Logistics of this SARS-CoV-2 pandemic.
First, in the USA, due to administrative bungling, inaction, and aggressive denial, we do not have sufficient test kits to properly address this pandemic. We recently acquired 75,000 test kits and there should be more coming. This is, relative to the probable numbers currently infected, utterly inadequate.
Discussing this with ER personnel, we expect virtually all ER staff to get this disease within the next month, and that a great many already have it. Most of those ER staff will have light cases, and there are not enough kits to test them either. There are approximately 25,000 board certified ER physicians in the USA, and at least that many specialists who are called into the ER on a daily basis. For each of ER physician, there are around 4 ER nurses and often a non-RN/MD administrator, plus several janitorial staff, and security staff, all of whom are critical to operations.
Do the math, and we would need around 250,000 test kits just to test the ER staff of the USA once. And, right now, these tests are taking as long as 2 weeks to get results back. Clearly, this cannot happen when there are 75,000 test kits available now. Equally clearly, the ER system cannot, and will not, shut down.
Keep in mind that in the USA, due to political nonsense, your ER does not receive Federal dollars, but only local hospital dollars taken from other operations. ER operations in the USA are an unfunded mandate. They must provide care, but there is no funding for it.
Given this reality, most of the time ER staff will not get tested because they need those tests to confirm the serious cases that come in. For themselves, they will rely on symptoms and they will treat themselves without confirmation in most cases. Given that the ER system cannot shut down, there will be infected ER staff who will continue to work. That is the culture of the ER — they keep going no matter what, come hell or high water. The ER operation must go on. They will wear masks, gloves, gowns, and attempt to minimize infectious contacts with those that come in. Keep this in mind when you visit the ER. Do it because you really have to.
But don’t think that even if nobody that worked in an ER came to work sick that it would make much difference. Waiting rooms will have sick people in them and currently we don’t use vaporized hydrogen peroxide or chlorine dioxide to deactivate these viruses. In this case of SARS-CoV-2, people are efficiently shedding virus prior to symptoms. During influenza epidemics, when ER staff are vaccinated, we should expect that 30% or so should contract influenza, have such a light case they don’t even know it, and be shedding virus during that time. So not much is different.
Quite obviously, this also means, that until this situation changes with test kits (and the laboratory staff are available to use them), the ER simply cannot test everyone that arrives who wants to be tested. You may be right. You may have SARS-CoV-2. You may be wrong. But if your symptoms are not sufficient, and you don’t fit the criteria, what are now precious test kits will not be allocated to you. It would not be responsible to do so, and it should not happen. Please don’t get angry at them for this.
There is also the problem that since the test kits we do have are put together quickly, and lab staff are learning how these kits work, (that includes kits from China and South Korea) they have an uncomfortably high false negative rate. This is another medical reality that we have to deal with. So, the best we can do is to truly minimize our infectious contacts. But, what is a potentially infectious contact?
Based on the most recent work, a potentially infectious contact is almost any thing within a few feet (or farther if you are in a room without good HVAC) of someone that is breathing. This virus is shed efficiently for a few days without needing a cough and there need not be any symptoms. It is aerosol spread.
80% of those who get SARS-CoV-2 will not become seriously ill. In Table 1 are figures from China. Now, the situation is not as bad as this table shows, because many more people get sick than get seriously ill and these are the figures for confirmed cases.
What is accurate here is the relative case load by age of serious illness. You can see this in the China percentage of total deaths column. What you see is that almost everyone who gets seriously ill is over 50. What this means is that if you are older — PLEASE STAY AWAY FROM YOUR KIDS AND GRANDKIDS. Stay away from children and parents of young children. That is the primary social distancing you can do.
The kids are probably passing this around and showing few signs. Their parents are probably getting it in pretty high frequency, and mostly both parents and children are not having a serious illness. So, if you are younger, don’t take the kiddies over to see grandma or grandpa. Just don’t do it for a few months. Skype and have phone calls. Maybe drop off groceries for them. But if you have any question about your health, don’t to that either.
If you are under 40, take precautions if you absolutely must visit parents and older friends. Wear a mask to help protect your older friends and parents from you. And leave the kids at home!
