COVID-19 and Crozet

via facebook :

I am a family doctor and I am terrified for the vulnerable members of our community. These are the numbers. In our small community of Crozet, VA, approximately 10K people, estimated between 40 and 238 deaths from covid-19 coronavirus, unless we as community members enact drastic social distancing measures immediately. If we wait until we have a documented case we have missed our chance to #flattenthecurve. That first case will represent many, many undiagnosed cases that may have been circulating for weeks. Please protect yourself and our most vulnerable and do not go to school, work, or other activities. You can transmit this virus unknowingly to someone who can die from this. Someone please tell me that my math is wrong?

I want to clarify that I am not terrified for myself, my husband, or my children. If any of us contract this virus, especially the kids, we will most likely have a mild case that we will recover from without much difficulty. As a physician, I am terrified for the most vulnerable members of our community who will not recover so easily. I am terrified that we know this data, yet it is not getting out to the public. We should learn lessons from Italy, Washington state, California, where very good hospitals are becoming overwhelmed, without enough ventilators to keep patients alive or enough protective equipment to prevent the doctors from getting infected. This virus is very contagious and people with mild cold like symptoms can easily spread it to others. The only known way to reduce deaths in a community is for all of us to stay home. Including those who feel fine.   I don’t want everyone else to feel terrified. But I do want everyone to take this extremely seriously. 


From a longer email she sent to her patients:

The World Health Organization currently estimates the overall risk of death from covid-19 at 3.4%, based on data from China. Dr. Fauci at the CDC has put this at 1%. These numbers may over-represent the actual risk of death as more mild cases were likely not diagnosed or tested. These numbers will change as we learn more.

Please protect yourself and those you care about by doing the following:

1. Social distancing:

-Do not attend any unnecessary gatherings of people. 

-Do not attend religious services.

-Do not go to the gym.

-Do not travel. 

-Keep your kids/yourself home from school if possible.

-Work from home if possible.

-Stay in your own home or outdoor areas as much as possible.   

-If you are a leader of any organization, suspend all meetings/classes/practices/games.  

We cannot stress highly enough the importance of this. 

The time to do this is NOW, before we have widespread transmission in our local community.

This is going further than the current Virginia Department of Health and CDC guidelines, but we strongly believe it is necessary.  Due to the current limited testing, the number of cases in Virginia is likely much higher than we know, and social distancing is the only known way to slow the spread of this virus.

This protects you and your family, but also protects the vulnerable members of our community.

Without these measures, the current medical system runs a real risk of being unable to keep up with the needs of our patients (not enough breathing machines and other supplies to care for all who will need it).

Widespread social distancing as soon as possible can make an enormous difference in number of infections and deaths. 

See details here: coronavirus: why you must act now

and here: https://www.theatlantic.com/ideas/archive/2020/03/coronavirus-cancel-everything/607675/

2.       Wash your hands with soap and water for 20 seconds or use a hand sanitizer that contains at least 60% alcohol prior to eating and after touching potentially contaminated faucets, door handles, and counters.  Avoid touching your eyes, nose and mouth.

3.       Prepare for future changes by having a at least a 2-3 week supply of anything you would need, including prescription medications.

Symptoms of covid-19 may include:

– Fever (88% of lab confirmed cases)
– Dry cough (67%)
– Fatigue (38%)
– Sputum production (33%)
– Shortness of breath (18%)
– Sore throat (14%)
– Headache (13%)
– Muscle/joint aches (15%)
– Chills (11%)
– Nausea/vomiting (5%)
– Stuffy nose (5%)
– Diarrhea (4%)
– Coughing up blood (1%)

If you develop symptoms:

1.  Self-isolate in your own home, in a room separate from other family members and pets.  Most cases are mild cold symptoms that will resolve on their own.  You can use over the counter medications as needed for symptom management. 

2.  If you have difficulty breathing, call 911 or go directly to the emergency department.  Wear a mask if you have one to protect those you may come into contact with, and call the emergency department to let them know you are coming.

3.  As of right now, testing in Virginia is limited and we do not have the capability to test in our office.  If you are concerned that you may have covid-19, please contact your doctor, who can discuss recommendations.

This is a rapidly evolving clinical situation and all of this is subject to change.  Again, this is what we are currently recommending for our own family, in order to do everything we can to protect the most vulnerable around us.  The Virginia Department of Health recommendations can be found here: http://www.vdh.virginia.gov/surveillance-and-investigation/novel-coronavirus/ and CDC recommendations can be found here: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Maura McLaughlin, MD and Tim McLaughlin, MD



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12 Replies to “COVID-19 and Crozet”

  1. I have to question the data used in this chart. Specifically the infection rate. What is the source of an estimated infection rate of 40%-70%? Without the source identified of that data, this chart should not be considered valid.

    Using current population data readily available as well as the coronavirus data here: https://www.worldometers.info/coronavirus/ it is easy to come up with the current infection rate which is: Number of cases / Population.

    If you do this the percent of cases in China, which is apparently seeing very few new cases, is: 0.0017%. In Italy the case rate is currently: 0.025%. In South Korea it is: 0.016%. And in the US currently we are at 0.0006%.

    So how in the world can a reasonable person get to a 40-70% infection rate using the currently available data?

  2. I posted a question earlier asking for the source of the very high 40-70% infection rate used in the chart. Based on the data available on multiple sources that I had included in my post, those numbers are ridiculously high. Why is that? And why is Mr. Duncan supporting this panic narrative?

    1. https://thehill.com/changing-america/well-being/prevention-cures/482794-officials-say-the-cdc-is-preparing-for :

      Copied from the hill:

      Harvard epidemiologist Marc Lipsitch told The Wall Street Journal that “it’s likely we’ll see a global pandemic” of coronavirus, with 40 to 70 percent of the world’s population likely to be infected this year. (WSJ behind paywall).

      Ira Longini, a biostatistician and adviser to the World Health Organization (WHO), has predicted that two-thirds of the global population may eventually contract COVID-19.

      Prof Gabriel Leung, the chair of public health medicine at Hong Kong University, says if the transmission estimate of 2.5 additional people for each infected rate is accurate, that would result in an “attack rate” that would affect 60 to 80 percent of the world’s population.

      —-

      me (the emailer):

      Part of the reason that the estimates of infection rate are so high is that symptoms are so mild that in many people, people are walking around with this virus and not knowing it, and transmitting to others who also may not know they have it etc (vs influenza when they feel so bad they are in bed). I haven’t seen any estimate less than 40% of people getting this (for most of us it will be similar to a regular cold)–the key is that the vulnerable people don’t all get it at once, but get it spread out time-wise so that the medical system can care for them

  3. Sent by a doctor:

    Dear Friends,

    So much confusion, misinformation and denial is bouncing around on social media about the coronavirus that I thought I would try to explain, in plain language, why the experts see this as such an emergency.

    You will see the claim online that this virus is a lot like the viruses that cause colds, and that if you get it, it will probably just seem like a bad cold and you are very unlikely to die. Depending on who you are, these statements are probably true. But they are incomplete, and the missing information is the key to understanding the problem.

    This is a coronavirus that is new to the human population, jumping into people late last year from some kind of animal, probably at a wildlife market in Wuhan, China. It is related to the viruses that cause colds, and acts a lot like them in many ways. It is very easy to transmit through the respiratory droplets that all of us give off. But nobody has ever been exposed to this before, which means nobody has any immunity to it.

    The virus is now moving explosively through the human population. While most people will recover, about 20 percent of the people who catch it will wind up with a serious disease. They will get pneumonia that causes shortness of breath, and they may need hospitalization.

    Some of those people will get so sick that they cannot be saved and will die of the pneumonia. The overall death rate for people who develop symptoms seems to be 2 or 3 percent. Once we have enough testing to find out how many people caught the virus but did not develop symptoms, that might come down to about 1 percent, optimistically.

    This is a large number. It is at least 10 times higher than the mortality rate for the seasonal flu, for instance, which in some years kills 60,000 or 70,000 Americans. So just on that math, we could be looking at 600,000 or 700,000 dead in the United States. But it gets worse.

    Older people with existing health problems are much more vulnerable, on average. The mortality rate of coronavirus among people over age 80 may be 15 or 20 percent. It appears to have 7 or 8 percent mortality for people aged 70 to 79. Here is the terrible part: If you are a healthy younger person, you can catch the virus and, without developing serious symptoms yourself, you can pass it along to older people. In other words, as the virus spreads, it is going to be very easy to go out and catch it, give it to your grandmother and kill her, even though you will not die yourself. You can catch it by touching a door knob or an elevator button.

    Scientists measure the spread of an epidemic by a number called R0, or “R naught.” That number is calculated this way: for every person who develops the illness, how many other people do they give it to before they are cured (or dead) and no longer infectious? The R0 for coronavirus, in the absence of a control strategy, appears to be a number close to 3 – maybe a bit higher or lower, but in that ballpark. This is an extremely frightening number for such a deadly disease.
    Suppose you catch the virus. You will give it to 3 other people, and they will each give it to three others, and so forth.

    Here is how the math works, where you, the “index case,” are the first line:
    1
    3
    9
    27
    81
    243
    729
    2,187
    6,561
    19,683
    59,046
    177,147
    531,441
    1,594,323
    4,782,969
    14,348,907

    So, in just 15 steps of transmission, the virus has gone from just one index case to 14.3 million other people. Those 15 steps might take only a few weeks. The index person may be young and healthy, but many of those 14 million people will be old and sick, and they will likely die because they got a virus that started in one person’s throat.

    The United States is not at this point yet, with millions infected, as best we can tell. We don’t really know, because our government has failed us. We are many, many weeks behind other countries in rolling out widespread testing, so we don’t really have a clue how far the thing has spread. We do know that cases are starting to pop up all over the place, with many of the people having no known exposure to travelers from China, so that means this virus has escaped into our communities.

    We do not have approved treatments, yet. We do not have a vaccine. The only tool we really have now is to try to slow down the chain of transmission.
    This can be done. In other words, R0 is not fixed – it can be lowered by control measures. If we can get the number below 1, the epidemic will die out. This is the point of the quarantines and the contact-tracing that you are hearing so much about in the news. But the virus is exploding so fast that we will not have the labor available to trace contacts for much longer, so we have to shift strategies. This has already begun, but we are not doing it fast enough.
    It is now likely that the majority of Americans will get this virus. But slowing it down is still crucial. Why? Because the healthcare system has limited resources. We only have about a million hospital beds in America. We have well under a million ventilators. If millions of Americans get sick enough to need treatment, we will have a calamity on our hands. What will happen is a form of battlefield triage, where the doctors focus on trying to treat the young and allow the older people to die.

    This is not theoretical. It is already happening in Italy, where people over 65 are being left alone on hospital gurneys to suffocate to death from pneumonia. They basically drown in their own sputum. There is simply not enough medical capacity to take care of them. The United States appears to be about two weeks behind Italy on the epidemic growth curve.

    What do we need to do now? We need to cancel all large gatherings – all of them. You have probably seen that the N.B.A. has postponed the rest of its season. Other sporting events, concerts, plays and everything else involving large audiences in a small space – all of it needs to be canceled. Even if these events take place, do not go to them. No lectures, no plays, no movies, no cruises – nothing.

    Stay at home as much as possible.Stay out of restaurants. I would cancel any travel that is not absolutely essential. Work from home if you possibly can. You may have to go buy groceries and medicine, of course, but make the trips quick and purposeful. Wash your hands assiduously after you have been in public places, for a full 20 seconds, soaping up thoroughly and being sure to get between the fingers. Sunlight and alcohol will kill the virus.

    And please stop passing around statements on social media claiming that the situation is not serious or is being exaggerated. This is a national crisis, and conveying misinformation to your friends and family may put their lives in danger.

    1. Thanks for this. We need to limit and maybe stop visitations to nursing homes,adult care facilities and make it mandatory for all workers at these facilities to wear protective gear. All hospitals should report cases of isolating patients who are exhibiting symptoms but they don’t have kits to confirm them.We need to protect the most vulnerable before we push for social distancing amongst the younger and less vulnerable.

      1. Priscilla, thanks for your support and you thoughts. The reason to push for social distancing among the younger and less vulnerable is to slow the spread of disease throughout the overall population. If too many people get this too fast, we will overwhelm the medical system like what happened in Italy, and people will die because we do not have enough breathing machines. Doctors will die because we do not have enough gloves, face masks, and gowns.

        These are real risks in our own country. Doctors are already being instructed to re-use face masks and gowns that are potentially contaminated and are meant to be disposed of, because we do not have adequate supplies. Countries that have instituted extreme social distancing measures for all ages have been able to slow the spread enough that the hospitals are better able to care for the critically ill and less people die than would have otherwise.

        To work, social distancing needs to be done before cases are widespread. If we wait, it will be too late to work. This virus is extremely contagious; people can spread it when having mild symptoms or no symptoms at all (per CDC), and current data shows each person with it will infect 3 other people.

        The more young healthy people who are walking around with the virus, the more risk that they will contact a vulnerable person who could die from this. We have no idea how widespread cases are in central Virginia because there are a minimal amount of tests for the whole state and symptomatic people with concerning travel history or possible exposure are not being tested.

        I suspect there has been community transmission going on for weeks. The reported numbers are not accurate because we do not have tests. So, to help protect all, please, if at all possible, stay home (or go for a walk or a hike) with your family, no matter what your age.

        If everything blows over in the next couple days, great! If this continues to progress, we will at least each done what we could to protect all in our community.

        * Jim’s note: I edited to add line breaks

  4. Jack, the 40-70% infection rate comes from Marc Lipsitch, Epidemiology Professor at Harvard. This means that the estimate is that with time, 40-70% of all people will be infected with this virus. Most of them will have only mild symptoms. Unfortunately, some of those infected (1% CDC estimation, 3.5% WHO estimation) will die. Interview with Marc Lipsitch here:
    https://www.cbsnews.com/news/coronavirus-infection-outbreak-worldwide-virus-expert-warning-today-2020-03-02/
    Other estimates are 66% of all people (Ira Longini, biostatition, and advisor to WHO: https://www.bloomberg.com/news/articles/2020-02-13/coronavirus-could-infect-two-thirds-of-globe-researcher-says)
    and 60-80% of all people (Gabriel Leung, chair of public health medicine at Hong Kong University https://www.theguardian.com/world/2020/feb/11/coronavirus-expert-warns-infection-could-reach-60-of-worlds-population)

Something to say?