The national statistics and CDC summary descriptions make it plain that this virus preys on the elderly and those with underlying medical conditions. Young people are largely unaffected or only mildly so. Symptoms, if any, in the young consist of a mild fever for five days or so, possibly accompanied by a brief cough towards the end of the illness.
In the 20-30 yrs age group which makes up the bulk of any ship’s crew, the death rate is near zero and hospitalization rate is extremely low. In fact, far and away the most likely result of infection in that age group is … nothing. No symptoms. For example, the carrier Roosevelt, which has been hit hard with infections has noted very little impact despite the since-fired Captain’s impassioned plea for help – as if he were facing an Ebola outbreak or the plague.
As reported in a 13-Apr USNI News article, the Navy has tested 92 percent of the sailors assigned to Roosevelt and discovered 585 positive cases of the virus. …
Infections on Roosevelt account for 63 percent of the Navy’s 929 active duty COVID-19 cases. Of the sailors who have tested positive, almost 70 percent have been asymptomatic, a Navy official told USNI News … [emphasis added] (1)
Of those infected and showing symptoms, four have been hospitalized and one has died.
… four Roosevelt sailors were hospitalized over the weekend.
“All are in stable condition, none are in ICU or on ventilators,” a Navy official told USNI News. (1)
The sailor who died was 41 yrs old.(2) His pre-infection medical condition was not revealed but the description of his case strongly suggests an underlying condition.
This entire Coronavirus pandemic has been a media-induced panicked over reaction that was simply not warranted by the facts of the illness. The cure has been far worse than the illness.
This is not to say that the virus is harmless. For the elderly and medically challenged it is quite serious – but so is the common cold and the regular flu. Did you know that around 24,000 people die every year from the regular flu, according to CDC statistics, and yet we don’t shut the country down every year during flu season?
In total, the CDC estimates that up to 42.9 million people got sick during the 2018-2019 flu season, 647,000 people were hospitalized and 61,200 died. That’s fairly on par with a typical season, and well below the CDC’s 2017-2018 estimates of 48.8 million illnesses, 959,000 hospitalizations and 79,400 deaths. (3)
A more reasonable approach to dealing with the virus would have been targeted isolation efforts aimed at the high risk groups while the younger groups continued to work and hold the economy together.
Similarly, the Navy should continue operations as normal with the targeted precautions for the older members.
(1)USNI News website, “Carrier Roosevelt Sailor Dies from COVID-19, 4 Sailors Hospitalized”, Sam LaGrone, 13-Apr-2020,https://news.usni.org/2020/04/13/carrier-roosevelt-sailor-dies-from-covid-19-complications
(2)USNI News website, “Navy Identifies Carrier Roosevelt Sailor Who Died from COVID-19”, Sam LaGrone, 13-Apr-2020,https://news.usni.org/2020/04/16/navy-identifies-carrier-roosevelt-sailor-who-died-from-covid-19
While I agree with most of what you said, Marines dip, Sailors smoke or vape. Smoking and vaping place someone at higher risk. COVID reinforces the need for COs to get the troops to stop smoking or vaping.ReplyDelete
Quite right. While the military may be in better shape than the general population, there are still self-inflicted ways to worsen one's medical condition. Hopefully, this virus will waken people to the dangers of doing anything that adversely affects the lungs (or any other body part!).Delete
"Marines dip, Sailors smoke or vape."Delete
On the other hand, they should also be running and doing fairly high level cardiovascular exercise which strengthens the respiratory system and which, presumably, would reduce the negative effects of the virus if they develop symptoms. So, again, they should have a significantly lower risk of serious illness than the general population.
I dont think that COs are in the business of stopping tobacco or related product use, or should be. Its legal. Not smart or healthy, but, as long as sailors and Marines pass their PRTs, so be it. COs have more important things to work on like training, readiness, maintenance etc......Delete
On the same track are all the chemicals and inhalant risks sailors are exposed to; fuel fumes,cleaners,paint,metal shavings and grinding ops, etc.Delete
The infectious dose (the number of virus particles the patient is exposed to at the time of infection) may play a role in the severity of the disease. This is true for influenza, MERS and SARS, so is also likely with COVID-19.ReplyDelete
Sanitation of the air to reduce viable viral particle counts would seem to be a reasonable intervention.
"Sanitation of the air to reduce viable viral particle counts would seem to be a reasonable intervention."Delete
For high risk groups, perhaps. However, there is a very good argument to be made that avoiding every bacteria or virus in the world ultimately weakens us since we don't build up natural immunities. If we attempt to live our lives in a protective bubble then we're totally unprepared for exposure to the real world when it inevitably happens.
We've decided that some diseases, like polio, are simply too horrific to allow but this virus does not fall into that category.
Exposure of the younger age groups to this virus ensures enhanced immunities down the road. Exposure should be accepted, not feared.
This infection has shown a weakness in the supply of vessels at sea that potential adversaries are sure to note and develop means to exploit the weakness. The NBC systems can filter the replacement air on the ship but once a biologic agent is on the ship it appears there is no effective way to combat it. If China identified a few sailors that were bound for a resupply flight to a carrier and infected them with a virus that was 30 to 50% lethal like SARS or MERS the outcome would be much different than COVID-19. Isolation procedures should be in place to limit the contact new arrivals have with other crew to prevent spread of potential biologic weapons.Delete
"China identified a few sailors"Delete
Bear in mind that biological weapons, which is exactly what you're talking about, are classified as weapons of mass destruction and the US policy is to respond in kind. Since we have no chemical or biological weapons that leaves only nuclear. If the US were attacked in the manner you postulate, the US would, according to policy, respond with a nuclear attack. Would that be worth the risk to the Chinese? I don't know but I suspect not.
That said, your isolation procedure suggestion in a time of war has merit.
While the risk of death from Corona is negligible for younger individuals, it should be noted that very little is known about the virus' long-term effects, which might include neurological damage or sterility.ReplyDelete
There's not a shred of evidence to support that, that I'm aware of. Do you have some evidence?Delete
Right, evidence pending cuts both ways. In the meantime, why isn't this practice for the next time which may be worse. Mental and physical. Protect and defend the constitution involves not shooting anything 99.99% of the time.Delete
Obviously hard evidence is fairly scarce at this point, but there are some worrying signs.Delete
"Obviously hard evidence is fairly scarce at this point, but there are some worrying signs."Delete
I assume you read the papers but did you understand what you were reading? I ask that academically, not mockingly. The papers discuss metabolic changes that may occur during the course of the disease. While I did not read every word of every paper, I saw no indication that the authors were claiming some kind of long term neurological problem or sterility. They were merely pointing out various changes during the course of the disease. ALL viruses cause such changes, to a greater or lesser extent. It's how viruses replicate. They 'hijack' the host's cellular processes. As the disease ends, the host processes eventually return to normal although full recovery may take some time.
Is it possible that you've misinterpreted what you've read?
I would also point out that the predecessor viruses to the current SARS-CoV-2 have shown no such long term effects that I'm aware of. Their similarity to the current virus and lack of long term effects suggests, but does not prove, that there is no reason to believe long, permanent effects will occur.
There is the potential for long term lung damage.Delete
From I've read, the cases that have had brain damage are due to oxygen deprivation.
"There is the potential for long term lung damage."Delete
Anything is possible. The relevant question is what is the likelihood? The common cold has the potential to kill but it's unlikely and we willingly accept the risk, as a society.
Unfortunately, this will be a "hindsight" thing. We won't have a full understanding of the repercussions of the virus until well down the road.Delete
The significance of lung damage, besides the obvious problems associated with that, leaving people vulnerable to reinfection to COVI19 again is a possibility that need studying.
Theres also the theory that certain blood types are more at risk. Theories that need time to tested.
I've already stated what are national response should have been, PPE, testing, transparency.
The comparison to the common cold, in my opinion, is kinda the reason why this problem was ignored until it couldn't be anymore...
In hindsight, crews about to sail, should have been priorty for testing to limit disruption to mission readiness. Thou, I doubt, that would have received little support politically and publically.Delete
"We won't have a full understanding of the repercussions of the virus until well down the road."Delete
We've got a good understanding, now, of the long term effects of closely related viruses (there were none of significance) that preceded this one so there's no reason to suspect that there will be any unusual effects from this virus. To suggest that there is doom coming from long term effects is just engaging in unsupported fear mongering. Sure, there will be a few unfortunate people with some kind of long term effect (as there is with the common cold, the regular flu, and acne) but, statistically, it will be insignificant. Is it theoretically possible that some previously unknown, long term effect will catastrophically reveal itself in future years? Sure, but it's too unlikely to even consider. I'm more worried about being struck my a meteor - another theoretical possibility.
"The comparison to the common cold, in my opinion, is kinda the reason why this problem was ignored until it couldn't be anymore..."
Have you looked at the regular flu hospitalization and death statistics? This virus MIGHT turn out to be slightly more serious but even that has yet to be demonstrated. In fact, if all the cases of people who were infected but not tested (because they had no symptoms, because their symptoms were too mild to care about, because we didn't initially have test kits) are included in the overall statistics, the death and hospitalization rates drop significantly for this virus.
So, if this virus was ignored - and I don't think it was - the statistics suggest that it was for reasonable reason. What has hurt America more than the virus is the over-the-top panicked reaction which has destroyed our economy.
"We've got a good understanding, now, of the long term effects of closely related viruses (there were none of significance) that preceded this one..."Delete
Bone necrosis and pulmonary fibrosis are insignificant?
"To suggest that there is doom coming from long term effects is just engaging in unsupported fear mongering..."
First off, just like you, I hate having things taken out of context. No, this is not the end of the world.
Second, evidence is showing some people, not all, are not gaining a immunity to this virus. I said this cannot be dismissed with out furthur research.
"Have you looked at the regular flu hospitalization and death statistics? This virus MIGHT turn out to be slightly more serious..."
Yes, I have look at the statistics. It isn't the Spanish Flu nor is it the common flu.
"What has hurt America more than the virus is the over-the-top panicked reaction which has destroyed our economy."
Agreed. However, the government could have mitigated that greatly by having a unified position on the virus and been more transparent. They became reactionary in their responses and left control of the narrative to big networks.
I've been researching this high flu death counts everyone's been posting. The "actuals" aren't even getting close to the "estimated" deaths.Delete
For example, California had 295 flu deaths in the 2017-18 flu season, which was a bad year.
Just something interesting I've been seeing, looking it up by state.
Here's an interesting tidbit that I came across from an LA Times story:Delete
"California officials collect flu death data only on people under 65. So many more people 65 and older die of the flu each year that the deaths under 65 reveal more about the severity of the flu season, they say."
CDC reports 61,000 or 79,000 flu deaths for the 2017-18 season. They explain the different numbers with a long, disjointed explanation about estimating techniques.
"CDC reports 61,000 or 79,000 flu deaths for the 2017-18 season. They explain the different numbers with a long, disjointed explanation about estimating techniques."Delete
That's the thing, I been trying to find the "actual" numbers that have been recorded, not the estimated ones.
Admittedly, its kind of difficult, seeing as different figures are reported. For example, Texas is all across the board, "around" 400, 2355 (flu and pneumonia) deaths to 9500 or higher, for the same 2017-18 flu period.
And those numbers aren't synching up with other state's numbers reported death tolls, such as California.
What do you think explains the irregularities? Different criteria or record keeping between states? Or am I not looking in the right place or misinterpreting the info?
"I been trying to find the "actual" numbers"Delete
There's no such thing as actual numbers. Most deaths, unless they occur under medically unusual circumstances, don't have an autopsy performed so the cause of death is just listed as whatever seems most likely - it's an estimated cause of death. Generally, it's probably correct although in the elderly, with many underlying medical conditions, it's often a toss up as to which condition caused the actual death.
I've read reports that for this coronavirus, if someone dies and has ANY of the symptoms of the virus then the death is listed as COVID. The most common symptom is fever but do you understand how many diseases and conditions have fever as a symptom. Without a doubt, that is significantly overestimating the COVID death count. Is it by 5%? 50%? Who knows?
For regular flu, there is even less interest in establishing the exact cause of death. Estimates are all we have.
Trying to compare death counts from different sources is pointless - they'll never agree and add up. The best you can do is pick one source - the CDC would seem to be the most logical - that at least uses consistent methodology. Consistent methodology at least allows you to make broad comparisons. For example, using CDC's flu and COVID numbers one can make the broad statement that this Coronavirus is on the same general order of lethality as the regular flu. Trying to argue whether it's a percent higher or lower is pointless and irrelevant.
As far as COVID death rates, one needs to remember that due to the lack of test kits, we've largely been testing only people who show symptoms. We know there are LOTS of asymptomatic cases out there that haven't been tested and counted so the actual death rate is much lower than the reported rate. I would guess on the order of 10 to 50 times lower.
To summarize, pick a single source and use it for broad comparisons. That's about the best you can do.
One version I heard for the reason TR being pulled and no way to know if really true or not, heard from a retired nuke office is that there was about 10 or so cases from the reactor room. She explained how you can't just keep working with reduced qualified crews, you need the right number and you can't really just pull qualified nuke people from other carriers...probably could in case of war but peacetime, it would have to be approved way from the top. I guess it's not like if a Super Hornet pilot or aircraft mechanic gets sick, you could just replace them but for nuke officers and teams, not that easy.ReplyDelete
I wonder too how much was the worry for the older people onboard, yes, probably crew majority are between 18 and 25 years old but I bet most of the pilots are little bit older than that plus everybody in leadership is probably late 30s to 40s, maybe even a few 50s in there? That's a lot of leadership potentially on the sidelines....
As I of said before, we should look into this virus as an simulated attack on our military and procedures. There's plenty to learn and probably a few changes needed. Sadly, not seeing much done and studied, our enemies sure are, Russia intelligence has looked into what and how Covid has affected our military, chain of command, logistics, time response, etc,etc...Russia might not being doing better than us BUT they are looking at how it is affecting their enemy,US!
" you can't just keep working with reduced qualified crews"Delete
Hey, if you need to pull into dock for a brief period while crew members recover, that's fine. I would remind you that the course of the disease for those affected is just several days. After that time, your sick crew are back to work.
Also, given the observed 70% asymptomatic rate, does it seem reasonable to you that the nuclear operators lost enough crew to warrant sidelining the ship? The actual ship's data suggests that, worst case, 70% of the nuclear operators would be unaffected. So, again, does what you heard sound plausible?
Regarding older crew, until you reach 60+ years old, the likelihood of significant illness and complications/death, while greater than for the yound, is still fairly low. The most likely result would be a case of the 'flu' or 'bad cold'.
Just spit balling here, but we are constantly hearing the skilled workers in the shipbuilding industry are aging out and there is going to be an influx of newbies while we are trying to ramp up. Now we are pushing ahead with the builds putting these old guys at increased risk, and I'm sure they float around active Navy plenty. We don't need to be losing them now. Their wisdom is worth more down the road. Besides, we need to change the plan anyway, why keep rushing down the wrong road.ReplyDelete
My family were allies of Governor Bligh. But he was Captain Bligh before that. I fear ComNavOps will suffer the same fate. https://en.wikipedia.org/wiki/Mutiny_on_the_BountyReplyDelete
One good thing about Corona virus is that airlines won't be poaching pilots anymore. Air forces will get to keep their aircrew.ReplyDelete
I will defer to the experienced doctors at the CDC.
Is there something you feel is not backed up by data? If so, present some data supporting whatever it is that you believe. Otherwise, accept the presented data which comes from "the experienced doctors at the CDC" - exactly what you seem to be calling for!
The question I have is not should we have done this time, but what should we be doing when we have a disease with both a high mortality rate and highly infectious. What preparation should we be making now for that eventuality?ReplyDelete
We have two hospital ships, but they are optimized for trauma and not for contagious diseases. The open treatment areas are an invitation to see diseases move patient to patient. Should we try for hospital ships optimized for infectious diseases, or go strictly shore based?
REGARDING POSSIBLE WORSE FUTURE PANDEMICSDelete
Hi. I am a civilian physician, but attempted some general comments on that subject following the Lepanto blog post.
As others have eluded to, there is a long history of viruses that are both highly contagious and highly fatal (eg Ebola), being relatively less transmittable (ie how many infections each case actually causes) in real-life. The best explanation for this is that symptoms come on early, causing the sick and well to isolate themselves from each other, resulting in less time to spread infection.
As an aside, not accounting for obvious human responses to infection is a common flaw in how various models used to predict outcome are reported, as reporting tends to focus on the hypothetical situation where no-one changes their behaviour, rather than the more-likely situation where individuals reduce their contact with each other regardless of whatever government policy is put in place. This is one reason why you should take media headlines of predicted numbers of deaths with a grain of salt.
The risk of the particular kind of threat you mention becoming a worldwide pandemic is thus low. However, as you imply, when we plan we need to balance probability vs severity.
Any facility, whether land-based or waterborne, can be optimised for isolation, at the expense of other capabilities, or increased cost.
We can use a shipbuilding analogy here, perhaps. Systems are expensive (ie ducts, medical-grade filters and the more-powerful pumps needed for them and the negative pressures we wish to generate). Steel may not be cheap, but it is cheaper. Air inside our “box” isn’t free (each cubic metre needs expensive ventilation and other systems to service it), but air outside our box is almost free (for our analogy the cost of outside air is that needed to service/acquire the land/area our facility is spread out over).
Compared to being stuck in a cramped cruise ship, the outside air is a very powerful diffusion-based filtration system. Individual tents/mobile shelters separated by space are thus vastly cheaper than building a ship or ships that have the same isolation capability.
There are many nitty-gritty choices and options we could discuss here. For example, old-style external walkways open to the outside air might be more efficient than we think in a hospital ship, compared to internal spaces that require internal ventilation. It would be interesting to see information on cruise ship infection rates in those with outside balconies vs those with internal cabins, although it seems the ships’ crew were probably the main mechanism of transmission. Naval traditionalists everywhere may be pleased.
However, a ship can potentially go anywhere there is navigable water and be within helicopter range of almost everywhere we would want our personnel to be. Land-based facilities require national territory or a friendly host nation, which may or may not be close to where our personnel are at the start of the crisis. There are vast reserves of tentage/temporary structures than could be drawn upon if logistics allow. There may be suitable pre-existing civilian logistics (port, roads, trucks, water, power, sanitation) for our location, or there may not. There may be suitable pre-existing structures we can use (convention centres are proving ideal because they are non-essential large spaces with large-scale utility hookups), or there may not.
My answer is that ideally we would have both hospital ships and land-based facilities able to provide useful functions. Both for this low chance/high consequence contingency, and other contingencies as well.
Regardless of whether our novel coronavirus fades into history, or becomes a seasonal threat, our future planners will place greater weight on isolation capacity, and the trade-offs that are inherent in all ship designs will possibly include more isolation capacity. The nature of the acceptable compromise will shift. Hospital ships will hopefully be more numerous, and also balance the same competing needs. And on land, the readiness of field hospitals, medical personnel and the logistics needed to shift/support them is likely to be increased.
" Hospital ships will hopefully be more numerous"Delete
Brendan, you provided some excellent discussion previously and continue to do so now so, thank you!
I'd like to direct your attention to an aspect that we haven't yet discussed and that is cure/immunization.
We've talked about isolation and its derivative which is prevention of spread and how those efforts would impact ship/land facility designs but we haven't talked about what we should do in the future in the area of cure/immunization.
For example, this current virus has predecessors in the various SARS viruses we've seen before so it shouldn't have been a complete surprise that this virus arose. I get the impression that we did not devote much effort to understanding and developing cures or vaccines for those types of virus once their impact receded. Perhaps I'm wrong?
I also understand that each virus is unique and there is no universal vaccine. However, a better understanding of the requirements to make a cure/vaccine for one virus ought to enable a better/faster response to a similar virus down the road.
Regardless, I wonder if it would be possible to better prepare to do the whole cure/immunization process. We're working on a vaccine for this virus, now, but we could have started backed when the first cases emerged in China. Even now, do we have the facilities and procedures to produce a vaccine in the fastest possible time and in sufficient quantities in a short period of time? Part of the process, for an emergency response, might include waiving or streamlining some of the regulatory, testing, and approval process. Of course, we don't want to go the other extreme and just start flinging totally unproven drugs and vaccines around and using patients as guinea pigs but I wonder if we couldn't make changes to the process that would greatly speed up vaccine development? Part of that speeding up would likely involve greater research into what's come before.
Any thoughts on ways to better respond, in terms of cures/vaccines, to future problems?
A very good question. A clear answer requires brevity, and an answer from a very focused point of view. Here is my answer to that question. It does ignore some aspects for clarity, and if you ask someone else, you'll get something a bit different.
REGARDING ANTIVIRAL MEDICATION - COVID19
Historically, a relatively small amount of effort has been spent on antiviral medication. From the perspective of a large pharmaceutical company, there has been in the past a relatively unprofitable market for this. However, with sufficient effort and time we have always been able to create effective antiviral agents where the will exists.
The best recent example is HIV, the first specific antiviral agent was commercially released 4 years after HIV was isolated, the first satisfactorily effective treatment was released 14 years after it's isolation. With greater effort and modern technology we can expect much shorter time-frames, however we are possibly talking years to get a new tablet in your hand, even with loosened regulations.
Having an existing treatment is always preferable. The best recent example is Tamiflu for certain types of influenza, which existed, was proven (some controversy here), was certified, and had existing manufacturing capacity during the H5N1 (bird flu) epidemic of 2005. Unfortunately, we don't have a similar agent for coronaviruses. As you state, after the coronavirus epidemics of SARS and MERS in 2003 and 2012, increased effort was put into coronavirus treatment, but this was not sustained (no potential profit plus no government action).
As an aside, I would not call Tamiflu (or other anti-influenza agents) highly effective. Effective efforts at developing a highly effective anti-influenza agent did not continue. It is a question of will, time and effort (aka money).
Certain existing agents, such as HIV agents and hydroxychloroquine are being studied at present, and it would be great if they worked (well enough for our purposes), but this cannot be assumed. Historically, hydroxychloroquine/chloroquine has shown activity against a variety of viruses, but the required dose has tended to be rather high relative to it's side effect burden, and not good enough for our purposes.
Convalescent plasma (basically a blood transfusion from a donor with antibodies against the infection in question) is probably at least partially effective against any virus infection. It is a very finite resource but is available currently.
As an aside, media reports that a certain agent kills viruses in the lab should always be treated with caution. Almost anything kills viruses in the lab. Getting something to kill viruses inside the human body without unacceptable side effects is always the tricky bit.
There are trade-offs between medication safety and cost/speed. This compromise is not fixed, and in the current crisis we are already seeing greatly abbreviated testing regimes. Also, to use a military analogy, in the future a wise government could use the precious time given by "peacetime" (ie the time between epidemics) to invest funds in preliminary research to identify agents for possible future use, even if this work is not carried through to full non-epidemic certification (where much of the current cost of drug development lies).
Any estimate I give for when we might see the first available antiviral agent will eventually be shown to be incorrect. No-one likes to get things wrong. However, for the sake of discussion I will give some educated guesses. It is possible that a combination of existing agents may be shown to be partially effective within six months, and with sustained effort we should have a novel agent in your hands ready to swallow within 2 years. Getting something highly effective may take 5 years, with massive sustained effort (of the sort we did not see with influenza). Convalescent plasma supply will continue to increase, but will lag behind the demand until after the peak of the infection, and our understanding of it's use and limitations will increase.
REGARDING VACCINATION - COVID19
Creating a vaccine is a known science. There are many that exist right now (in trials). Testing and production is always the limiting step. Proving it works to our satisfaction (even with abbreviated studies) will take time. Scaling up production takes time also.
With sustained maximal effort, we should have a vaccine available to give every US resident within one year. If you are a healthcare worker (or US Navy reactor technician) then perhaps 6 months.
The western governments are spending a lot on COVID-19 treatments right now, so our current effort, although not maximal, is close enough for our purposes. Nationalising industry and further increases in budget would probably make the current effort faster, at the risk of sacrificing future efficiency and being critically dependent on choosing people who can get things done. Personally, I am not sure if that is worth the trade-off at present.
The question is how long the protection from a vaccine may last. The past history of immune respone to other coronaviruses suggests that immunity will not be lifelong. This implies that development and production of a vaccine will only continue if this is shown to be an ongoing or recurrent threat, which seems more likely than not at present. It is more likely to be something given yearly or two-yearly, similar to a flu jab, as opposed to a vaccination you get just once with perhaps a booster decades later.
A worse case scenario is that pathogenic coronaviruses develop new/multiple dangerous strains greater than our ability to package immunity in a single vaccination. This is the case with the common cold, where 140 strains of rhinovirus exist (greater than our ability to cram protection against perhaps 24 in a vaccination). However, this is unlikely. Again, for the sake of readers who have knowledge in this field, I stress that this is a grotesque simplification for clarity and brevity.
REGARDING BETTER RESPONSE TO FUTURE THREATS
You specifically ask about increasing future preparedness. This is a very good question.
The best clear explanation I can give is to use a relatively well-known US mask production analogy. One domestic supplier (Prestige Ameritech) increased it's ability to produce masks during a previous epidemic crisis, but then had to cut back production and lay-off staff after the crisis passed and customers switched to the lowest price product, which was made in China. This made domestic supply more vulnerable to our current pandemic, when the supply is most needed. It also made private industry more reluctant to increase supply on their own initiative.
For discussion, we can propose a model where we consider private companies as efficient for routine situations, but that government agencies (such as the military) should exist for unpredictable severe contingencies.
As above, government can subsidise the development of antiviral agents for specific viruses in advance, such as influenza.
Also, government can subsidise the production facilities for vaccinations and medications. As we have seen, seeking peacetime efficiency through seeking cheaper off-shore labour has created vulnerability when we might most need those products. Just as countries above a certain size prioritise the ability to build their own warships, they should do the same for vaccines and pharmaceuticals.
We can also develop, and events are already forcing us to develop, a more nuanced response to balancing risk vs benefit, as you and others have alluded to in discussing how COVID-19 has affected current naval deployment. The "zero risk" culture we have makes us ill-suited to addressing the current crisis, which is beyond our ability to handle in a zero-risk fashion. Countries world-wide are having to face the question of how much we are willing to sacrifice to save multiple lives, and these questions will become more stark in the months ahead.
Again, a good discussion of treatment and vaccination issues!Delete
Cost, I would note, should be a non-issue. Whatever the cost burden might be of stockpiling supplies, or conducting subsidized research, or building production facilities that would stand idle for much of the time, the costs pale to insignificance compared to the cost of shutting down the economy as we've done now. Therefore, we should be able to justify any required degree of spending if it would enhance our ability to respond to a future epidemic.
You also make the very good observation about our zero-risk mentality as it relates to the virus.
As SARS and MERS were bought under control funding dried up. And went to whatever the current problem was. A lot of SARS-COV2 research is picking up suspended SARS/MERS research from where it was abandoned.Delete
The 4 cold causing corona viruses (most are rhino viruses) do not give life long protection. There is no reason to expect a vaccine.
Until recently I was infected with a virus for 40 years. A cure was eventually invented with horrible side effects. 10 years later a different cure with no side effects was invented. So there is hope. The first cure uses interferon, and interferon as a nasal spray prevents colds (with horrible side effects).
One concern is, if current events don't change behaviour, is the flu will be stopped in its tracks this year. If people don't continue to vaccinate against flu next year we'll start losing herd immunity and will have a bad flu season in the future.
", I would note, should be a non-issue. Whatever the cost burden might be of stockpiling supplies, or conducting subsidized research, or building production facilities that would stand idle for much of the time, the costs pale to insignificance compared to the cost of shutting down the economy as we've done now. Therefore, we should be able to justify any required degree of spending if it would enhance our ability to respond to a future epidemic."Delete
This is definitely somethng that the government will have to play a role in, and maintain even when things seem a-ok. I'm reminded of Governor Schwarzenegger's foresight in establishing a disaster relief fund in the California state budget, where money was set aside to maintain a stockpile of crisis relief supplies... that was immediately slashed by his sucessor looking to improve the budget.
Responsible, farsighted government must take charge - you can't just leave it to industry and shareholders, with their short-sighted focus on profits and share payouts. Why are so many american jobs gone to China? Because American shareholders want to maximise their profits and don't want to pay American workers reasonable wages. Why is agriculture so reliant on migrant labor? Because outside mom-and-pop farms, farmers don't want to pay American workers a decent wage.
The use of rna vaccines would allow for rapid response to future problems. Rna vaccines encode the antigen needed to induce immunity in rna, which is injected into the host, the host's cells make the antigen using the rna from the vaccine, and the immune system develops immunity against the antigen. A small rna synthesis machine and a way to get the rna into the cell is all that is need once you know the sequence of nucleotides for the antigen. The equipment needed isn't that complex.ReplyDelete
REGARDING COVID-19 IN NAVAL CREWSReplyDelete
For the sake of discussion, I would like to restate (from the other blog post) my thoughts on this, which have developed over time. I find this discussion useful.
The estimated and actual mortality (thus far) of COVID-19 in naval crews is low. It may well end up causing fewer deaths than accidents.
However, I would like to stress that while we may not be preventing mass death by pausing operations and isolating crews, we are preventing suffering. This is a goal worth recognising, and balancing against operational requirements.
At the time key decisions with the TR were made, it was evident that at least a sizeable minority of young people with active coronavirus infection have no symptoms. It is even more clear now.
However, a significant number of young people will suffer symptoms and survive. A key point is that many of them feel sicker than they have ever felt in their lives, and this continues for much longer than we are used to, with two weeks or more of fever, and a feeling of not getting enough air that worsens over many days. In addition, the pattern of illness may see improvement, before rapid and unpredictable onset of breathing difficulty in some patients.
While our people in uniform are willing to risk violent death on our behalf, I suspect that this new and unpredictable danger, where they see their buddies falling ill around them and worry about if and when they will catch it, is a very different morale issue than seasonal influenza.
The internal US Navy information available at the time key decisions were made with the TF, that CDR Salamander has kindly provided, focuses a lot on numbers and curves. I see little about morale and the burden of symptoms in them. I note that the TR set sail with a preventative medicine unit on-board, in addition to it's own physicians and other medical personnel. I can only speculate about the decision-making processes in play. I suspect there was a stark disconnect between the at-sea experience and the comprehension of the shore-based leadership. Perhaps Captain Crozier would have been more accurate to argue that "sailors do not need to suffer, as much".
While many of us may well catch COVID-19 and recover before effective vaccination and/or treatment is available, this new disease, which is novel, more serious than we are used to facing, and about which much remains uncertain, has required our leaders to act. All governments have (eventually) been forced to change the way society operates, to a greater or lesser degree. And thus far, both the US and French navies have been forced to pause operations when an outbreak occurs, albeit mainly for political reasons rather than actual danger to life. I believe that it is correct to argue that ships did not need to return to port, but eventually the choice was made to do so.
While it is less dangerous to young healthy military personnel, we face a binary choice rather than the range of isolation/distancing options governments can pursue on land. Either we send ships to sea or we don't.
Individual isolation of crews for 14 days prior to routine deployment or redeployment is an obvious option. I note that at least one UK SSN crew isolated as a group before sailing. And I assume this is probably already in place for SSBN crews, being a high-priority routine task. Deployable isolation, either in a shipboard hospital or land-based facility, of the kind we have already discussed, may give in-theatre options for preventative isolation, in addition to treatment isolation.
"balancing against operational requirements."Delete
An excellent reminder. During peacetime we have no operational goals that are of any consequence. Therefore, putting into port to alleviate suffering or simply as a matter of convenience is not a drawback. Problems arise only when we engage in panic and mass hysteria fueled by a lack of knowledge and data. The carrier's Captain should have been educated on the very mild effects to be expected. If he wasn't, that's the Navy's fault. If he was and panicked anyway, that's his fault. I don't know which it was.
However, at some point our militaries and society are going to have to chose how they conduct ongoing operations and maintain military readiness in the face of an increased threat of infectious disease.
This is not a decision we are used to making. But we will have to, or an aggressor will eventually make it for us.
ON MORALE AND LEADERSHIPReplyDelete
I am constantly amazed at how much our people in uniform are willing to give us, and how little they ask in return. And yet that little is so often neglected or refused.
For myself, I concluded in January that staff morale was going to be the make-or-break factor at maintaining our clinic's ability to help others during the coming months, and on an ongoing basis.
Aside from leading from the front, proper respiratory protection was going to be key, but that it's main benefit would be staff morale, over and above it's benefit in preserving staff health. The "zero-risk" single-use disposable mask everyone in authority kept recommending until it was too late to change preparations, was obviously not going to be sustainable. And so we have reusable elastomeric half-face masks with encapsulated particle filters available for staff. I judge them not as good for a single patient as a disposable properly-fitted face mask, but a lot better in a situation where we have to reuse equipment. We looked beyond the "zero-risk" mentality early enough to make a difference.
Likewise, we need to show our people that we are making an effort. They will risk suffering for our purposes, if we give them that what they need.
First, we can use the time-tested method of firing a few admirals. This has historically been an effective way of demonstrating to our people that we mean business now, and things are changing.
Likewise, we need to make them feel that their safety is valued. Military-issue facemasks, and reusable and easy to remove overgarments for those not hanging around machinery in confined spaces is one way of doing this, even if it looks marginal for cost-effectiveness on paper. And we could re-examine our routine deployments. Our people will risk their health willingly if they feel the mission is worth it.
I've had the "pleasure" of being involved in a few emergency response efforts, and it has become abundantly clear to me that we don't really have a dedicated emergency response capability. For that reason, whenever there is an emergency situation, we get off to a slow start until we put together ad hoc response teams. Katrina in New Orleans, Maria in Puerto Rico, the BP oil spill, and now this, are all examples where it took us a while to get boots on the ground actually doing things.ReplyDelete
FEMA is not an emergency response agency. It's an emergency management agency, meaning that local and state governments respond and FEMA writes checks to reimburse them. Obviously from this crisis, CDC, FDA, and NIH are not emergency response agencies either. They are primarily health research and policy arms, not execution agencies. Nor, for that matter, was the so-called pandemic response team. If you read their roadmap or gameplay, it's about coordinating federal agencies at the top, not about actually doing response stuff in the field. To respond to an emergency of scale in a country of 330 million people requires tens of thousands, if not hundreds of thousands, of people. And they have to be skilled in handling emergencies, which is a unique management and execution challenge that requires training.
Eventually, we seem to figure it out. But it would be far better if we could hit the ground running. Here it would have been better if we could have done more testing sooner. But by whom? And where? And with what tests? Those things simply weren't in place and it took days and weeks to get them in place.
I see only one group with the headcount, potential budget, and training opportunity to fill the need. That is the National Guard. I would repurpose them from a sort of reserve Army Reserve to focus on civil defense and emergency response as primary missions. Replace their tanks and artillery with bulldozers and backhoes. Transfer those who really want to be soldier boys (and girls) to the Army (or Air Force) Reserve. Train them on responding to emergencies that are apt to occur in their areas--hurricanes in the Southeast, earthquakes in California, tornadoes in the Midwest. And all those have a significant medical component.
How would that work here? Mobilize the Guard. They would already be trained in pandemic response, so they would have an execution game plan that they have trained on and know how to execute. Have them set up mobile testing tents in Walmart, Target, and shopping center parking lots across the country. With a pandemic response mindset, they could have brought pressure to bear on CDC and FDA to get a test (WHO or our own) approved and to get enough state, local, and private labs set up to prepare and evaluate tests. Separate testing facilities would have kept COVID-19 cases from having to go to hospitals, doctors' offices, or ERs to get tested, which would have avoided spreading it in those locations. Once the testing is set up, identify hot spots and set up mobile hospitals to take care of overflow in those areas. Implement lessons learned during training. Realistic training would identify equipment shortfalls in the way that paper exercises cannot. If people had to simulate masks and gowns for training, they would figure out pretty quickly that we didn't have enough masks and gowns, and those could have been replenished.
As for the oil spill, that is a unique case and not exactly in the Guard's wheelhouse. But there is a preparedness solution. The German navy has developed the Bottsand class of oil spill clean up ships, which can get about 90% of the oil from a spill. Here in the USA, Herman Schellstede has proposed SeaClean, a large barge that can process 38,000 gallons per minute. Build some of both of those, have them positioned where offshore drilling and oil shipping operations occur, and have a Sea Guard component trained and ready to operate them in an emergency.
That's some pretty impressive and creative thinking! Well worth consideration. Hopefully, someone in authority will read this.Delete
"and set up mobile hospitals to take care of overflow"Delete
This is a useful and thought-provoking post.
I agree with your comments on getting out of existing facilities during pandemics.
A hospital or healthcare facility is just a weatherproof shell to protect the people and equipment performing the processes we want. They have been slowly developed and modified over decades for routine situations. However, we are reluctant to step away from them in emergencies, including the fear of creating the impression of losing control.
Sadly, our existing facilities are not optimised for isolation. Whether individual isolation, or isolating streams of patients from each other. For example, separating those at higher risk of having pandemic infection (coughs), from those at lower risk of having pandemic infection (not coughing), and those at higher risk of dying if they get pandemic infection (frail, elderly, cancer patients).
In fact, they are often optimised against isolation.
I work in a country where hospital care is free at point-of-care. In the US system the incentives are different, but I believe the following is is a useful general point. Our healthcare system has "learnt" that one way to reduce demand and the all-important "time waiting in ER" is to reduce (or constrain) the physical size of the ER facility and it's waiting room. To be more precise, the thought processes involved are not so malign, but although giving staff more space increases throughput and productivity (and thus making populations healthier, or at least more treated), it does nothing to reduce waiting times and may increase them. Therefore physical space is not prioritised when decisions are made.
This is not just apparent congestion caused by trolleys in the corridors, or solely a desire to cram in as much capacity as possible in a fixed space. The physical size of the corridors and treatment spaces is usually less (in my local experience) than other parts of the hospital.
In many ways our existing healthcare facilities are the worst places to handle initial triage/treatment during a pandemic. Physical separation of higher risk patients into more spread out field facilities needs to be done earlier next time. And therefore setting these up needs to be practiced to avoid delays in actual pandemics.
I was fortunate in that we had a suitably large carpark and management committed enough to shift operations outside when we needed to. However, in many places this occurred late, and cramped physician waiting rooms was probably a contributing factor to early spread in Italy.
"Two Defense Department civilians and one dependent were reported deceased of COVID-19 complications on Tuesday, bringing DoD’s overall deaths to 25 and its mortality rate to more than 4 percent, according to the latest data." https://www.militarytimes.com/news/your-military/2020/04/22/dods-coronavirus-death-toll-rises-to-25/ReplyDelete
so? so the Pentagon will lose a brigade KI"A" if there's one-hundred thousand Pentagon's sick
I appreciate and enjoy your blog, but regarding your opinion on our country's reaction to the covid19 virus I prefer to go with the CDC's conclusions and recommendations vs your idea that the reaction has been overdriven by the media. Good luck to you, and good health.ReplyDelete
Glad you enjoy the blog. Thanks for that! There's no requirement to agree with everything I say although hopefully you find it informative and thought-provoking even when you disagree. If I can get people to at least think about the issues then I'm reasonably satisfied.Delete
More generally, any topics you'd like to see covered that haven't been?
in the meantime https://www.navytimes.com/news/your-navy/2020/04/24/destroyer-underway-in-pacific-fighting-covid-19-outbreak/ReplyDelete