Friday, March 27
Are we victims of our own success?
There has been a lot of debate over the worldwide and local response to the COVID-19 pandemic. It got me thinking, what if the SARS-CoV-2 virus had appeared 20 years ago? What would have been different? Is it possible we would not have even known it was happening? Perhaps we would have commented after-the-fact that it had been a tough flu season? Or maybe it would be closer to the 1918 pandemic -- infecting a third of the planet and leaving 675,000 or about 1% of Americans dead?
Twenty years ago, we would not have been able to ID the virus and develop a test for it in such a short time. Twenty years ago the automated RT-PCR instruments that can kick out 100s of tests per day did not exist. Rapid DNA testing technology was in its infancy twenty years ago. In 2000 FamilyTreeDNA offered the first Direct-To-Consumer DNA testing. Today millions have purchased their genetic fingerprint for under $100.
A vaccine went into clinical trials a week ago. I have been out of the pharma industry for a few years, but I still know enough to say that is insanely fast. Not possible 20 years-ago.
Yesterday, RayBiotech offered its finger-prick test for SARS-CoV-2 IgG and IgM antibodies on its website. It is not FDA approved. Supposedly they have made over a million of these kits. The speed with which that was done is mind-blowing to me, but I am sure some people will complain about it. Twenty years ago, we would still be trying to identify what the antibodies were, let alone having a commercial test available.
Today we all know where Wuhan is. (or do we?) Twenty years ago news out of this region of China was limited. We complain about how information about the Chinese epidemic was surpressed, but twenty years ago, even if the info was not supressed, it would have been even longer in getting to us.
Twenty years ago, fewer people would have been able to work from home. The technology was primitive with fewer highspeed connections. The ability to conduct some business while isolated may save us from a total economic stoppage. There was no Zoom or Webex or GoToMeeting. I remember distinctly the technology I was using for a global virtual meeting on 9/11/2001.
The world population has grown 33% from six billion to eight billion in the last twenty years with disproportional growth in high density areas. The province of Hubei (where Wuhan is located) has 12 cities with populations over two million. This density certainly makes controlling epidemics more difficult today than 20 years ago.
What hasn't changed? Personal Hygiene? Cleanliness of Public Areas? On my recent visit to San Diego, I found most of the public restrooms closed. It appears that public restrooms attracted camps of homeless and could not be kept clean. (I caught the flu in SanDiego in January and needed a restroom quite badly. My Uber driver drove me from spot to spot, only to find them closed. ;-)) My experience in the NYC subway in the last ten years is not extensive enough to render a definitive opinion, but they do not appear to be getting cleaner. My gym provides handsanitizer & disinfectant spray, but I see few people using it. The check-in uses a keypad and fingerprint scanner which I have never seen cleaned.
What will the world's pandemic response be 20 years from now? It probably cannot even be imagined. My prediction is that face masks and ventilators will not be the biggest problem.
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Here are the latest numbers for Westchester and New York City. If you don't like numbers, you will find this tedious. If you like numbers that are easily interpreted, you will be frustrated. There are at least three problems with using the test results to estimate viral spread rate and extent of spread. 1) It appears testing is still being rationed. 2) Test results lag infection date by days or weeks and 3) even if testing were not rationed asymptomatic cases would not be detected.
The 3/27 numbers for Westchester include another 1243 new cases bringing the total to 7187 or about 7 per 1000. Westchester has more cases per capita than any county in the country. If Westchester were a state, it would rank #2 (after NY) in number of cases. It has almost double the cases per capita of NYC. 3227 tests were performed in Westchester so almost 40% were positive. That is much higher than the US average of about 15% which makes me think testing is still being rationed in Westchester and the total actual infections are underreported.
www.bit.ly/COVID-Westchester
New York City in comparison had 4005 new cases from 6923 tests or 60%. Once again this tells me tests are being rationed and the total cases is underreported. NYC has 25398 total cases or 3 per 1000.
Both the NYC and Westchester numbers contain hot spots within those areas. Westchester is a big county stretching north from the Bronx over 30 miles. The southern third has the densest population, is closest to NYC, and is where the cases are concentrated. This area includes New Rochelle and Yonkers (where I am writing this note). The reporting of actual cases in these municipalities lags the county reports by several days due to a state policy of not making those numbers public until all test results have been reported to patients. The New Rochelle cluster included the first NY case and was spread to his family, work colleagues, and synagogue members.
Another county, Nassau, borders Queens on the east. It has 743 new positives out of 1411 tests bringing its total to 4657 or more than 3 in 1000.
Queens is a hotspot in NYC. Note that the 300 cases reported in the NYPD is a rate of 5 in 1000, higher than NYC but not out of the range for the NYC area.
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SD Biosensor
https://www.henryschein.com/us-en/images/corporate/covid-19-rapid-test-qa.3.26.2020.pdf
