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COVID-19 is all about concentration

Png-clipart-crowd-cartoon-characters-illustrationBy Roberta Millstein

We were flattening the curve.  We were staying at home.  We were doing the right thing.  Then our leaders – county, state, and federal – blinked.  They caved to pressure from the business community to “open up.”  And they opened up even where it made no sense to open up: bars, restaurants, churches, movie theaters. Now the prevalence of COVID-19 is far worse in our region than it ever was.

Here is what our leaders should have said to the business community:  “If we open up, cases will spike and we will have to shut down again.  Not only will it be costly to ramp up only to have to close down again (especially for restaurants), but also, it will delay an economic recovery even further.” In other words, they should have led.

Instead, they somehow expected that families and friends from different households wouldn’t get together even though people were getting together in bars.  And now they blame citizens instead of blaming themselves for putting out a mixed and inconsistent message.

There are some sensible ways to open up, but they require paying attention to “The Six C’s” (Note: I have modified this from others):

  • Closed spaces – If you have to be around people outside your household, it is better to be outdoors than indoors. If you have to be indoors and you can open a window to improve ventilation, do so.
  • Closeness – Keep at least 6 feet apart from those outside your household. More distance is even better.
  • Crowds – It is better to be around fewer people.
  • Continued contact – Briefer periods near people outside your household are better than longer ones.

Closed spaces + closeness + crowds + continued contact = concentration.  You want to be around the lowest potential concentration of airborne COVID-19 particles possible.  If you avoid closed spaces, avoid closeness, avoid crowds, and avoid continued contact to the extent you can, you will keep your exposure to airborne COVID-19 lower.

And last, but not least:

  • Coverage­ – Wear a mask. Ask others around you to wear a mask if they are not.  Call out businesses who are not enforcing mask wearing.

And yes, by all means keep washing your hands.  However, keep in mind that our best findings so far suggest that most transmission is through the air, not through touch, so washing your hands, washing surfaces, etc., will only take you so far.

This is, of course, advice for us all, but it is also advice that should inform our leadership in making policies.  For example, if there is an activity that can be moved outside, help move it outside.  Outdoor restaurant eating is a fine example that the city of Davis supporting lately.  (Although to be honest, I probably wouldn’t do it – I get take-out instead – the risk seems a lot less than eating indoors).  Or maybe even schools?

Let’s pressure our leaders to get creative and think of other ways we can attend to The Six C’s.

Let’s also speak up and let them know to hold the line this time, and not cave to “opening up” pressure that harms both public health and the economy.

Finally, Bernie Sanders has called for the Senate to approve sweeping Covid-19 stimulus legislation that:

  • Uses federal funds to cover workers’ paychecks and prevent more layoffs;
  • Extends the $600-per-week boost in unemployment benefits;
  • Expands Medicare to cover the uninsured;
  • Provides emergency funding to prevent the collapse of the U.S. Postal Service;
  • Sends a $2,000 monthly check to every working-class person in the U.S. until the end of the pandemic;
  • Cancels rent and mortgage payments until the end of the pandemic;
  • Increases federal nutrition benefits; and
  • Requires the federal government to manufacture and distribute free face masks to everyone in the U.S.

How do we pay for this?  Cut military spending by 10%.  It makes no sense to sacrifice our day-to-day safety for more military equipment.

Let’s pressure our local leaders to ask for this stimulus legislation and pressure our national leaders directly ourselves.  This is the path forward, not opening up bars and pretending everything is OK when it isn’t.


Greg Rowe

Great article, Roberta. For anyone desiring an overall perspective on the current situation (and the future pandemics that surely will come), I strongly advise reading the book referenced below. It lays out all the national policy shortcomings and a proposed comprehensive approach. The book was published in 2017, but the 2020 revision starts with a chapter on COVID-19. The lead author is director of the Center for Infectious Disease Research and Policy at Univ of Minnesota, and has done work worldwide ranging from Ebola, SARS to MERS, etc.

Deadliest Enemy - Our War Against Killer Germs. Michael T. Osterholm, Ph.D., MPD and Mark Olshaker. Little, Brown Spark.

And, as John Bolton says in his new book, national policy can't be made on the basis of impulse and whim!

John Troidl

Holy smokes, Dr. Millstein:

You jacked that ball right out of the park! What a tremendous letter! There are a lot of really solid, pragmatic recommendations there.

May I add to your excellent content an explicit PUBLIC HEALTH path out of the wilderness? At the beginning of April the New England Journal of Medicine published a piece by Dr. Harvey Fineberg, a noted public health authority.

That article is here: https://www.nejm.org/doi/full/10.1056/NEJMe2007263

His "10 Weeks To Crush the Curve" laid out six essential steps to deal with this epidemic:

1. Establish unified command.

2. Make millions of diagnostic tests available.

3. Supply health workers with PPE and equip hospitals to care for a surge in severely ill patients.

4. Differentiate the population into five groups and treat accordingly.

5. Inspire and mobilize the public.

6. Learn while doing through real-time, fundamental research

We have a choice..... either use the public health science that Dr. Fineberg has laid out to get us out of this pandemic or suffer the consequences. And they will be tragic consequences:

The Director of the CDC warned us the other day that unless we act, this Fall and Winter, we will face the worst public health times we as Americans have ever experienced. That's ever, people, ever. https://www.yahoo.com/news/cdc-director-predicts-fall-winter-003703797.html?guccounter=2

So, can we please get our act together now, before we run headlong into flu season with a still out of control coronavirus epidemic?

This request requires leadership, as Dr. Millstein said. Right here in River City.




PS I have been asked to share my background on these kinds of posts: I have worked in health services all my career and have a PhD in Public Health from Berkeley.

Roberta L. Millstein

Thanks, Greg and John. Great suggestions.

Robin Wiener

Thank you, Roberta. Very well said.

Larry D. Guenther

Absolutely agree. This - like many other things - is NOT a failure of the medical industry, it is NOT a failure of the people, it is a failure of leadership.

John Troidl

Dear Friends,

You know, whenever I post something here or elsewhere about the CV Epidemic and what I or others are observing, recommending or doing about it..... I always feel like adding a portion at the end which says, "This is all to the best of my knowledge" and/or even just "IMHO".

Humility really is the order of the day in our current, extremely complicated situation.

Regarding our expectations of local and state electeds and public health officials here in Davis/Yolo, I am reminded of an exchange between the Santa Clara County Board of Supervisors and their famous Health Officer Sara Cody, which went something like this: "Dr. Cody, it is ok if you just tell us that you don't know the answer to any of our questions, rather than giving us long responses which don't answer the question. This is a new thing, a NOVEL corona virus and none of us know all the answers and we do not expect you to, either. So, just say, 'I dont' know' when you don't know.".

That was a sincere gesture by the BOS to encourage frank and straightforward discussion in this time of pandemic and support their health officer.

So, I wanted to add here that, IMHO, I think that our local and state electeds are doing the absolute best job that they know how to do in reacting to a totally unexpected emergency and NOVEL viral epidemic. They have been putting in tons of "bonus hours" and have entered into a very, very steep learning curve to help manage our response to the pandemic.

Same goes for our local businesses. As they get hammered by this pandemic, I have tried to patronize local businesses, including prepaying some of my purchases so that they can have a bit of cash flow. And many of these are businesses that i have gone to for years, so I really want to see them around here for years to come.

So, it was really heartening to see the recent survey results of the Davis Chamber of Commerce, published in the Davis Enterprise, which showed the following priorities from Davis' businesses:

“We also asked our members what actions the city of Davis and Yolo County could take to provide meaningful assistance to them,” the chamber press release said. “The most frequent responses included requests to provide greater clarity and strengthen education on health and safety guidelines, lower taxes and fees, and encourage open air policies.”

BRAVO! Big priority for the Davis businesses was to obtain greater clarify and education on health and safety guidelines.

Thank you, thank you, thank you!

So, every once in a while during our enthusiastic efforts to provide advice to business and government, perhaps it would be good to pause and say, "Thank you!" for all the good work they are doing and acknowledge that we are all in this together bound on a steep learning curve.



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