Gawande Writes Article On COVID-19
May 25, 2020 at 8:51 p.m.
By -
He is the author of “Complications: A Surgeon’s Notes on an Imperfect Science,” “Better: A Surgeon’s Notes on Performance,” “The Checklist Manifesto and Being Mortal: Medicine” and “What Matters in the End.” All of these books are informative and worth reading. He is also a surgeon and public health researcher and writes extensively for Slate and the New Yorker.
His recent article from the latter is titled “Amid the Corona Virus Crisis, a Regimen for Reentry.” In it he describes all of the elements needed to control the spread of COVID-19, including hygiene methods (including handwashing), screening, distancing and masks. When taken together they help shut down the virus. Skip one and the treatment will not work.
Everyone seems to understand that cleaning the hands is essential, but frequency is just as important. A study conducted in a military camp found that handwashing five times a day cut medical visits for respiratory infections by 45%. Other research on the SARS virus outbreak found that washing hands 10 times a day reduced people’s infection rate even more. Another important point is that the virus spreads primarily through respiratory droplets emitted by infected persons when they cough, sneeze, talk or simply exhale; the droplets are then breathed by others. Loud talking even generates more droplets than quieter talking.
According to research, under the right conditions of temperature, humidity and air circulation, forceful coughing or sneezing can propel a cloudburst of respiratory droplets more than 20 feet. The recommended 6 feet is a choice guided by practicality.
Infectivity is also part of the article. Fortunately, COVID-19 is not as bad as measles. Measles has an RO value of 18. By comparison, a person with COVID-19 will infect, on average only two or three others out of all the people he or she encounters while going about daily activities.
RO pronounced R naught is a pathogen’s basic reproduction number and represents the number of new infections caused on average by a single contagious person. It anticipates a worst case scenario that assumes the entire population is susceptible. Epidemiologists focus on RO at the onset of the disease to disclose how bad the disease actually is.
According to estimates it is 1.5 to 3.5. If the pathogen’s number is less than 1, a pandemic won’t occur. If it is greater, an outgrowth has the potential to grow exponentially until it reaches pandemic proportions.
According to a recent article in the Wall Street Journal, a simple formula for calculating the effective reproduction number known as R, is (1-P) x R0, where P is the proportion of the population that is immune. It is understood that R is likely to be less than RO, but it is difficult to estimate how many people are immune.
There is rarely enough information. Assuming that 21% of the population is immune and the virus had an RO of 2.5, the effective reproduction number would be 1.98, a figure that would still permit exponential growth of the disease. A simple formula for estimating the percentage of the population that needs to be immune to achieve herd immunity if 1 – (1/RO). With an RO of 2.5, the result would be 60%, the threshold used as a target for immunization coverage of the population.
Screening or testing is another critical element in the battle against COVID-19. Mild symptoms are the most important to screen for, they include fever, cough, sore throat, shortness of breath, loss of taste or smell, or even just nasal congestion or a runny nose. Testing when people have symptoms is important; with a positive result, a case can be quickly identified, and close contacts at work or at home can be notified. With a negative result, people can quickly get back to work. Unfortunately, COVID-19 can make people infectious before they develop symptoms of illness. Studies now consistently indicate that infectivity starts before symptoms do, that it peaks right around the day that they start, and it declines substantially by five days or so.
Dr. Gawande therefore recommends distancing with masks. They provide “source control” by blocking the spread of respiratory droplets from a person with an active, but perhaps unrecognized, infection. Masks are effective, a recent study in Nature magazine reported that if worn properly and with the right fit, surgical masks are effective at blocking 99% of the respiratory droplets expelled by people with corona or flu viruses. Surgical masks are three times better than homemade masks at blocking outward transmission of respiratory viruses.
In summary, Dr. Gawande believes that the four pillars of strategy: hygiene, distancing, screening and masks will not return us to normal life, but, when signs indicate that the virus is under control, they could get people out of their homes and moving again. I highly recommend reading his article, it is free and can be down loaded from the internet and printed for future reference.
Max Sherman is a medical writer and pharmacist retired from the medical device industry. He has taught college courses on regulatory and compliance issues at Ivy Tech, Grace College and Butler University. Sherman has an unquenchable thirst for knowledge on all levels. Eclectic Science, the title of his column, touches on famed doctors and scientists, human senses, aging, various diseases, and little-known facts about many species, including their contributions to scientific research. He can be reached by email at [email protected].
He is the author of “Complications: A Surgeon’s Notes on an Imperfect Science,” “Better: A Surgeon’s Notes on Performance,” “The Checklist Manifesto and Being Mortal: Medicine” and “What Matters in the End.” All of these books are informative and worth reading. He is also a surgeon and public health researcher and writes extensively for Slate and the New Yorker.
His recent article from the latter is titled “Amid the Corona Virus Crisis, a Regimen for Reentry.” In it he describes all of the elements needed to control the spread of COVID-19, including hygiene methods (including handwashing), screening, distancing and masks. When taken together they help shut down the virus. Skip one and the treatment will not work.
Everyone seems to understand that cleaning the hands is essential, but frequency is just as important. A study conducted in a military camp found that handwashing five times a day cut medical visits for respiratory infections by 45%. Other research on the SARS virus outbreak found that washing hands 10 times a day reduced people’s infection rate even more. Another important point is that the virus spreads primarily through respiratory droplets emitted by infected persons when they cough, sneeze, talk or simply exhale; the droplets are then breathed by others. Loud talking even generates more droplets than quieter talking.
According to research, under the right conditions of temperature, humidity and air circulation, forceful coughing or sneezing can propel a cloudburst of respiratory droplets more than 20 feet. The recommended 6 feet is a choice guided by practicality.
Infectivity is also part of the article. Fortunately, COVID-19 is not as bad as measles. Measles has an RO value of 18. By comparison, a person with COVID-19 will infect, on average only two or three others out of all the people he or she encounters while going about daily activities.
RO pronounced R naught is a pathogen’s basic reproduction number and represents the number of new infections caused on average by a single contagious person. It anticipates a worst case scenario that assumes the entire population is susceptible. Epidemiologists focus on RO at the onset of the disease to disclose how bad the disease actually is.
According to estimates it is 1.5 to 3.5. If the pathogen’s number is less than 1, a pandemic won’t occur. If it is greater, an outgrowth has the potential to grow exponentially until it reaches pandemic proportions.
According to a recent article in the Wall Street Journal, a simple formula for calculating the effective reproduction number known as R, is (1-P) x R0, where P is the proportion of the population that is immune. It is understood that R is likely to be less than RO, but it is difficult to estimate how many people are immune.
There is rarely enough information. Assuming that 21% of the population is immune and the virus had an RO of 2.5, the effective reproduction number would be 1.98, a figure that would still permit exponential growth of the disease. A simple formula for estimating the percentage of the population that needs to be immune to achieve herd immunity if 1 – (1/RO). With an RO of 2.5, the result would be 60%, the threshold used as a target for immunization coverage of the population.
Screening or testing is another critical element in the battle against COVID-19. Mild symptoms are the most important to screen for, they include fever, cough, sore throat, shortness of breath, loss of taste or smell, or even just nasal congestion or a runny nose. Testing when people have symptoms is important; with a positive result, a case can be quickly identified, and close contacts at work or at home can be notified. With a negative result, people can quickly get back to work. Unfortunately, COVID-19 can make people infectious before they develop symptoms of illness. Studies now consistently indicate that infectivity starts before symptoms do, that it peaks right around the day that they start, and it declines substantially by five days or so.
Dr. Gawande therefore recommends distancing with masks. They provide “source control” by blocking the spread of respiratory droplets from a person with an active, but perhaps unrecognized, infection. Masks are effective, a recent study in Nature magazine reported that if worn properly and with the right fit, surgical masks are effective at blocking 99% of the respiratory droplets expelled by people with corona or flu viruses. Surgical masks are three times better than homemade masks at blocking outward transmission of respiratory viruses.
In summary, Dr. Gawande believes that the four pillars of strategy: hygiene, distancing, screening and masks will not return us to normal life, but, when signs indicate that the virus is under control, they could get people out of their homes and moving again. I highly recommend reading his article, it is free and can be down loaded from the internet and printed for future reference.
Max Sherman is a medical writer and pharmacist retired from the medical device industry. He has taught college courses on regulatory and compliance issues at Ivy Tech, Grace College and Butler University. Sherman has an unquenchable thirst for knowledge on all levels. Eclectic Science, the title of his column, touches on famed doctors and scientists, human senses, aging, various diseases, and little-known facts about many species, including their contributions to scientific research. He can be reached by email at [email protected].
Have a news tip? Email [email protected] or Call/Text 360-922-3092