Discussions of Book of Mormon issues and evidences, plus other topics related to The Church of Jesus Christ of Latter-day Saints.

Sunday, March 08, 2020

Skip Church if You Are Ill and Other Tips for Coping with COVID-19 and the Corona Virus (SARS-CoV-2)

In my previous posts warning about the need to prepare for the Corona virus, my greatest concern has not been the risk of getting ill, but the risk of a society that panics over the virus. We've seen that in addition to the health impact, the personal, social, and economic impact of a vigorous military/police response to enforce widespread lockdowns can be terribly painful, and pray that China and other affected nations can recover quickly and open their communities up soon.

One reason why it is wise to have basic supplies of food, water, and sanitation supplies is not because the virus will wipe them out, but because panic and political reactions can strip shelves, shut down supply chains, and essentially imprison people in their own homes. China has taken efforts to provide access to food and basics to those who are locked down, but if we go to local lockdowns in the States, we may face all sorts of new challenges and pains along the way. Don't rely on questionable supply chains to take care of you in times of trouble Make gradual ongoing preparation a part of your lifestyle. Hopefully you've been doing that for a long time already.

South Korea has set a good example of how a pandemic can be controlled while maintaining the liberties that are fundamental in a Constitutional republic or democracy. In such a country, the government in theory should not have the power to shut down travel, lock people in their homes, and control who can do what. (To understand why from a perspective I find reasonable, see "What Would Murray [Rothbard] Say About the Coronavirus?") In the US and other nations facing the virus, one can already see some pundits, some government leaders, and other voices considering the possible "need" to step in and take away many basic rights in the name of a crisis, as so many of the world's politicians love to do (always to their benefit, it seems, and to the benefit of their friends as they pick the winners and losers in the massive redistribution of wealth and power that they may claim is needed to "fix" every new crisis). But South Korea seems to be taking a different course. Rather than running roughshod over personal liberty, they are providing means and incentives for widespread testing to quickly identify those who are infected so that they can self-quarantine and get early treatment. No need to haul citizens away or have armed guards threatening them if they try to leave their neighborhood or city.

Abundant testing has been a key in South Korea and seems to be working. See Bloomberg's "Virus Testing Blitz Appears to Keep Korea Death Rate Low," which attributes a low death rate to early treatment of cases identified by aggressive testing, but may overlook the simple mathematical effect of catching many more cases with which to divide the number of deaths, resulting in a lower death rate. Many mild cases go undetected, except in South Korea with its widespread testing. Also see "South Korea has tested 140,000 people for the coronavirus. That could explain why its death rate is just 0.6% — far lower than in China or the US" at BusinessInsider.com. [Update, 3/13/2020: ScienceNews.org reports that based on examination of cases on the Princess Diamond cruise ship, the real mortality rate for the virus is probably around 0.6% on average (much higher for the elderly), making it deadlier than the flu but not nearly as frightening as the questionable 3% figure reported by the World Health Organization. This is consistent with what we are seeing from South Korea.]

Because of wise preparation and actively working to allow companies to bring effective test kits to the market much faster than normal, South Korea has created an abundance of test kits. It's a shame the US did not follow suit and a shame that we did not seek South Korea's aid in importing test kits that could be used here, where testing has been grossly inadequate. I hope the US will reconsider the barriers that left the CDC and the nation in a poorly prepared state relative to test kits, but we can rightfully be proud of excellent healthcare facilities in the US. I look forward to the nation obtaining test kits and hope the number of tests we do relative to the need will not be such an embarrassment that the CDC has to take down the info on their website about the number of tests that have been conducted as it did on March 2. Regarding the trouble with the CDC's test kits in the US and our national poor preparation regarding test kits, please see the interview with a doctor and an FDA representative in the CNBC story, "New York City doctor says he has to ‘plead to test people’ for coronavirus." The doctor feels our lack of test kits is a national scandal and will exacerbate the problem. But the good news is that based on South Korea's data, the best data we have so far on the impact of the virus, the death rate may be only twice as bad or so as a regular flu. Panic is unwarranted, elimination of fundamental liberties is not needed, but preparation is still key.

Note that in the interview above, the death rate shown in South Korean data is said to be even lower than 0.6%, perhaps around 0.2%. More time may be needed to determine the real death rate. But this is much more encouraging than an early Lancet publication on the virus suggesting the mortality rate might be as high as 11%. South Korea's numbers have helped me realize the danger may be much lower than I feared.

Unfortunately, some panic may have been exacerbated by the alarming and now rather questionable numbers reported by the WHO, which claimed that the death rate was over 3%. Some suspicious folks have rudely alleged that since China was reporting a death rate of around 2%, WHO's claim may have been part of some plan to support China, implying that China's  medical care (such as amazing new hospitals in Wuhan which, in spite of some possible limitations in plumbing and privacy, are marvels to have been built in just a few days) and vigorous containment had resulted in a much lower death rate than normal. That's mere speculation and I can't comment on what the numbers in China are or may mean because I don't have any inside information there, but in any case it seems that the WHO's surprisingly high numbers for mortality may be questionable in light of what we see when ample testing is done. And perhaps China's mortality rates are actually even higher than they should be, contrary to unkind allegations that they are artificially low. Time will help clarify all these issues.

So what should we do? I'm not an expert, but here are some thoughts to consider. Do your own diligence. 

 

1. Don't panic.
Yes, the virus is more virulent than the flu and apparently more deadly, and we definitely need to prepare, but keep in mind that if we end up in a catastrophe with, say, 10 million Americans infected with a death rate of 0.4%, we could have 40,000 Americans die over the coming year or so, a tragic disaster slightly more severe than one year of automobile fatalities. (But it's possible that the numbers could be much worse -- or much better.) As far as I can tell, we have not locked down entire cities or states because of the risk of automobile deaths. We have not taken away their automobiles, banned travel between states or cities, forced people to stay in their homes instead of driving, or spent billions to redistribute wealth to those friends of politicians who are supposedly heavily impacted by the "automobile virus." Heavens knows I should not suggest that in jest because a lot of our leading politicians would just love to "solve" that problem in their quest for more power ("never let a crisis go to waste," as they say). But as serious as the Corona virus is, it is not the end of the world and we should not make it the end of the economy or our personal liberty. Sadly, it has been an economic disaster for the nation where I have been living the past 8+ years, but hope they can swiftly recover. I hope our response will not be so draconian.

May we learn from China, where much has been achieved as they struggle valiantly with the brunt of this disease, but let's not assume that we should repeat all aspects of their approach. There may be more appropriate ways for the U.S. and other nations with much different systems. May we also learn from South Korea and be better prepared for the next virus and get adequate kits in place for the current one, even if we might need to humbly ask China, Korea, or Canada for their help.

2. Increase your caution to reduce being infected or spreading infection. 
There is still much about this disease we don't know and there is not yet a vaccine nor high levels of immunity in the population, so this virus deserves more caution than an ordinary flu. Be much more cautious so that you don't become infected or spread the infection. A key factor according to every expert I've heard is that we need to wash our hands frequently and avoid touching our mouth, nose, and eyes where a virus can enter our body.

Here in quiet Wisconsin, with its lone case of COVID-19, face masks are generally sold out. Not just face masks, but also hand sanitizer. Gloves are nearly gone. Many cold and flu OTC medications such as zinc lozenges were sold out when I looked on Saturday. Anti-microbial soap was apparently out of stock at Walmart for a while but I was able to buy some yesterday since I arrived right as as few bottles had just come in. Who knows what would happen if the disease rate here triples next week and we suddenly have an alarming 3 cases??

There is a debate over face masks. Should you have some? The Surgeon General, per his recent Tweet, wants us ordinary people to stop buying them because they are "ineffective," and because healthcare professionals desperately need them. Maybe he's right. But some say how can something so ineffective be desperately needed? His point, I think, is that masks aren't very effective if worn improperly, but I am uncomfortable with the Surgeon General's statement. I wish he would have said something like, "they may not be very effective if worn improperly." As stated, it has the ring of misinformation, especially when one considers that the CDC's own website has a peer-reviewed article showing us that in households with an infected person, surgical masks can actually be effective in reducing transmission (if worn diligently) -- and that's exactly the scenario that motivates many of us to want face masks for our family. Not because we need to wear them on the street, as is required in many parts of China, but because we want to be prepared if someone we love becomes ill. See C. Raina MacIntyre et al.,  "Face Mask Use and Control of Respiratory Virus Transmission in Households," Emerging Infectious Diseases, Volume 15, Number 2 (February 2009). In their study of the transmission of influenza virus, they found that when masks are not strictly worn in dealing with sick family members, they were not effective -- no surprise there. But for those who adhered to sound procedures, they made a large difference:
We estimated that, irrespective of the assumed value for the incubation period (1 or 2 days), the relative reduction in the daily risk of acquiring a respiratory infection associated with adherent mask use (P2 or surgical) was in the range of 60%–80%. Those results are consistent with those of a simpler analysis in which persons were stratified according to adherence (Technical Appendix). We emphasize that this level of risk reduction is dependent on the context, namely, adults in the household caring for a sick child after exposure to a single index case. We urge caution in extrapolating our results to school, workplace, or community contexts, or where multiple, repeated exposures may occur, such as in healthcare settings. The exact mechanism of potential clinical effectiveness of face mask use may be the prevention of inhalation of respiratory pathogens but may also be a reduction in hand-to-face contact. Our study could not determine the relative contributions of these mechanisms. In this study, it is only possible to talk about a statistical association between adherent mask use and reduction in the risk of ILI-infection. The causal link cannot be demonstrated because adherence was not randomized in the trial. Although we found no significant difference in handwashing practices between adherent and non-adherent mask users, it is possible that adherent mask use is correlated with other, unobserved variables that reduce the risk of infection. Further work will therefore be needed to definitively demonstrate that adherent mask use reduces the risk of ILI-infection.
The mechanism is not certain, and it may be the value of the mask is in reducing the degree of hand-to-face contact. Contrary to this report, the Surgeon General and others have suggested that masks may actually make things worse by increasing hand-to-face contact, but I wonder of that argument really has any merit. Again, if someone is careless, then mask or no mask, they will have elevated risk. But I think it would be better to tell citizens how to use masks effectively in caring for an ill family members and to warn them to not touch their face if they are going to use masks, rather than to tell them to give up and not try masks at all. But I understand the desire to make them more available for healthcare professionals. But that's a supply chain problem that can be solved without questionable or incomplete information to control public behavior. Make more masks, get more into the hands of medical workers, but don't tell or force us to stop buying them. There are legitimate reasons for us to have them, whether it's protecting people from infection when a family member is ill or reducing the risk of spreading a disease when we are infectious.

There's also a debate about whether cheap surgical masks are truly inferior to the much more expensive and uncomfortable N95 respirators that are often worn by medical professionals. Again, I'm not an expert, so do your own research on this and all other topics raised here, but a major study just published in 2019 appears to resolve that debate, and the answer seems to be that there is no clear significant difference. See "Surgical masks as good as respirators for flu and respiratory virus protection" reported on Sept. 3, 2019 on the University of Texas Southwestern Medical Center's newsroom regarding their major peer-reviewed study published in the nation's leading medical journal, JAMA. So if you wish to obtain a face mask or two, don't grossly overpay the gougers selling N95 masks. Better to grossly overpay the gougers a lot less for a relatively cheap mask. (Or wait for the glut when the panic subsides, if you choose.) Hats off to those who are already prepared with masks and willing to share with family and neighbors when they need them. (See my related post on the kind Vietnamese family whom I found giving away surgical masks to offset the harm or price gouging. What better form of charity than to graciously help others in times of shortage? We were so inspired by their goodness.)

As for hand sanitizer, which is in short supply and subject to ridiculous price gouging, look at alternatives. Soap and water is great for most needs, IMO. Hand sanitizer is often just rubbing alcohol or ethanol, and these fluids tend to still be available. So go to a drugstore or grocery store and buy a bottle of rubbing alcohol or other low-cost disinfectant. You can put some in a little bottle and carry it and use it before eating, etc.  (But I suggest you don't stockpile vodka. It's only 50% ethanol,n and might not be strong enough to kill many microbes, as I recall. And others might misunderstad.)

3. If you are sick, stay home if you can. Be sensitive about the risks of spreading whatever virus you might have. 
At Church in one of the units I've attended since returning to the States, a missionary threw up in the foyer. It was an ugly mess. I was one of the first to see this happen. My instinct was to run to the kitchen and grab a lot of paper towels and a wet cloth, and I quickly returned and helped in wiping up the mess on his shoes and the carpet, and gave him a glass of water as well. Then as others moved in to help, it hit me: since I'm without a home as a "medical refugee" of sorts from China, temporarily hanging out with some of my family now, including an expectant daughter-in-law, I can't afford to get sick and bring that missionary's illness home. I threw away what I had collected (most of the mess) and left the rest of clean up to the many others who gathered to help as I dashed to a bathroom to carefully wash up.

Unfortunately, I learned that the sick missionary had been sick all week. Hope it's nothing serious. I've been there and understand how young people can overdo it sometimes and might feel that they should just keep going, especially when they are trying hard to do their duty and are seeking to be faithful, but it perhaps it would be wiser to consider that the best way to advance the Gospel cause right now might be to not infect a large number of members and investigators. All of us may wish to carefully think about protecting others when we are ill.  I also hope mission presidents might consider this and urge their missionaries to stay home if there's a risk of being infectious with flu or something worse. That's just my opinion, of course. (BTW, I was pleased to see that the Church took missionaries out of Hong Kong when the virus looked threatening there and moved them elsewhere for their protection.)

On the other hand, if people stay home for every sniffle, very little work would get done in the world. But let's make a concerted effort not to infect others. For some, your little fever and cough could be a serious disease. Be cautious and think of how your illness might impact others. Think of the Hippocratic Oath that begins with, "First, do no harm."

4. Stay healthy. Eat well, exercise, get enough sleep, and let your immune system be at its best. 
Help your family do the same. Veggies, fruit, grains, and not too much sugar or junk food. Be wise and also review the Word of Wisdom as well. And if you are smoking, this would be a great time to stop. The real danger of COVID-19 seems to be the pneumonia it can cause. Anything that damages your lungs already is a dangerous step in the wrong direction.

May you and your community fare well and avoid severe pain from COVID-19 or the reaction of others to the threat of the disease. Prepare now, not in panic, but in measured steps with a focus on basic hygiene as a key to reducing risk.

5. In case things get unexpectedly bad, have some sanitation and survival supplies, including toilet paper.
I hope the fuss over COVID-19 will soon be a faint memory, but there are many other risks in our future. It's best to be prepared for unexpected trouble with some basic supplies of food, water, clothing, and sanitation supplies. If you've seen what's been happening in the people's paradise of Venezuela, you'll note that the system of government there has not been conducive to private enterprise, which tends to result in great shortages. One of the dramatic images you may have seen are the crowds of people who leave Venezuela to buy basic supplies and then march back across the boarder carrying precious goods, the most recognizable of which is often toilet paper. It's something we tend to take for granted, but when commerce is crushed, it runs out quickly and if you've grown up with that, it's hard to get used to alternatives like bark or cactus. Surprisingly, at Walmart yesterday morning I noticed that the most popular brands of toilet paper were already sold out or in very short supply. I suggest you gradually build a supply of that item if it's something you care about.

Other suggestions for preparing for trouble? Do this calmly and gradually, and avoid paying ridiculously high prices to gougers just because there's a momentary shortage.

Update, 3/8/2020:
The reference to Murray Rothbard above is likely to trouble some who object to his skepticism about government as the solution for most of the problems in the world, when in many cases he saw the foolishness, greed, and corruption of government as part of the problem rather than a panacea. 

On a related note, after my previous and possibly misguided inquiry about the possible benefits of  glucosamine, based in part on a peer-reviewed study linking it to decreased mortality from pneumonia, one critic replied that we might as well ask if other random materials like aspirin could prevent the Corona virus. That suggestion actually brings us back to Rothbard's views. Here was my reply (slightly edited):
"We may as well be asking if aspirin can prevent coronavirus." Oh, so there's a peer-reviewed study linking aspirin intake to surviving respiratory disease? If not, then there's quite a difference.

In fact, aspirin was a cause of death for the Spanish flu, when the U.S. government, influenced by a big pharma company seeking to profit from the disease, made a terrible recommendation to take very high aspirin levels to treat the flu, levels that today are known to be well above the maximum safe limit. See the New York Times article, "In 1918 Pandemic, Another Possible Killer: Aspirin." In fact, one peer-reviewed study suggests that high aspirin intake, driven by the US government's irresponsible recommendation, may have been a major contributor to the high mortality rate in that dreadful pandemic. See Karen M. Starko, "Salicylates and Pandemic Influenza Mortality, 1918–1919: Pharmacology, Pathology, and Historic Evidence," Clinical Infectious Diseases, Volume 49, Issue 9 (15 November 2009): 1405–1410, DOE: doi.org/10.1086/606060.

Has the reliability of information from the US government become significantly greater over time? Or is it still improperly influenced by big money, sometimes to our detriment? Do your own diligence, but I don't think that we can always trust what government officials say.
When we talk about mortality of the Corona virus in any nation and the policies required to cope with such a crisis, it's fair to wonder if the actions and statements of various governments have been accurate, helpful, and made in good faith, or if they may, as Rothbard generally feared, have been influenced by big sources of money, the quest for power, or other inappropriate motives. Do some influential groups stand to profit from panic? Do any big companies stand to gain from the $8 billion Congress is dishing out to deal with the virus? Could the profit motive or personal benefit possibly influence what companies press politicians to do? Naw, not a chance, right?

Anyway, thanks for the reminder about aspirin,  mortality from influenza, and the helpful guidance we have received from the government in the past.

Update, 3/12/2020: Church meetings worldwide have now been suspended temporarily to reduce risks related to the SARS-CoV-2 virus (Corona virus) and COVID-19. See the announcement at the Newsroom at ChurchofJesusChrist.org and also on my March 12 post.

6 comments:

Anonymous said...

I seem to recall that Rothbard thought that parents had the right to let their children die, free from interference. Madness.

Jeff Lindsay said...

Yes, he said some crazy stuff like that. He took his "beautiful" academic ideas to some ugly extremes, lacking the grounding of faith in God and experience as a parent (though he was married). Perhaps had he found God or raised children he might have adjusted his theories. But the ugly extremes don't undermine the basic logic about the State in a free society having limits on what it can compel us to do.

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Ramer said...

So I guess "Unknown's" response to the coronavirus outbreak is to... make spam comments on Jeff's blog?

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