma of people who have had the virus, in order to make use of the antibodies their immune response system created. The theory is that this would jump start or aid someone's immune system in combatting the virus.
Another is antibody testing, which is used to determine whether someone has contracted the virus, and their immune system defeated it. When this is the case, one presumably has an immunity to the virus, at least for a while, and can safely return to work. This technique has been used for over a century but with "varying results and limitations" says Scott Koepsell of the University of Nebraska Medical Center.
And Hydroxychloroquine which has been promoted by Trump who reportedly has or is rumored to have a small interest in the company that makes it. A clinical trial of this in Brazil was stopped due to its potential negative impact on people's hearts / conditions, after eleven people died of heart complications. A man in Arizona reportedly self medicated using chloroquine phosphate in a CoVid related case and then died. His wife did too, and was reported in critical condition.
One of the most promising drugs appears to be Remdesivir created by Gilead Sciences. The drug was originally targeted to combat the Ebola virus which quickly faded away. While it has not been approved for use, the Chinese apparently used it with some success to combat CoVid 19. A Febuary 5th, 2020 Time Magazine report states,
"...While Gilead's experimental drug isn't licensed or approved anywhere in the world, it is being rushed into human trials in China on coronavirus patients after showing early signs of being highly effective."
Remdesivir was used to treat the first Washington State CoVid 19 case, and succeeded. Stay tuned while many of the world's leading biotech firms pursue a therapy / cure.
Containment & Mitigation of SARS-CoV-2
At present therapies and cures elude us, so we have to fight the virus with containment & mitigation efforts. Containment is done by quarantining people either known or suspected to have the virus - or conversely - by quarantining people with high risk profiles in order to protect them from a potentially fatal illness.
For example, a number of members of the NYPD and MTA were unable to report to work while the crisis was raging, not necessarily because they had the virus - although some did and some died of it - but most because they had come into contact with someone who did have it, and thus they were quarantined in order to prevent any further spread of it.
People are also encouraged to self-quarantine in their homes, or within certain rooms in their homes if living with others - if they have it or believe they have it, in order to stop the spread of it, as it's easily transmitted. Governor Cuomo showed a chart showing the range of rates of transmission [0.9 - 1.2] in his April 16th press briefing. Those numbers are centered around one - which means every infected person infects either more than one [1.2] which accelerates the spread, or less than one [.9] which means the spread of the virus is being dampened. We were at 1.2 around or shortly after the NY Pause program began and now we're at .9 which means we're back on top of it. But it's not over because it's still being spread.
Another tool in the kit when you don't have a therapy, cure or vaccine is to employ mitigation efforts. These include things like social distancing - keeping six feet away from people, washing your hands, wearing a face mask, upping your cleaning regimen and testing and isolating people as quickly as you can after they've become infected.
The Trump Administration, for the past month or so, has laid false claim to asserting that anyone who wants a test can get it. But, even a month after the outbreak, this is still not true.
Getting Back to Work Using Science
Follow social distancing, thoroughly wash your hands with soap and rinse, STEP UP YOUR CLEANING REGIMEN [this is not emphasized enough], and don't touch your face before washing your hands. Quarantine the elderly and people with impaired immune systems and / or health issues. Wearing a face mask is now required when in close contact with others - but pay heed to where your hands have been since last washed while putting on, taking off or fiddling with the mask [it is for this reason that I think urging folks to wear face masks is bad advice].
Getting Back to Work - SARS-CoV-2 - Test & Isolate
The key to getting back to work is to quickly identify [testing] and isolate those with the virus. Governor Cuomo has highlighted testing as one of the key ingredients of a return to the new normal. But in spite of what President Trump says, there aren't enough tests available to do full population testing in New York State - let alone the nation.
New York has by far tested more of its population than anywhere else in the nation. And yet in New York State which has the highest testing rate in the nation, we've only tested between 2% - 3% of the population over the course of the past month. At this rate it would take three years to test the entire population of New York state. But work is afoot for an easier test with a faster read out, so stay tuned on this one.
There's also been talk about contact tracing - whereby after one tests positive, the government would seek out those with whom the subject was in close contact. They've done that in countries in Asia, but many believe that's not likely to go over well here, as it is considered a violation of privacy.
So what can we do now? Absent the tests, people can mitigate the spread by making sure they cover their mouths when coughing and trying not to cough in public. They can stay home when they feel ill. They can continue to social distance. They can wash their hands and step up their home cleaning regimen to sanitize or at least wash frequently used surfaces.
Getting Back to Work - SARS-CoV-2 - Clean the MTA
In the public sphere start with the public transit system [see photo at the beginning of this story done by a Brooklyn artist showing the bacteria he collected on the subway].
I've highlighted this in prior reports. Millions of New Yorkers use the subway on a daily basis. Just as there is no quicker way to move large masses of people around town, there is no quicker way to spread a viral agent than on public transit. The cleaning regimen of the subway system must be raised, and I would say - based on my frequent ridership of it - raised significantly. You clean up the subway system - really clean it and then regularly keep it clean daily - and you probably have won half the battle [along with other measures like social distancing, hands washing & cleaning in place except the store closings].
At least 59 MTA workers have died from SARS-CoV-2. That doesn't seem a coincidence.
We're fortunate in that the warmer weather is here so more people can commute via bicycle or walking.
Getting Back to Work - Clean, Clean & Clean Some More
And at all places of business up the cleaning regimen especially for door knobs, light switches, table and desk tops, computer keyboards and mice, cell phones, tv clickers and all hard and smooth surfaces where the little SARS-CoV-2 might lie in wait.
Be advised that there's new information being published by the scientific / medical community nearly daily as we learn about the CoVid 19 virus which as mentioned above, is now technically called SARS-CoV-2.