Courtesy of commentor Redshift:
What Happens Next?
COVID-19 Futures, Explained With Playable Simulations
— Marcel Salathé (@marcelsalathe) May 2, 2020
#Covid19 vaccines may set records for development, with some manufacturers predicting they could have data to support emergency use in the fall. But such predictions may be misleading the public on when average folks will be vaccinated, experts worry. https://t.co/kuSVK5S0eL
— Helen Branswell (@HelenBranswell) May 6, 2020
Read the whole thing — seriously:
… Even if the stages of vaccine development could be compressed and supplies could be rapidly manufactured and deployed, it could take many more months or longer before most Americans would be able to roll up their sleeves. And in many countries around the world, the wait could be far longer still — perpetuating the worldwide risk the new coronavirus poses for several years to come.
That reality is being obscured by reports that some of the earliest vaccine candidates — including one from the biotechnology company Moderna and another from University of Oxford — may within months have enough evidence behind them to be administered on an emergency use basis.
Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, is worried people aren’t preparing for the possibility of a fall wave of infections — which some experts fear will be bigger than what we’ve seen so far — because they expect a vaccine will be at hand.
“I’ve actually heard higher education experts say, ‘Well, you know, we’re kind of counting on the vaccine maybe by September because we keep hearing about that.’ And of course, in their mind, they’re equating [that to mean] colleges and universities will have the vaccine,” he told STAT…
Assuming a vaccine can be developed quickly, the issue of manufacturing is not a small one. Production of some vaccine candidates could be more easily ramped up than others, noted Emilio Emini, who is leading work at the Bill and Melinda Gates Foundation on the issue.
Should some of the more “scalable” vaccines prove to be protective, it’s conceivable that they could be made at existing plants, rather than require the construction of whole new facilities. Production of this type of candidate could reach hundreds of millions of doses within about a year, Emini said. But any vaccines that would require bricks-and-mortar construction is obviously going to take longer to reach those output levels…
Health care workers would likely followed by people at the highest risk — those 65 and older and people with chronic health conditions, like diabetes, that have been seen to increase the risk of dying from Covid-19, Robinson said.
“I don’t think that the general population will have vaccine probably until the second half of 2021. And that’s if everything works OK,” he said.
Since the novel coronavirus arrived in the United States, it has ravaged mainly urban communities. @aetiology warns that the rate of COVID-19 infections and deaths may soon pick up in rural areas, where it may be even more difficult to combat:https://t.co/3Ya7FeOixb
— Foreign Affairs (@ForeignAffairs) May 6, 2020
One of my go-to twitter reads — “Tara C. Smith, Professor of Epidemiology at Kent State University in Ohio. Her research focuses on disease transmission in rural populations”:
… The pandemic in rural America will not be the same as the one that has overwhelmed cities across the nation. Less dense and less interconnected (without the sprawling public transit systems and international airports that serve cities), many of these regions are likely to experience outbreaks that are less dramatic than those in urban centers. But rural areas are woefully unprepared for even a slower-moving epidemic. Just as they have suffered factory closures and job losses over the last decade, these regions have been devastated by the loss of hospitals and medical personnel. One hundred and twenty-eight rural hospitals have closed since 2010, scattered across the country but concentrated in the South and Midwest. An additional 430 rural hospitals were described by one consulting firm in 2019—prior to the pandemic—as “near collapse.” And the loss of hospitals often means the loss of the medical providers these institutions employed, leaving fewer health professionals to treat rural residents, who tend to be in worse health overall than their urban counterparts.
Rural Americans are more likely to be obese, to smoke, and to have high blood pressure than Americans who live in cities. They have higher poverty rates, have lower rates of health insurance coverage, and are generally less physically active. All of these factors make them more likely to suffer serious complications if they are infected with the coronavirus.
In many ways, Ohio’s experience with the novel coronavirus has been representative of the nation’s at large. Governor Mike DeWine ordered schools to close in March, when there were scarcely more than a dozen confirmed cases in the entire state. He closed down businesses shortly thereafter. Although the state still lacks critical testing capacity, the numbers of confirmed cases and deaths have risen relatively slowly compared with the numbers in neighboring states of similar size that implemented shutdowns later, such as Michigan and Pennsylvania.
As anticipated, cases were initially concentrated in urban areas such as Cleveland and Columbus. But that changed on April 20, when test results from the Marion Correctional Institute were released. With almost 2,100 cases among inmates and 300 among staff, rural Marion County, population 66,000, suddenly became Ohio’s coronavirus capital, eclipsing even Cleveland’s Cuyahoga County with a population 18 times greater. Rural Pickaway County, with a population of 55,000, is not far behind with 1,825 cases to date that stem from the county’s two state prisons. Per capita, infection rates in Marion (3,600 per 100,000 people) and Pickaway (3,300 per 100,000) Counties are higher than those in New York City (2,107 per 100,000)…
While rural communities are weeks or even months behind their urban counterparts on the pandemic curve, they may be about to see a sudden increase in COVID-19 cases and deaths. The outbreaks currently underway in high-risk facilities will inevitably spread outward, following workers, patients, and inmates to their homes and neighborhoods. Poorer health among rural Americans in general means there will likely be a higher percentage of serious cases in these regions. Lack of health insurance will mean that more people wait until the infection is potentially life-threatening before they report to an emergency room—if one is even accessible. And inability to test to identify early mild cases means that these communities won’t even know that the outbreak is increasing until hospitals start to be overwhelmed.
Rural outbreaks will be slower, steadier, and likely to continue for a longer period of time than those in urban areas. In some ways this may be advantageous—because there are fewer medical facilities, the curve in rural areas needs to be much flatter than in cities to avoid overwhelming local hospitals. But a flatter curve means a longer epidemic—potentially months of watching the infection spread slowly among friends and loved ones. This will be particularly crushing to first responders and other medical professionals. In small communities, doctors usually know friends or relatives of their patients—if not the patients themselves. Now, doctors will have to watch many of these people suffer or die from the illness. And with 60 percent of rural Americans living in areas with a shortage of mental health professionals, survivors may be left traumatized and without help to process their experiences…
And if areas are reopened before testing capacity increases, which is all but certain, these outbreaks may go undetected until they are too large to contain, necessitating another round of lockdowns. Ironically, in rural areas, where some social distancing occurs naturally, lockdowns may not even be the most efficient way to slow the spread of the disease. Face coverings may be a better option, but there has been some resistance to making them mandatory…
Before any of this began, I used to wonder about the ‘historical amnesia’ of Americans who lived through the Spanish Flu. Despite the impact it must have had, it just didn’t seem to exist in books or movies written by the survivors. Now I suspect at least some of it was a form of deliberate avoidance — a sort of societal PTSD.
Pretty sure I posted the video tweet when it first appeared, but it’s worth parsing:
A short thread
If there's only one thing you watch, let it be this: pic.twitter.com/62xWGVApaF
— Abraar Karan, MD MPH DTM&H (@AbraarKaran) May 5, 2020
4/ My favorite line from his whole speech is this:
"If you need to be right before you move, you will never win."
Read that one more time. And then consider how many times we have done the opposite in our response here in the US.
— Abraar Karan, MD MPH DTM&H (@AbraarKaran) May 5, 2020
Some more thoughts on this thread below…in another threadhttps://t.co/kri7HOyuaO
— Abraar Karan, MD MPH DTM&H (@AbraarKaran) May 5, 2020
The responses from other medical professionals to Dr. Karan’s thread are worth reading, too!
Doug Saunders, The Globe and Mail’s international affairs columnist, on the difference between this and ‘historic’ pandemics:
… When a pandemic comes, cities scare the hell out of people. The crush and bustle of the sidewalks and subways feels like a big petri dish. One instinct is to run. The literature of viral apocalypse, including recent masterpieces such as Robert Harris’s The Second Sleep and Emily St. John Mandel’s Station Eleven, starts with masses fleeing to the countryside. This choice rarely turns out well.
That’s the paradox of the megalopolis. Its population density means it’s the place where viruses often begin and that epidemics, if undetected, can explode fast there. New York is about to become a major focal point of infection and mortality, and London is not looking too good, either, because they didn’t close their crowded drinking places earlier.
But the biggest cities are also the safest places in the world.
Only they have the infrastructure, staff and organization to really quash an outbreak – Taipei and Tokyo, both more dense than New York, were able to flatten their virus-spread curves almost instantly using the unavoidable communications, visible deterrence and bureaucracies that only a tight-packed urban centre can muster. If you’ve spent any time in a small town, you’ll know how hard it is to keep people inside or away from each other.
And only huge cities have the resources and the reserve armies of medical talent to tool their health-care systems up to pandemic-level capacity in time to save lives. New York, because it’s able to build and staff huge convention-centre hospitals in short order, will have a lower mortality rate than the smaller, more elderly towns and cities that will be hit next…
Cities were, until the 19th century, “population sumps,” in the words of the late Canadian historian William H. McNeill, that attracted thousands of immigrants every year and promptly killed them with epidemic diseases. London required 6,000 immigrants a year in the 1700s just to maintain its population of 650,000 because disease deaths greatly outnumbered births.
Then two things happened. First, the tight-knit populations of cities, and their connections to other cities, meant that the urban world became a homogenous human pool of immunity. The practice of inoculation saw its first widespread Western practice in the English countryside at the end of the 18th century to fight smallpox – by that point, Londoners didn’t need it because their immunity had transformed it into a fairly harmless childhood disease. In 1790, London baptisms outnumbered deaths for the first time and, from then on, cities became safer than towns…