Hope: Death toll in Italy falls for second straight day

I feel like we’re about to have an extremely stupid national debate on the utility of social distancing at the very moment that social distancing is starting to pay off in other countries.

Are we seeing anything like that here yet? Seattle has been practicing social distancing for awhile now. Here’s the latest data from the University of Washington’s Department of Laboratory Medicine:

I’m treating each single day of data as a separate “poll.” The more polls we have, the more confident we can be that a real trend has been detected. We’ll have a better sense by the end of the week if things are beginning to cool off there. But while we wait, here’s the trend in fevers measured by Kinsa smart thermometers in King County, Washington according to the Kinsa “health weather” map:

New York City has also been practicing increasingly severe social distancing measures. Here’s what Manhattan looks like:

The wrinkle with the Kinsa data is that it only measures fevers, not what’s causing the fevers. Obviously, we’d expect a certain number of fevers due to the flu or “influenza-like illnesses” in King County and Manhattan at this time of year even in a world without COVID-19. Without question, the social distancing we’re practicing to drive down coronavirus infections is also driving down flu infections. So it *may* be that the declining fever rates in NYC and Seattle detected by Kinsa mostly reflect a steeply falling rate of flu infections, with the rate of coronavirus infections in each place obscured by that effect. We can’t be sure. But certainly it’s possible if not likely that coronavirus and flu infections are falling in both places.

Doctors in Italy offered some free, and surprising, advice to the rest of the world on Saturday: Start treating COVID-19 patients at home to whatever extent you can. It’s not just a matter of there always being a bed available at a patient’s home. It’s matter of hospitals becoming hotbeds of contagion, with the virus spreading quickly from COVID to non-COVID patients.

“All my friends in Italy tell me the same thing,” Cereda said. “[Covid-19] patients started arriving and the rate of infection in other patients soared. That is one thing that probably led to the current disaster.”…

“Managing patients at home is a brilliant thing,” Cereda said, and one that could be augmented by mobile clinics and telemedicine. “Bring them nutrition, measure their oxygen levels, even bring them oxygen, and you can probably keep many of them at home. This is what we mean by moving from patient-centered medicine: Of course you still care for and care about the patient, but you also think about the population as a whole. That change would decrease transmission and protect other patients as well as health care workers.”

For patients who need more intensive care, dedicated Covid-19 medical centers, akin to the “fever hospitals” that London set aside for smallpox, cholera, and typhus patients 200 years ago, would be a safer way to deliver care than the current system, Cereda said.

He also recommends encouraging everyone with flu-like symptoms to assume they have the virus and isolate themselves accordingly so long as a testing shortage exists. Don’t bother getting tested. Save the tests for people in hot spots who need them the most, the front-line health-care workers and nursing-home residents at the greatest risk from infection. Some U.S. jurisdictions are already following that advice, in fact.

As for house calls, how feasible are they realistically in major population centers like New York where tens of thousands are sick all at once? Even if EMTs are only visiting the 15 percent or so of infected who need some “light” hospitalization measures (like supplemental oxygen) each day, that’s a few thousand visits per day. Do they have the resources for that?

I don’t think contagion at hospitals is the chief threat right now in any case. The chief threat is people, especially young people, continuing not to take this seriously enough:

Doctors and nurses in Miami are so exasperated by lax social distancing that 75 of them penned an open letter to the community today warning them not to believe the complacent garbage they’re reading on social media and heed the warnings about what’s going on in ERs right now. (“If they don’t believe the media, or think what they’re hearing is rumors or hype, we have something to tell them, and it’s based on reality.”) If you’ve been following the Kinsa data since it went live last week, you know that Florida currently has the scariest fever data in the country. That rate is beginning to drop there too per the most recent numbers, thankfully, but the potential exists right now for a Biblical disaster given all the senior citizens who live in FL. I hope people listen to the pros and stay home.

And if they don’t, send in the Italians. They know how to make their point.

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