4/27/2020 i have stopped updating this website on corona since the NEJM group , NYT, JAMA and MMS as well as many other sites are doing a great job. if you have any questions please reach out to me directly nargy@nicolasargy.com Stay safe!! Hope to see your comments as i post daily on LinkedIn please follow me
03/26/2020
Fauci "The virus makes the timeline"
Experts warn of possible second wave of infections. Trump in time of Pandemic blames media for encouraging shutdown so he will not be reelected??!! Congress in unanimous vote approves $2 Trillion stimulus
What can we do
1. Stay home
2 Social distance
3 Wash hands
4 Show kindness compassion and help those in need
The current shutdown may last well into 2021
03/24/2020
Continued significant US and European spread. Feckless federal response persists. More communities and states impose shelter in place and social distancing measures.
Nassim Taleb speaks out on Coronavirus seebelow
THE NOVEL CORONAVIRUS emerging out of Wuhan, China has been identified as a deadly strain that is also highly contagious. The response by China to date has included travel restrictions on tens of millions across several major cities in an effort to slow its spread. Despite this, positively identified cases have already been detected in many countries spanning the globe and there are doubts such containment would be effective. This note outlines some principles to bear in relation to such a process. Clearly, we are dealing with an extreme fat-tailed process owing to an increased connectivity, which increases the spreading in a nonlinear way [1], [2]. Fat tailed processes have special attributes, making conventional risk-management approaches inadequate.
GENERAL PRECAUTIONARY PRINCIPLE
The general (non-naive) precautionary principle [3] delineates conditions where actions must be taken to reduce risk of ruin, and traditional cost-benefit analyses must not be used. These are ruin problems where, over time, exposure to tail events leads to a certain eventual extinction. While there is a very high probability for humanity surviving a single such event, over time, there is eventually zero probability of surviving repeated exposures to such events. While repeated risks can be taken by individuals with a limited life expectancy, ruin exposures must never be taken at the systemic and collective level. In technical terms, the precautionary principle applies when traditional statistical averages are invalid because risks are not ergodic.
NAIVE EMPIRICISM
Next we address the problem of naive empiricism in discussions related to this problem. Spreading rate: Historically based estimates of spreading rates for pandemics in general, and for the current one in particular, underestimate the rate of spread because of the rapid increases in transportation connectivity over recent years. This means that expectations of the extent of harm are underestimates both because events are inherently fat tailed, and because the tail is becoming fatter as connectivity increases. Global connectivity is at an all-time high, with China one of the most globally connected societies. Fundamentally, viral contagion events depend on the interaction of agents in physical space, and with the forward-looking uncertainty that novel outbreaks necessarily carry, reducing connectivity temporarily to slow flows of potentially contagious individuals is the only approach that is robust against misestimations in the properties of a virus or other pathogen.
Jan 26, 2020. Corresponding author: N N Taleb, email NNT1@nyu.edu.
Reproductive ratio: Estimates of the virus’s reproductive ratio R0—the number of cases one case generates on average over the course of its infectious period in an otherwise uninfected population—are biased downwards. This property comes from fat-tailedness [4] due to individual ‘superspreader’ events. Simply, R0 is estimated from an average which takes longer to converge as it is itself a fat-tailed variable.
Mortality rate: Mortality and morbidity rates are also downward biased, due to the lag between identified cases, deaths and reporting of those deaths. Increasingly Fatal Rapidly Spreading Emergent Pathogens: With increasing transportation we are close to a transition to conditions in which extinction becomes certain both because of rapid spread and because of the selective dominance of increasingly worse pathogens. [5] Asymmetric Uncertainty: Properties of the virus that are uncertain will have substantial impact on whether policies implemented are effective. For instance, whether contagious asymptomatic carriers exist. These uncertainties make it unclear whether measures such as temperature screening at major ports will have the desired impact. Practically all the uncertainty tends to make the problem potentially worse, not better, as these processes are convex to uncertainty. Fatalism and inaction: Perhaps due to these challenges, a common public health response is fatalistic, accepting what will happen because of a belief that nothing can be done. This response is incorrect as the leverage of correctly selected extraordinary interventions can be very high.
Conclusion: Standard individual-scale policy approaches such as isolation, contact tracing and monitoring are rapidly (computationally) overwhelmed in the face of mass infection, and thus also cannot be relied upon to stop a pandemic. Multiscale population approaches including drastically pruning contact networks using collective boundaries and social behavior change, and community self-monitoring, are essential. Together, these observations lead to the necessity of a precautionary approach to current and potential pandemic outbreaks that must include constraining mobility patterns in the early stages of an outbreak, especially when little is known about the true parameters of the pathogen. It will cost something to reduce mobility in the short term, but to fail do so will eventually cost everything—if not from this event, then one in the future. Outbreaks are inevitable, but an appropriately precautionary response can mitigate systemic risk to the globe at large. But policy- and decision-makers must ct swiftly and avoid the fallacy that to have an appropriate respect for uncertainty in the face of possible irreversible catastrophe amounts to "paranoia," or the converse a belief That nothing can be done.
REFERENCES
[1] Y. Bar-Yam, “Dynamics of complex systems,” 1997.
[2] ——, “Transition to extinction: Pandemics in a connected world„” 2016.
[3] N. N. Taleb, R. Read, R. Douady, J. Norman, and Y. Bar-Yam, “The
precautionary principle (with application to the genetic modification of
organisms),” arXiv preprint arXiv:1410.5787, 2014.
[4] N. N. Taleb, The Statistical Consequences of Fat Tails. STEM Academic
Press, 2020.
[5] E. M. Rauch and Y. Bar-Yam, “Long-range interactions and evolutionary
stability in a predator-prey system,” Physical Review E, vol. 73, no. 2, p.
020903, 2006
03/19/2020
From the NYT
■ For the first time since the crisis began, China today reported no new local infections for the previous 24 hours. Experts have said at least 14 straight days without new infections are needed for the outbreak to be considered over.
■ New C.D.C. data showed that nearly 40 percent of hospitalized patients in the U.S. were aged 20 to 54. But the risk of dying was significantly higher in older people.
■ Immigration and Customs Enforcement said it would stop making arrests, except for those considered “mission critical,” until the crisis ends.
■ As school systems shut across the U.S., administrators are pleading for guidance from the federal government.
■ The virus has now infected and killed more people in Europe — over 82,000 cases and more than 3,400 dead — than it has in China. “This is serious,” Chancellor Angela Merkel of Germany said in a televised address on Wednesday. “Take it seriously.”
■ Australia will bar all foreign visitors starting Friday. Canada and New Zealand have made similar orders.
■ Singapore, Hong Kong and Taiwan have kept the number of cases down with some success, but the virus continues to spread rapidly in most of the world. Our charts show the trajectory of the pandemic in various places.
■ Russia has limited personal freedoms in ways that mirror recent moves by Western democracies, but the measures also let President Vladimir Putin show an uneasy public the effectiveness of a strong, centralized state. Russia, which announced its first coronavirus death today, has reported 147 confirmed coronavirus cases, but many Russians believe the real total is far higher
03/16/2020
CDC has just lost all credibility
Most recent advice No meetings of 50 or more people???
Do you take comfort that there are only 49 people at your gathering??
The exception on the website
"This recommendation does not apply to the day to day operation of organizations such as schools, institutes of higher learning, or businesses."
The virus does not discriminate based on venue.
Not prudent rational or evidence based. Please social distancing everywhere in all settings
03/15/2020
As of today 19 states have shut down all public schools. Spain and France are on lock-down and US hospitals cancel elective surgeries and scramble to create larger ICUs and access to more ventilators.
03/13/2020
Updated references from the NEJM at the references section. Is US Lock Down Inevitable??
National Guard in New Rochelle
Italy made the decision to Lock down the entire country
With completely inadequate testing and unknown risk many sectors shutting down sports, entertainment, schools, theater, conferences any large gatherings. Fauci says the current situation is the “most disruption” he has in his 37 year career. He states too many unknowns.
03/12/2020
A quick check of the projected numbers is staggering making ramping up the health care system an exercise in futility. If 40 to 70% of the population gets the virus then 200,000,000 people in the US will be infected and 10%-15% need hospitalization approximately 20,000,000. We only have 800,000 beds in the USA. We do not have the doctors nurses or equipment to deal with that level of infection.
Of course we should make every effort to delay and mitigate the pandemic to allow a chance for a vaccine and drugs to treat to be developed. The longer the time window for spread, the better our resources can be utilized.
03/10/2020
Italy spread leads to nationwide lockdown. Strategy has moved from containment to mitigation worldwide. WHO continues to be backward not admitting pandemic. Mixed messages from US government leading to some confusion. Increasing social distancing and limiting conferences sporting events without empty stadiums. Hoarding of certain items masks and sanitizer continues. Global markets crash and endure huge volatility. Health care workers at serious risk.
Biogen conference in Boston leads to widespread closures quarantine and canceling of many events as well as school closures. Many classes and meetings being held remotely to limit spread.
03/02/2020
After almost 2 months of experience and spread of coronavirus all over the world preparation for a pandemic is occurring. Public health officials have been unfortunately drawn into the political sphere in both China and the United States regarding controlling the narrative. The public has remained calm fortunately and ongoing advice for handwashing and social distancing seem to be the watchwords.
Homeland security has advised having two weeks worth of food available in the event of prolong social distancing. Cancellation of public events is increasing and likely will continue. The stock market has taken a significant dive and currently no end is in sight.
While discussions of the creation of a vaccine have been raised this is highly unlikely to occur in less than a year.. An improperly tested vaccine could end up being more harmful than good as was seen in the case with respiratory syncytial virus which created enhanced immunity and actually exacerbated the underlying illness Possible antiviral agents are being investigated.
Ongoing debates as to the utility of facemask continue. Clearly indicated for those who have symptoms but debated for those who are trying to protect themselves. The N 95 mask is protective but conventional surgical mask are less effective Little or no risk is associated with wearing a mask, even for those trying to protect themselves. The key is to maintain access to masks for health care workers and not use a mask to create a false sense of security leading to unsafe behavior such as going out in public when not necessary
03/01/2020
Ongoing spread world wide continues with Italy and Iran being hotspots. US now recognizing increasing community spread. Really no end in sight and possibly a long haul with pharma ramping up vaccine and rug treatment efforts. Runs on Masks and hand sanitizer creating shortages. Japan closing schools for a full month which is very likely not long enough and of limited value if not combined with more extensive social distancing.
02/29/2020
Contnued community spread in the US and now runs being made on stores for masks , hand sanitizers and staples. Nice updated reference in JAMA on swift action to address. https://jamanetwork.com/journals/jama/fullarticle/2762510
02/27/2020
Coronavirus: Ineffective containment strategies continue. Continuing new cases effecting all populated continents spreads. Japan closes schools for one month...highly unlikely to have any significant impact.
Spanish flu of 1918 infected 500 million and killed 50 million lasted 18 months.
Challenges continue and preparation by public private sectors as well as individuals
02/26/2020
Continued multi-continent spread in Europe and Middle east Austria, Italy, Croatia Spain France Germany Greece Afghanistan, Bahrain, Kuwait, Iraq, Oman
02/25/2020
BREAKING NEWS: CDC expects ‘community spread’ of coronavirus in the US, as top official warns disruptions could be ‘severe’ Balancing preparedness and prudent public health measures while not engendering undue fear is a delicate balance.
02/24/2020
Continuing spread to South Korea, announcing state of emergency, Italy and Iran with direct spread to Lebanon and Canada from Iran.. Stock market plunge and CDC announcing US preparation for possible school and business closings.
02/21/2020
New article in Harvard gazette update
Harvard School of Public Health expert predicts pandemic
Full text below
Attempts to contain cases in China have proved ineffective
Government-imposed quarantines, a shutdown of outbound flights and trains, and locked-down cities in China slowed down the new coronavirus but didn’t stop its surge across the world, and the time has come for the global community to brace for a worldwide disease spread, said a Harvard epidemiologist.
“The infectious-disease epidemiology community and policymakers have come to the conclusion that it’s very likely that this virus is going to continue spreading throughout the world over time,” said Michael Mina, assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health. “Things have really shifted a little bit from trying to stop its spread in China to now saying, ‘What can we, as a global community, as individual nations, and even as individual hospitals, do to prepare for what seems more and more potentially inevitable that we will start seeing cases locally throughout the world?’”
Mina participated in a Facebook Live event on Wednesday sponsored by The Forum at Harvard T.H. Chan School of Public Health and PRI’s “The World.” Mina and “The World” reporter Elana Gordon discussed the latest updates on the pneumonia-like illness that has sickened more than 75,000 around the world since it originated in Wuhan, a city of 11 million in China, in December. In late January, the World Health Organization (WHO) declared the coronavirus outbreak a “global health emergency.”
WHO’s Feb. 20 situation report said 75,765 cases have been confirmed, and the number of deaths has surpassed the 2,000 mark. The virus has been found in 27 countries, with more than 74,000 cases in China. The second-highest number of cases, 634, was found on the Diamond Princess cruise ship. According to WHO and the Centers for Disease and Control Prevention (CDC), there have been 15 confirmed cases in the U.S.
The number of daily confirmed cases in China spiked last week due to a change in the definition of what could be officially counted, said Mina. Before the change, confirmed cases were reported only after a positive molecular diagnostic test called PCR, but as resources became stretched in China additional clinical diagnostic criteria were allowed, including scans of lungs that can reveal coronavirus-infected pneumonia. After the adoption of the new protocol, totals skyrocketed from about 2,000 to 15,000 between Feb. 11 and Feb. 12.
“The moment the definition changed, the cases that had been clinically apparent to be coronavirus were allowed to be counted, and all of a sudden, in one day, there were about 14,000 new cases,” said Mina. “But it was really a reporting issue, and the number has subsided. Now it’s really a combination of both the molecular tests and the clinical cases being reported together.”
According to WHO, the number of cases reported dropped from more than 4,000 on Feb. 13 to 1,800 on Feb. 17. Yet researchers are concerned about the virus mortality rate, which, at 2 percent, is 10 times higher than the flu. In reality, said Mina, it could be much higher.
“The numbers we’re getting still might be the tip of the iceberg,” said Mina. “The most likely situation is actually that there are many, many more people getting infected in China than are
being reported, and that’s just because it’s a strained health system. That, I think, is maybe the critical piece of information that continues to remain unknown in this epidemic.”
Researchers around the world are racing to develop a vaccine against the novel coronavirus. Efforts are focused on creating an antiviral drug that can block the spike protein, a piece of the virus that binds to a human cell, which could prevent replication in the host, said Mina.
New advances in vaccine technology make Mina optimistic about a coronavirus vaccine, which could be ready to start a phase one clinical trial in patients in the spring or early summer. But he cautions that it might not available to a wider audience until next year.
For now, the public should continue exercising basic precautions: wash your hands frequently, avoid touching your face, and quarantine yourself if symptoms develop. Mina also warned against falling prey to unfounded fears of contracting the virus in Chinese restaurants. “There have been a lot of unfortunate reports of people being afraid of going to Chinatown,” he said. “We should not be afraid that there is an excess risk when you go to Chinatown.”
UPDATED 02/16/2020
02/16/2020 More cases, deaths, geographic spread suggests ongoing difficulties. CDC predicts spread tot he US and the pandemic lasting one to two years possibly. Containing spread including suspected African cases and further spread in Europe. The inability to contain spread on a cruise ships highlights difficulties and China has imposed progressively draconian travel restrictions and social distancing affecting over 600 million people almost twice the population of the US
02/12/2020 Hong Kong is investigating the potential for water spread through pipes in a building with several reported case of inhabitants on different floors.
While unlikely this additional wrinkle raises the complexity of minimizing contagion.
02/10/20 AP reports
Mainland China has reported another rise in cases of the new virus after a sharp decline the previous day, while the number of deaths grow by 97 to 908, with at least two more outside the country. On Monday, China's health ministry said another 3,062 cases had been reported over the previous 24 hours, raising the Chinese mainland's total to 40,171.
02/07/2020
Cases and fatalities increasing
Chinese escalate lockdown, create quarantine centers
Steep rise in cruise ship cases in Japan ((opportunity to assess spread, infectivity and virulence)
Tragic Death of Dr. Li Wenliang 34yo who initially reported the virus and was admonished. He noted asymptomatic patient infected him and her own family
02/04/2020 basic reproductive number for the virus, a measure of how easily the virus can be transmitted is thought to be high which raises ongoing concern for significant spread.
02/03/2020 Update Increasing numbers of cases and fatalities with progressive travel restrictions and increasing quarantines. Fatality rate estimated around 2%, lower than SARS, but infectivity seems quite high.
02/02/2020 Lancet publishes model of spread of coronavirus which is referenced below. The potential for significant pandemic is present and caution is advised
02/01/2020 Travel restrictions in the US from flights from China are increased as the number of cases of coronavirus rises to over 14,000. Interestingly the pandemic of 1918 started in the spring of 1918 and ended a little over a year later in the summer of 1919 after infecting 500 million and killing nearly 50 million. In the current time where international airplane travel is routine it would be expected that a pandemic would worsen much more quickly and end much more quickly without intervention. . Somewhat paradoxically the more public health measures travel restrictions and quarantine measures are employed, the longer the pandemic will last since the number of uninfected individuals is protected from exposure . The goal would primarily be to limit the spread to a very small region allowing those infected to recover develop immunity and not be infectious and/or if lucky contain disease long enough to allow a vaccine to be developed to inoculate the population. Unfortunately vaccine development is not a quick process. Continue to follow the public health response and recheck this blog for updates.
01/30/2020 WHO declares coronavirus outbreak a global health emergency
01/29/2020 Continuing spread, greater public health measures strongly favor a cautious approach with limiting social travel and elective gatherings. Reported deaths also increasing. Documented cases for patients with no travel history to China suggest ongoing spread. Careful hand hygiene and respiratory precautions especially in high risk settings. Limiting elective business and social meetings, having more people communicate virtually and work from home seems prudent as more information emerges. Making sure everyone in your household follows these simple rules as well .
The media has started broad coverage of the possibility of a pandemic with coronavirus and there have been aggressive public health measures instituted very early on to address this potential problem. What is the reality and possible outcome of this infection and what public health measures are available to control it? We have had previous pandemics including the devastating 1918 influenza pandemic which infected 500 million and killed 50 million people worldwide. What has changed that make the current environment potentially more dangerous?
The current use of international travel has made the risks of pandemics infinitely greater and reasonable measures to control pandemics are problematic at best. The dramatic increase in population and urban centers with crowded public spaces also has increased from 1918. Answering basic questions about infection control and opportunities to limit spread are worthwhile to educate the public about how to protect themselves and minimize risk.
The coronavirus has been a well recognized pathogen for many years. Once a new variant is discovered the risk for spread and contagion arises. Many types of coronavirus exist. Most are mild and self limited but two human coronaviruses, MERS-CoV and SARS-CoV have been known to frequently cause severe symptoms. MERS symptoms usually include fever, cough, and shortness of breath which often progress to pneumonia. New varieties always present novel risk.
The coronavirus can be spread by air including coughing and sneezing. According to the CDC personal contacts such as touching or shaking hands is a means of transmission as well as touching an object or surface with the virus on it and then leading to mouth nose or eye contamination. This form of transmission means that there are multiple avenues to become infected and the ability of the virus to lie on inanimate objects (fomites) and then be transmitted is highly dependent on the nature of the virulence and inherent characteristics of the virus.
Symptoms can include
runny nose
headache
cough
sore throat
fever
a general feeling of being unwell
More severe symptoms can include shortness of breath, difficulty breathing chest pain etc
Typical preventative measures such as hand washing, sterilizing surfaces as well as respiratory protections including wearing a mask by both those who are infected and those trying to minimize the risk of infection are advised.
EVERYDAY PREVENTIVE ACTIONS
Everyone should always practice good personal health habits to help prevent transmission
Stay home when you are sick. Stay home for at least 24 hours after you no longer have a fever or signs of a fever without the use of fever-reducing medicines.
Cover your coughs and sneezes with a tissue.
Wash your hands often with soap and water for at least 20 seconds. Use at least a 60% alcohol-based hand sanitizer if soap and water are not available.
Clean frequently touched surfaces and objects.
More extensive interventions can be implemented for pandemics
RESERVED FOR A FLU PANDEMIC
Communities should be prepared to take these additional actions if recommended by public health officials.*
Stay home if someone in your house is sick.
Increase the space to at least 3 feet between people, and limit face-to-face contact in schools, workplaces, and at large events, as much as possible.
Temporarily dismiss students attending childcare facilities, K-12 schools, and institutions of higher education.
Modify, postpone, or cancel large events.
*These additional actions may be recommended for severe, very severe, or extreme flu pandemics.
Often times public health interventions are categorized from individual actions to community based
Human surveillance
Case reporting
Early rapid viral diagnosis
Disinfection
Hand hygiene
Respiratory etiquette
Surgical and N95 Masks
Other personal protective equipment
Patient Management
Isolation of sick individuals
Provision of social support services to the isolated
Contact Management
Quarantine†
Voluntary sheltering
Contact tracing
Community Restrictions
School closures
Workplace closures
Cancellation of group events
International and domestic travel restrictions
Currently the airports in Los Angeles, New York, Chicago, Atlanta and San Francisco are screening passengers arriving from China particularly the city involved. The Chinese government has placed a quarantine on over 30 million people in the city involved Wuhan. This is a daunting task and does generate the risk for hysteria and overreaction but there are limited additional options. China is faced with a population of 1.4 billion and with the emergence of constantly escalating number of cases within their country, aggressively addressing the issue is a reasonable option. While government efforts to contain infection or laudable, both the ability to implement public health interventions and effectiveness of these methods is highly variable . Practical advice for citizens would include making every effort to avoid travel to areas where the disease has emerged. Minimizing contact with those who are ill. Contacting Healthcare workers to determine the best course of action if symptoms develop and immediately wearing a mask if fever or symptoms emerge after contact with a potential exposure. Using handwashing is useful for all forms of respiratory spread and hand spread infections such as influenza and should be maintained regardless of new or emerging infection.
Since there are limited treatments for these typical viral illnesses and no current vaccines for the new coronavirus, most therapeutic intervention is supportive. Staying aware of recommendations and information regarding the distribution of the disease and following the advice of public health specialists from the Center for Disease Control is strongly advised.
While previous experience with Ebola and other potential pathogens have not materialized into devastating pandemics there is a plethora of information about the fact that a pandemic is highly likely, the only question is when. Preparation for coordinated efforts at public health intervention are mandated on local, regional, state, federal and international basis will be required to coordinate public health measures. Already long lines have emerged at hospitals in China and a balance between overreaction and complacency must be maintained.
I will continue to update followers on information and recommend all stay current as new information and recommendations arise.
References updated
03/28/2020
JAMA
Opinion
COVID-19 Case-Fatality Rate and Characteristics of Patients Dying in ItalyGraziano Onder, MD, PhD; Giovanni Rezza, MD; Silvio Brusaferro, MD
Research
Characteristics and Outcomes of Critically Ill Patients With COVID-19 in Washington StateMatt Arentz, MD; Eric Yim, MD; Lindy Klaff, MD; et al
Opinion
Treating COVID-19—Off-Label and Compassionate Use and Clinical Trials During PandemicsAndre C. Kalil, MD, MPH
Opinion
COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What Is the Evidence?Ankit B. Patel, MD, PhD; Ashish Verma, MBBS
Research
Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her NewbornLan Dong, MD; Jinhua Tian, MD; Songming He, MD; et al
Patient Information
Stopping the Spread of COVID-19Angel N. Desai, MD, MPH; Payal Patel, MD, MPH
Clinical Review & Education
Management of Critically Ill Adults With COVID-19Jason T. Poston, MD; Bhakti K. Patel, MD; Andrew M. Davis, MD, MPH
Research
Antibodies in Infants Born to Mothers With COVID-19Hui Zeng, MD; Chen Xu, BS; Junli Fan, MD; et al
Opinion
Postacute Care Preparedness for COVID-19David C. Grabowski, PhD; Karen E. Joynt Maddox, MD, MPH
Opinion
Social Media and Emergency Preparedness for the Coronavirus 2019 (COVID-19) PandemicRaina M. Merchant, MD, MSHP; Nicole Lurie, MD, MSPH
Opinion
Preserving Clinical Trial Integrity During the Coronavirus PandemicMary M. McDermott, MD; Anne B. Newman, MD, MPH
Opinion
Toward Universal Deployable Guidelines for the Care of Patients With COVID-19Francois Lamontagne, MD, MSc; Derek C. Angus, MD, MPH
Opinion
Can SARS-CoV-2 Infection Be Acquired In Utero?David W. Kimberlin, MD; Sergio Stagno, MD
Research
Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 RespiratorsLisa A. Pompeii, PhD; Colleen S. Kraft, MD, MSc; Erik A. Brownsword, MPP; et al.
Research
Ethics Committee Reviews of Applications for Research Studies at 1 Hospital in China During the 2019 Novel Coronavirus EpidemicHui Zhang, MBBS; Fengmin Shao, MD, PhD; Jianqin Gu, MD, PhD; et al
03/24/2020
https://www.washingtonpost.com/outlook/2020/03/23/coronavirus-count-confirmed-testing/
03/23/2020
PERSPECTIVE
The Toughest Triage — Allocating Ventilators in a Pandemic
R.D. Truog, C. Mitchell, and G.Q. Daley
SOUNDING BOARD
Fair Allocation of Scarce Medical Resources in the Time of Covid-19
E.J. Emanuel and Others
03/14/2020
Nice AMA resource guide for physicians and patients
https://lnkd.in/eaEGC2V
03/13/2020
NEJM
PERSPECTIVE
History in a Crisis — Lessons for Covid-19
D.S. Jones
CORRESPONDENCE
SARS-CoV-2 Infection among Travelers Returning from Wuhan, China
O.-T. Ng and Others
CORRESPONDENCE
Detection of Covid-19 in Children in Early January 2020 in Wuhan, China
W. Liu and Others
CLINICAL CONVERSATIONS
Talking with Patients about Covid-19
A.S. Fauci
Many excellent resources exist from the WHO and CDC. Below please find a small number.
03/08/2020
03/06/2020
https://www.nih.gov/health-information/coronavirus
02/28/2020
https://www.nejm.org/doi/full/10.1056/NEJMp2003762
02/17/2020
JAMA
Research
Clinical Characteristics of Patients With 2019 Novel Coronavirus (2019-nCoV)–Infected Pneumonia in Wuhan, ChinaDawei Wang, MD; Bo Hu, MD; Chang Hu, MD; et al
Research
Clinical Characteristics of Patients With Novel Coronavirus (2019-nCoV) Infection Hospitalized in Beijing, ChinaDe Chang, MD, PhD; Minggui Lin, MD; Lai Wei, MD; et al
Opinion
2019 Novel Coronavirus—Important Information for CliniciansCarlos del Rio, MD; Preeti N. Malani, MD, MSJ
02/11/2020 https://news.harvard.edu/gazette/story/2020/02/harvard-expert-says-coronavirus-likely-just-gathering-steam/
02/08/20
JAMA
Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, ChinaDawei Wang, MD; Bo Hu, MD; Chang Hu, MD; et al
JAMA
Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, ChinaDe Chang, MD, PhD; Minggui Lin, MD; Lai Wei, MD; et al
JAMA
2019 Novel Coronavirus—Important Information for CliniciansCarlos del Rio, MD; Preeti N. Malani, MD, MSJ
JAMA
Coronavirus Infections—More Than Just the Common ColdCatharine I. Paules, MD; Hilary D. Marston, MD, MPH; Anthony S. Fauci, MD
JAMA
The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health GovernanceAlexandra L. Phelan, SJD, LLM; Rebecca Katz, PhD, MPH; Lawrence O. Gostin, JD
JAMA
N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical TrialLewis J. Radonovich Jr, MD; Michael S. Simberkoff, MD; Mary T. Bessesen, MD; et al
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30260-9/fulltext
https://www.thelancet.com/coronavirus?dgcid=etoc-edschoice_email_tlcoronavirus20
Asymptomatic spread of coronavirus https://www.nejm.org/doi/full/10.1056/NEJMc2001468?query=featured_home
The Novel Coronavirus Originating in Wuhan, ChinaChallenges for Global Health Governance
Alexandra L. Phelan, SJD, LLM1,2; Rebecca Katz, PhD, MPH1; Lawrence O. Gostin, JD2
Published Online: January 30, 2020. doi:10.1001/jama.2020.1097
https://www.nejm.org/coronavirus?query=TOC
January 28, 2020 DOI: 10.1056/NEJMc2001272
A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment, Vincent J. Munster, Ph.D., Marion Koopmans, D.V.M., Neeltje van Doremalen, Ph.D., Debby van Riel, Ph.D., and Emmie de Wit, Ph.D. NEJM January 24, 2020 DOI: 10.1056/NEJMp2000929
Disease outbreak news (DONs). Geneva: World Health Organization, 2020 (https://www.who.int/csr/don/en/. opens in new tab).
de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol 2016;14:523-534.
Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. Geneva: World Health Organization, 2020 (https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-(2019-ncov)-in-suspected-human-cases. opens in new tab).
A checklist for pandemic influenza risk and impact management: building capacity for pandemic response. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO
Coronavirus Infections—More Than Just the Common Cold
Catharine I. Paules, MD1; Hilary D. Marston, MD, MPH2; Anthony S. Fauci, MD2
Author Affiliations Article Information
JAMA. Published online January 23, 2020. doi:10.1001/jama.2020.0757
https://openwho.org/courses/public-health-interventions
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-208/tables/3
Pandemic Flu Planning Resources
CDC Pandemic Flu Planning Tools and Resources
■■ Visit www.cdc.gov/npi for the latest information and resources about nonpharmaceutical interventions (NPIs)
■■ Learn who may be at high risk for flu complications http://www.cdc.gov/flu/about/disease/high_risk.htm
■■ Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017
http://dx.doi.org/10.15585/mmwr.rr6601a1
■■ Visit http://www.cdc.gov/flu/pandemic-resources/index.htm for the latest information and resources about
pandemic flu
■■ Reaching People of Diverse Languages and Cultures with Flu Communications
http://www.cdc.gov/healthcommunication/Audience/index.html
■■ Creating Easy-to-Understand Materials http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf
■■ Crisis and Emergency Risk Communication (CERC) http://emergency.cdc.gov/cerc/index.asp
■■ The Health Communicator’s Social Media Toolkit
http://www.cdc.gov/healthcommunication/ToolsTemplates/SocialMediaToolkit_BM.pdf
■■ CDC Message Mapping Guide and Training http://www.orau.gov/cdcynergy/messagemappingguide
■■ Read about the important differences between seasonal flu and pandemic flu
https://www.cdc.gov/flu/pandemic-resources/basics/about.html
■■ Principles of Community Engagement Report
http://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf
CDC Pandemic Flu NPI Planning Guides
■■ Get Ready for Pandemic Flu: Educational Settings
https://www.cdc.gov/nonpharmaceutical-interventions/pdf/gr-pan-flu-ed-set.pdf
■■ Get Ready for Pandemic Flu: Workplace Settings
https://www.cdc.gov/nonpharmaceutical-interventions/pdf/gr-pan-flu-work-set.pdf
■■ Get Ready for Pandemic Flu: Individuals and Households
https://www.cdc.gov/nonpharmaceutical-interventions/pdf/gr-pan-flu-ind-house.pdf
■■ Get Ready for Pandemic Flu: Event Planners
https://www.cdc.gov/nonpharmaceutical-interventions/pdf/gr-pan-flu-event-plan.pdf
■■ Get Ready for Pandemic Flu: Community and Faith-Based Organizations Serving Vulnerable Populations
https://www.cdc.gov/nonpharmaceutical-interventions/pdf/gr-pan-flu-com-faith-org-serv-vul-pop.pdf
CDC Checklists
■■ Pandemic Flu Checklist for Childcare Program Administrators http://www.cdc.gov/nonpharmaceutical-interventions/
pdf/pan-flu-checklist-childcare-program-administrators-item3.pdf
■■ Pandemic Flu Checklist for K-12 School Administrators
http://www.cdc.gov/nonpharmaceutical-interventions/pdf/pan-flu-checklist-k-12-school-administrators-item2.pdf
■■ Pandemic Flu Checklist for Workplace Administrators http://www.cdc.gov/nonpharmaceutical-interventions/
communication/pdf/pandemic-flu-checklist-workplace-administrators.pdf
■■ Pandemic Flu Checklist for Event Planners
http://www.cdc.gov/nonpharmaceutical-interventions/pdf/pan-flu-checklist-event-planners-item4.pdf
CDC Trainings
■■ NPI 101–Introduction to Nonpharmaceutical Interventions for Pandemic Influenza
http://cdc.train.org/DesktopModules/eLearning/CourseDetails/CourseDetailsForm.aspx?courseId=1051645
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