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By Jane M. Orient, M.D.
Clusters of a dozen or so deaths may get nonstop “if-it-bleeds-it-leads” press coverage. But the lack of preparedness for the really, really big threats may be met with virtual radio silence—until panic breaks out.
The worst, possibly existential, threat is the stealthy, invisible one that multiplies exponentially—in the accurate sense of the term: 400 cases today, 800 tomorrow, then 1600, 3200, 6400, 12800, 25600, etc.—nearly 1 million after only 12 doubling times. Biological threats proliferate—until they run out of susceptible victims.
In 1918, the great influenza pandemic killed as many people in 11 months as the medieval Black Death did in 4 years. Ultimately, at least 50 million may have perished. Young healthy people, especially young soldiers headed off to the front in World War I, succumbed quickly. To avoid interfering with the war effort, the U.S. government denied and covered up the threat, preventing the implementation of public health measures.
Since then, the world has gotten smaller. A virus that jumps the species barrier from animals to humans in a meat market in China can cross the Pacific in hours. And despite the expenditure of $80 billion on a National Biologic Defense, the U.S. is arguably no better prepared than it was in 1918, state Steven Hatfill, M.D., and coauthors in their new book Three Seconds until Midnight.
As in1918, we lack a vaccine or wonder drugs, but must rely on non-pharmaceutical interventions (NPI), and on public health authorities to track and try to contain the spread of infection.
Accurate information is critical. Can we trust governmental authorities to tell the truth? Travel restrictions, quarantine, closing businesses, and cancelling public events have a huge economic and potential political cost.
There can also be incentives to exaggerate the threat, in order to sell poorly tested vaccines or drugs. The 1976 swine flu epidemic was almost a non-event; more people were probably injured or even died from adverse effects of the heavily promoted vaccine.
The World Health Organization (WHO) has so far declined to declare the corona virus outbreak a global emergency, although cases have been reported in more than a dozen or so countries. China reported only hundreds of “confirmed” cases—while countless additional cases were not tested because of lack of diagnostic test kits.
The New England Journal of Medicine writes, “Another Decade, Another Coronavirus.” This 2019-nCoV virus is the third zoonotic (animal) coronavirus to infect humans in two decades. The SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) were contained. Other coronaviruses cause mild cold-like syndromes.
This virus has occasioned the quarantine of entire cities, for the first time since medieval times. This could not be done other than in authoritarian China, states virologist Steven Hatfill, but even there is unlikely to be effective—especially if 5 million people had left before the order was implemented.
The People’s Liberation Army has sent 450 medical personnel to Wuhan to help out at local hospitals, which are crammed with patients lying in packed corridors. Construction workers are reportedly trying to build a 1,000-bed hospital in Wuhan in five days. The U.S. and other nations are evacuating their citizens from Wuhan.
A report of 41 hospitalized patients in Wuhan, published in The Lancet, showed that patients were relatively young (median age 49) and fewer than half had an underlying illness. Only 66% had been exposed to the Huanan seafood market, the apparent source of the infection. One patient (2%) had no fever; all had pneumonia; 29% had severe respiratory distress syndrome; and 12% had acute cardiac injury. Most cases may be very mild, facilitating more rapid spread.
The corona virus is transmitted by droplets coming into contact with mucous membranes, including the eye. It can persist on surfaces for days. People without fever or symptoms can transmit the illness during the incubation period, which might be as long as two weeks. At present, definitive diagnostic testing is available only from the Centers for Disease Control and Prevention (CDC).
In a severe outbreak, people whose job is not critical may need to stay home. Those who do not have a supply of food, essential medications, or other needed supplies would likely end up in a frantic crowd. Personal protective gear, for people who need to be in contact with the public or care for a sick family member, is already out of stock in medical supply houses. This includes gloves, wrap-around eye protection, and N-95 protective masks—regular surgical masks are probably of little help.
Panic is never helpful; staying calm is always good advice. But failure to heed previous warnings of the need for robust disaster planning, and complacency about medical technology and governmental resources, has set the stage for potential unprecedented disaster.
Individuals need to recognize that they themselves, and not 911 or the emergency room or the Federal Emergency Management Agency, may hold the key to their family’s and their community’s survival. Local authorities need to know that they may be on their own. For now, stock up on supplies; cover those coughs and sneezes; wash hands frequently for at least 20 seconds; avoid crowds; and stay aware, as the situation could change rapidly .
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By Dr. Glenn Mollette
Groundhog Punxsutawney Phil is coming out soon to see or not see his shadow on his big day, in Punxsutawney, Pa. If old furry Phil wants to fly first class or even coach anywhere, he had better do it this year. The chances are he will be walking or riding with a friend in a car next Groundhog’s day.
A new rule proposed by the U.S. Department of Transportation would permit airlines to stop accepting emotional support animals on planes allowing only service dogs that are professionally trained to perform tasks or assist passengers with disabilities, including psychiatric disorders.
I’m all for this as airplanes have started looking like Noah’s Ark or flying zoos. Who wants to ride on an airplane with birds, cats, pigs and whatever anyone imagines to be their emotional support creature? Maybe you do. A lot of us do not.
This has developed into a lot malarkey over the years. Carole and I were traveling back from Maine several years ago. We had bought tickets well in advance so we could have the two front bulkhead seats. This was a small plane and our seats weren’t considered first class, but we had thee or four more inches of leg room.
Before boarding our flight, we heard our names called on the airport public address system. We went to the check-in counter and were almost told that we needed to give up our seats for a man with a disability and his wife who had service animals. We were young, naïve and gullible so being tenderhearted people we said OK.
The agent assigned us to the two seats directly behind our old seats which meant no extra leg room that we had planned for months in advance. The guy gets on the plane and he and his wife appear healthier than we are. He was wearing a hearing aid, but he was seeing and getting around fine as was his wife. With these people were “three” dogs. Yes, three dogs! The only thing I could tell that these dogs could do was stink up the area where we were sitting. To add insult to injury we had to ride now behind our original seats with these dogs occasionally staring at us.
I’m not doing it again. Many years ago, I developed a blood clot from extended travel and I’m not giving up my seat for some person who needs to sit and pet their dog. I’m not an animal hater. I love animals. I had a dog in my house for 16 years. For people who truly are disabled and need a documented trained service dog then that’s OK, but plan and buy your ticket in advance instead of bumping someone else out of their seat for your “dogs.”
Most real trained service dogs are better behaved than some passengers. It’s just finally time that our airlines can get some control over the zoos flying through the sky.
Glenn Mollette is a syndicated columnist and author and is read in all 50 states.