Covid-19: Washington State Leadership in Dealing With Coronavirus

Washington State has immense resources to apply to the coronavirus crisis.

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One of the leading university medical centers in the world.
Major biotech firms and a huge foundation dedicated to health science (Gates Foundation)
The world's leading logistics and delivery firm (Amazon).
One of leading brick and mortar food and supply firms (Costco)
World-leading software and machine learning firms and expertise (e.g., Microsoft, Amazon)
One of the leading tech centers in the world.

Our state has intellectual, scientific, technological, and financial resources equivalent to those of many nations.

Might we take a leadership role in tackling this crisis, not only for ourselves, but for the rest of the world as well? 

Could Washington State lead the nation in heavily investing in a complementary approach to social distancing, online learning, and sending people home from work?    Might Washington State fill the void left by an ineffective Federal response?

Importantly, could the current environment of despair and fear, be replaced with a more empowered one?

Imagine the following path in the future.

One in which local businesses and academic, put state capabilities on an immediate "war footing" to address the threat.

On March 18th, The University of Washington and major regional biotech firms, with the financial support of the Gates and Bezos foundations, announce that they will rapidly build the capacity to provide 100,000 tests a day for the coronavirus in Washington State, with results available within hours.  This includes the purchase of several Roche cobas 6800 systems that will have the capacity of processing over a million tests per month.  Such testing capacity is expect to be in place by April 10.

Governor Inslee announced on the same day that the test will be immediately available to all doctors and hospitals and that 50,000 test per day will be dedicated to random sampling of state residents.  Testing at this level began on April 3rd.

Governor Inslee noted  that anyone with a positive test will be experience mandatory quarantine.  He further noted that a new state fund will cover the salary of any quarantined individual.

"South Korea showed that potential of coupling massive testing with quarantine, and we will take this approach to a new level", announced the Governor.

The Governor also noted that all skilled nursing and other retirement communities will require all patient and caregivers to be tested, as will all visitors. " We must take all steps required to prevent our most vulnerable citizens from being exposed to this threat".

Jeff Bezos, leader of Amazon, announced on March 17th that Amazon would deliver food and other necessary supplies without delivery charge during the next 30 days.  "We will extend this offer, if the situation does not resolve itself," said Bezos.   "And considering that many people are home-bound, we will make all content on Amazon Prime freely available to the general public.  Amazon runs the biggest supply chain system in the world, and we will use it to assure food and other supplies will reach all home-bound" patients", said Bezos.

Costco also joined the effort, with a temporary program of no-cost delivery and the new ability to pre-order and pick up orders outside of any warehouse.  "No Costco shopper need to enter a store to purchase any of our products", noted Costco CEO W. Craig Jelinek.

A major issue had been the relatively simple modeling used to predict coronavirus spread and deaths, and their relative poor performance.   On March 16th, a joint effort between the University of Washington, the Gates Foundation, and the data analytics groups of Microsoft and Amazon was initiated to produce state-of-science predictive modeling for coronavirus by early April.   "

Microsoft has huge capacity in predictive analytics and machine learning, with particular expertise in the medical area.  Coupled with the expertise of the University of Washington and others, we will build the capability to more skillfully predict the trajectory of COVID-19 using the increasing volume of data assets" explained Microsoft CEO Satya Nadella.

By June the effects of massive testing and quarantine, coupled with the isolating of the most vulnerable elderly and infirm as well as social distancing, resulted in a significant decline of new cases, with regional loss of life in Washington State far more limited than initially expected.   The beneficial role of  warmer weather and contribution of the large pool of now-immune young people who had mild or little symptoms may also have been important in lessening the impact of COVID-19.

Addendum:  Why Massive Testing of the Population is How We Get Out of This

Social distancing may be a useful, short-term stop gap, but in the end something more effective is needed.   Social distance can buy time, but it is essentially kicking the can down the road, and society can not keep it in place for long without undermining its ability to function,  Economic activity will collapse.

The key aspect of social distancing is to prevent large portions of the population from getting in contact with an infected individual.  It does this by shutting down all avenues of interaction and gathering.    It is a blunt tool with significant negative impacts (e.g., cancellation of schools or degradation of teaching).



Far better to use a more precise tool:  massive testing.   Find the infected individuals and take them out of circulation.  Much more effective and less damaging.  This allows society to function, but it requires the ability to give  tens of thousands of tests per day or more, something that is technologically well within our reach.

Another issue with social distancing is that you can never cut off interactions completely--leaving a continuous base of cases and as soon as you pull back the restraints, the virus can explode again.

Source: Cordtwain.info

Coronavirus: Indonesia has succeeded in making 20 million Chloroquine (coronavirus drugs) Trump is very supportive

Public statements by the US and Indonesian presidents have sent demand for the drug – usually used to treat malaria – rocketing

 Information Covid-19

Update Today:

Info COVID-19 Indonesia

POSITIF     SEMBUH    MENINGGAL

Yet its effectiveness against Covid-19 is at best unproven and in the wrong hands it can be fatal

First they came for the vitamins, then they came for the face masks and the hand sanitiser. And then they came for the chloroquine.

Ever since the coronavirus was discovered, more and more customers have been coming to the Iskandar Muda Pharmacy in Medan, Indonesia, looking for ways to keep themselves and their loved ones safe.

In the past two days, customers have been arriving in droves in search of chloroquine, a drug that derives from quinine and is usually used to treat malaria.

“At first we were confused about why people wanted it, then we saw that [President Joko “Jokowi” Widodo] had announced that it was a possible treatment for Covid-19,” explained pharmacist Maria. “It all made sense.”

© Aisyah Llewellyn A pharmacy sign in Indonesia says ‘All masks, alcohol and hand sanitiser are sold out’. Photo: Aisyah Llewellyn

On March 23, Indonesia’s president announced the country had ordered 3 million chloroquine tablets. Chloroquine comes from the cinchona tree which grows widely across Indonesia. “There is neither a cure nor an antiviral to Covid-19, but in drawing from the experiences of countries, chloroquine can be used to help patients recover from disease,” Widodo said. He added that the tablets would be distributed to patients through hospitals.

There is no chloroquine at the Iskandar Muda Pharmacy, even though Maria reported up to 50 customers a day trying to source the drug. But increasingly grim statistics are helping to drive the demand regardless.

As of Wednesday, Indonesia had reported 790 infections, 58 deaths and 31 recoveries. However, studies this week suggested the true numbers could be far worse. The London-based Centre for Mathematical Modelling of Infectious Diseases estimated as few as 2 per cent of Indonesia’s infections had been reported. That would bring the true number to as many as 34,300, more than Iran. Other modellers have projected a worst-case scenario of 5 million cases in the capital, Jakarta, by the end of April.

Indonesia’s geography may make matters worse. Its health care system is highly decentralised, given that it is a sprawling archipelago of more than 17,000 islands with 260 million people, and is already under strain with a shortage of staff, beds and protective equipment.

© Reuters Indonesian President Joko Widodo inspects a hospital handling Covid-19 cases in Jakarta. Photo: Reuters

PRAISED BY TRUMP

Widodo is not alone in his praise of chloroquine. US President Donald Trump has also been regularly touting it on social media and in press briefings, despite any comprehensive evidence that it is effective against coronavirus.

In fact, a study by the Journal of Zhejiang University in China found chloroquine and a similar drug hydroxychloroquine had little effect on the coronavirus. In its study of 30 patients with the coronavirus, 15 were given hydroxychloroquine and 15 received conventional treatment like oxygen and bed rest. Of the 15 given the drug 13 shed the virus within a week. Of the 15 given the standard treatment, 14 recovered within a week, while one patient remained infected.

While a study on such a small scale can’t be considered definitive either way, even White House insiders are sceptical of the two drugs’ benefits in treating the coronavirus. Coronavirus task force member Anthony Fauci said any evidence so far was only “anecdotal”.

Even so, trials of the drugs have started in New York and public health experts in France are considering using them for extremely ill patients. Eight hundred people are taking part in trials as part of a wider initiative across Europe involving 3,200 patients.

Meanwhile, as potential demand surges across the globe, India banned exports of hydroxychloroquine on March 25 with immediate effect.

© AFP US President Donald Trump has regularly touted the use of chloroquine. Photo: AFP

MORE HARM THAN GOOD

The problem with chloroquine’s sudden rise to fame is that while it remains unclear if it can help those with coronavirus, it could actually cause more harm than good if people buy the drug and self-medicate. There have been reports of poisonings in Nigeria and the United States, where one man in Arizona died on March 24 after ingesting chloroquine phosphate, which is also used to clean aquariums and fish tanks.

The side effects of chloroquine include problems with heart rhythm, dangerously low blood pressure and damage to the body’s muscles and nerves.

For Dr Corona Rintawan, an emergency medicine doctor who is now the head of a task force in Indonesia run by Muhamadiyyah (the second largest non-governmental Muslim organisation in the country), self medication with chloroquine is almost a bigger worry than the virus itself.

“I am worried [about people poisoning themselves] and I think most other doctors are too,” he said. “I think the government must have regulations about chloroquine buying and implement them. As long as there are online shops selling chloroquine, people will be able to order it freely.”

A number of sellers of the drug have popped up online in the past few days, making regulations a challenge. It is also difficult to stop people from trying to source chloroquine through any means possible, given the psychological toll the virus is taking on people around the world, according to Irna Minauli, a psychologist based in Medan.

“If we look at the vicarious learning model theory, people learn by what they see other people doing. So if they get information about a drug that can help them and see or hear of people trying to buy it, they will do the same,” she said.

© Reuters Workers disinfect areas of Jakarta, Indonesia, to prevent the spread of the coronavirus disease, Covid-19. Photo: Reuters

DISINFORMATION

This information, or disinformation, about chloroquine has spread rapidly on Indonesian social media according to Santi Indra Astuti, a lecturer in the Faculty of Communication Science at the Islamic University of Bandung (UNISBA) and the Head of the Research Department of Mafindo, an online fact checking civil society organisation.

“Right now, we’ve found that hoaxes regarding coronavirus are spreading massively,” she said. “In terms of quantity, it is overwhelming. We have collected data regarding Covid-19 hoaxes since January and recent data shows that the number has risen to 201 in eight weeks.”

Mafindo has volunteer fact checkers in 18 cities across Indonesia who have been data mapping Covid-19 hoaxes and compiling an online resource to debunk them.

Astuti said chloroquine disinformation had become a new issue in recent days. “We found that the information about chloroquine has been spreading, most of it through WhatsApp. It became our concern that doctors or whoever was quoted in the messages have not yet been proven as reliable sources. The discourse regarding chloroquine itself is still ongoing, so we are collecting information about that and publishing it so that people know what’s going on. Overall, our fact checkers reported that hoaxes regarding alternative medicine, herbs or medicine have been rising this past week.”

When asked how Indonesia’s health authorities can best ensure that Widodo’s latest comments don’t set off a chain of illicit chloroquine purchases, Corona said that they need to, “Put out statements that people should not buy it through the media.”

This was echoed by Astuti, who said Mafindo had “received a call for collaboration from local governments and administration, as well as related institutions such as health units, religious groups and professional associations to share information and fact check strategies”.

“As the situation in Indonesia gets worse, we need to combat it online,” she added.

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Source : Cortdwain.info

Kate Praises Nurses & Midwives for "Supporting People At Their Most Vulnerable"

Last month, we learned the Duchess of Cambridge had privately spent two days with Kingston Hospital Maternity Unit in London. It was very much under wraps, though we knew it was in connection with her early years work and role as patron of the global campaign, Nursing Now. The three-year initiative is aimed at raising the profile and status of nursing worldwide, so that nurses can make an even greater contribution at the heart of efforts to tackle the rising burdens of disease. Tonight, we learned more about Kate's time at Kingston Hospital with the release of photographs and an open letter to midwives across the country ahead of 2020's 'Year of the Nurse and Midwife'.

From time spent at the hospital to accompanying midwives and nurses on home visits, Kate's letter praises the efforts of people in these essential professions, whose tireless work often goes under the radar. I'm handing the mic over to the Duchess herself by sharing extracts from her letter which accompany the images perfectly...

"Dear Midwives, Next year the world turns its attention to the International Year of the Nurse and Midwife, and recognising and celebrating the humbling work that you and your colleagues do day in, day out, to improve the lives of others. You are there for women at their most vulnerable; you witness strength, pain and unimaginable joy on a daily basis. Your work often goes on behind the scenes, and away from the spotlight. Recently however, I was privileged enough to witness a small section of it first hand, spending several days at Kingston Hospital's Maternity Unit. Although this was not my first encounter with the care and kindness provided by midwives across the country, it gave me a broader insight into the true impact you have on everybody you help."

"Over the last few years, I've dedicated a significant amount of my work to the Early Years - the pivotal period of development between pregnancy and the age of 5 where children build crucial .foundations for life. Your role in supporting this critical phase of development extends far beyond the complicated task of delivering a baby successfully. The help and reassurance you provide for parents to be and parents of newborns is just as crucial. It goes a long way in building parents' confidence from the start, with lifelong impact on the future happiness of their children. The Early Years are more critical for future health and happiness than any other moment in our lifetime. Even before we are born, our mother's emotional and physical health directly influences our development and by the age of 5 a child's brain has developed to 90 per cent of its adult size. Your role at the very start of this period is therefore of fundamental importance."

"During my time at Kingston I accompanied community midwives on their daily rounds and was welcomed in to people's homes. I was truly touched by the trust that people placed in me, sharing their experiences and voicing their fears openly. I also spent time in hospital clinics and on post-natal wards. No matter the setting, I was continually struck by the compassion that those of you I spent time with showed, and the incredible work ethic you demonstrated on behalf of your entire profession - not only performing your rounds but working tirelessly through the night to support people that were at their most vulnerable. The founder of modern nursing, Florence Nightingale - whose 200th anniversary we celebrate next year, once said: "I attribute my success to this: I never have or took an excuse" and it is that mantra that I have seen time and time again in all of my encounters with you. You don’t ask for praise or for recognition but instead unwaveringly continue your amazing work bringing new life into our world. You continue to demonstrate that despite your technical mastery and the advancement of modern medicine, it is the human to human relationships and simple acts of kindness that sometimes mean the most.

"So as we look ahead to next year, I want to thank you for all that you do. It has been a real privilege learning from you so far, and I look forward to meeting and learning from even more of you in the coming years and decades - Catherine".

The Duchess wore a pink geometric dress from Michael Michael Kors (with thanks to Heaven) The sold out dress is described as a "multicoloured printed midi dress featuring a v-neck, an all-over print, a belted waist, long sleeves, a mid-length and a straight hem."

And accessorised with her Kiki McDonough Lauren earrings.

I expect there's a good possibility we'll see the Cambridges attending Sunday service at Sandringham either this coming weekend or next. I hope you're all enjoying a festive break; I'm working on the annual Year in Review post and hope to have it published around New Year's Day :)