9 March 2020 Blog Post: On Social Distancing

Worldwide case are now soaring, mostly because #COVID-19 testing is becoming more widely available. Total cases worldwide now stand at 111,362 with 3,892 deaths and 65,932 recoveries. The United States now has 565 cases, 22 deaths and 8 recoveries.

The CDC on Sunday advised travelers, especially those with underlying medical conditions, to “defer all cruise ship travel worldwide” given the increased risk for person-to-person transmission of SARS-CoV-2. The agency also noted that older adults and those with health issues should avoid crowded places, long flights, and other potentially high-risk situations.

The Grand Princess cruise ship is set to dock in Oakland,today and its passengers will be brought to quarantine locations. A total of 21 people aboard the ship have tested positive for SARS-CoV-2 thus far (2 passengers and 19 crew members). The passengers will be taken off the ship despite previous comments by President Trump, who said on Friday that he would prefer to have all of them stay on board. Whomever insisted on disembarking the Grand Princess has done a great service to passengers and crew. Data from the Diamond Princess quarantine in Yokohama Japan revealed at 17% transmission rate as compared to 10.5% noted among #COVID-19 household contacts in Singapore. This likely because the crew was not equipped to carry out the quarantine, so lapses were inevitable.

One of the terms that you may start to hear is ‘social distancing’, this because data collected from China has shown that isolation of infected populations can contain the COVID-19 epidemic. The goal of such, along with other interventions, is to avoid an epidemic peak that overwhelms health-care services. You may also hear discussions about ‘flattening the epidemic curve’ (the diagram below illustrates such). With social distancing measures (green line), COVID-19 is contained within manageable levels, and permits additional time for vaccine development and manufacture on scale as well as identification of potential antiviral drug therapies.

So what is social distancing? In a nutshell, it is voluntary plus mandated quarantine, stoppage of mass gatherings, closure of educational institutes or places of work where infection has been identified, and isolation of households, towns, or even cities.

Writing in the Lancet, Anderson et al comment:
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“Individual behaviour will be crucial to control the spread of COVID-19. Personal, rather than government action, in western democracies might be the most important issue. Early self-isolation, seeking medical advice remotely unless symptoms are severe, and social distancing are key. Government actions to ban mass gatherings are important, as are good diagnostic facilities and remotely accessed health advice, together with specialised treatment for people with severe disease.”
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And further – “The known epidemiological characteristics of COVID-19 point to urgent priorities. Shortening the time from symptom onset to isolation is vital as it will reduce transmission and is likely to slow the epidemic.
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At Santa Monica Primary Care we are now in our second full week of remote triage and follow-up via telemedicine and videoconferencing technologies. There is much still to be learned about #COVID-19. For now,data from China, South Korea, Italy, and Iran suggest that the COVID-19 mortality rate increases sharply with age and is higher in people with COVID-19 and underlying chronic medical conditions. Targeted social distancing for these groups could be the most effective way to the burden of illness and reduce the risk of death.

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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