Coronavirus Update

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March 29, 2020

  1. Update 3/29/20 9AM


  1. Covid-19 is not just a respiratory infection. It is a systemic infectious disease that infects blood, heart, liver, kidney and intestinal tract. People die mainly from respiratory failure, but many deaths are caused from heart involvement. Abdominal symptoms are frequent.
  2. Cases in US increased by over 19,000 cases yesterday for a total of more than 123,000. This number is still not the real number of people infected in US. That number is likely many times higher. The number of deaths from Covid-19 jumped by more than 500 a day for a total of 2,200 and is a grim indicator of what to come. 
  3. US is now the epicenter of the Covid-19 epidemic. It is a tragedy that we bungled the early response by doing nothing in February and have a leadership that does not appear capable of understanding basic infectious disease epidemiology; this has resulted in an incoherent response to the pandemic. The lack of medical supplies in particular is a national shame.
  4. New Mexico has instituted a robust response from early on in the epidemic.
  5. Arizona was slow to respond and continue to be erratic in its measures to control the outbreak. Still no lockdown.
  6. The new cases in AZ are stressing the capacity of some of the hospitals.
  7. Testing is getting better but is still spotty in AZ.
  8. AZ has reported more than 770 cases with 3 cases in Cochise County. The latest case is a man with domestic travel history. All 3 cases are in home isolation.
  9. Cochise County has an excellent website for information about Covid-19

https://covid-cochisehealth.hub.arcgis.com/

  1. All counties in AZ except Greenlee have now reported cases.
  2. So far there has not been a case in Hidalgo County. 202 cases in NM
  3. Rural communities, especially tourist destinations, could be hit hard by Covid-1919.
  4. https://www.vox.com/2020/3/28/21197421/usa-coronavirus-covid-19-rural-america
  5. Here is information about how, where and criteria for getting tested for COVID-19:
  6. In Arizona: 1-844-542-8201 The Arizona Poison Control System at the University of AZ in Tucson is available for the general public for information relating to testing, isolation, and quarantine guidance.
  7. In New Mexico: 1-855-600-3453 Coronavirus hotline. In addition the NM Department of Health website https://cv.nmhealth.org/ provides a link to sites in NM where testing is done https://cv.nmhealth.org/public-health-screening-and-testing/ 
  8. In Hidalgo County the Animas Clinic has test kits in limited supply. An algorithm is used to determine if a patient qualifies for testing. Turn around time currently is 5 days.
  9. Seniors in AZ and NM that have problems getting groceries there are ways to get help:
  10. AZ Helpline information for seniors is posted above.

For Cochise County 520-432-2528

  1. NM phone line for seniors:
  2. 21.In NM 1-800-432-2080
  3. The state is offering help to New Mexico seniors. The Aging and Long Term Services Department says if you’re a senior or a disabled adult who cannot access groceries to call the number 1-800-432-2080 due to the coronavirus.
  4. Leave a message with your name, telephone number, and the city/town you reside in. Aging and Long-Term Services will be in contact with you within 2 hours of your call if not sooner. This comes as many New Mexicans have been raiding stores for toilet paper, hand sanitizer and more.
  5. NM has ordered lockdown as of 3/24. PUBLIC HEALTH ORDER NEW MEXICO DEPARTMENT OF HEALTH CABINET SECRETARY KATHYLEEN M. KUNKEL MARCH 23, 2020 Public Health Emergency Order Closing All Businesses and Non-Profit Entities Except for Those Deemed Essential and Providing Additional Restrictions on Mass Gatherings Due to COVID-19

Grocery stores are exempt.

  1. AZ has so far not issued a total lockdown
  2. Updated Recommendations for AZ - 3/20/2020

Effective close of business Friday, March 20, all restaurants in Arizona counties with confirmed COVID-19 cases are required to provide dine-out options only.

Effective close of business Friday, March 20, all bars, movie theaters, and gyms in counties with confirmed COVID-19 cases are required to close.

Halt all elective surgeries in the state of Arizona.

If someone in your family has tested positive for COVID-19, keep the entire household at home and contact your medical provider.

Expiration dates on Arizona driver licenses are delayed.

State-wide closures of Arizona schools through Friday, April 10, 2020.

When school resumes, school administrators should develop and implement precautions to ensure schools are a safe learning environment, including social distancing measures, regular intervals for administrators to wash and sanitize their hands, and guidance on how to properly and frequently sanitize equipment and common surfaces.

Recommendations to cancel or postpone mass gatherings of 10 or more people.

Recommend telework and other alternatives when available.


  1. By instituting strict protocols designed to mitigate spread of virus we can make it more likely that the hospitals we rely on in Tucson and other places in Arizona can deal with the influx of patients. A model for how that might be done is what San Francisco is doing. NY hospitals are now overwhelmed.
  2. 28.Decrease the risk of transmitting or getting COVID-19 by showing common sense and follow protocol especially when going to the Post Offices in Portal and Rodeo.cl
  3. 29.Social Distancing is really:  Physical distancing but Social engaging. Keep your distance from each other at 6 feet but connect with each other by other means like phone, skype, facetime
  4. 30.Jackie Lewis from Portal Rescue has started a drive for making homemade masks

If you would like to make masks to share with our clinics or if you have tight woven cotton fabric that you would like to donate, please let Jackie Lewis know.  winjac12@vtc.net or 558-2287  

https://drive.google.com/file/d/1l1qVBHsmwGja_7CsOtppN2ahYXQlGMy9/view

  1. Local businesses like Sky Island Grill and Grocery and Portal Café need your support. Please use them as they are vital to our community. Consider buying gift cards for future use. Be considerate and socially responsible to others by only buying what you need.


https://www.usnews.com/news/world/articles/2020-03-17/factbox-the-projection-that-changed-britains-coronavirus-policy


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ARIZONA


The Arizona Poison & Drug Information Center Is Available To Take Calls From Arizona Providers & The General Public: 1-844-542-8201


March 29, 2020

Three Cases In Cochise County


NEW MEXICO

Coronavirus Hot Line: 1-855-600-3453 


March 29, 2020

The state is offering help to New Mexico seniors. The Aging and Long Term Services Department says if you’re a senior or a disabled adult who cannot access groceries to call the number 1-800-432-2080 due to the coronavirus.

Leave a message with your name, telephone number, and the city/town you reside in. Aging and Long Term Services will be in contact with you within 2 hours of your call if not sooner. 

March 28, 2020

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                        How To Wash Your Hands

It's generally best to wash your hands with soap and water. Over-the-counter antibacterial soaps are no more effective at killing germs than is regular soap.

Follow these steps:

  • Wet your hands with clean, running water — either warm or cold.
  • Apply soap and lather well.
  • Rub your hands vigorously for at least 20 seconds. Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
  • Rinse well.
  • Dry your hands with a clean towel or air-dry them.

                           How To Use An Alcohol-Based Hand Sanitizer

Alcohol-based hand sanitizers, which don't require water, are an acceptable alternative when soap and water aren't available. If you use a hand sanitizer, make sure the product contains at least 60% alcohol. Follow these steps:

  • Apply the gel product to the palm of one hand. Check the label to find out the appropriate amount.
  • Rub your hands together.
  • Rub the gel over all the surfaces of your hands and fingers until your hands are dry.

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The following information regarding Coronavirus (COVID-19) is being supplied by Dr. Eskild Petersen. It will be updated as new information is published.


Coronavirus Update Portal March 14, 2020

Definitions:

Disease: COVID-19

Virus: SARS-CoV-2


Origin:  Close to Wuhan where it spread from bats to human directly or via a wild animal.  

It has been isolated from bats in caves and there is serological evidence for that people living near the caves have been infected at some time.

When: Outbreak noted in late December 2019 but more likely started in September 2019.


US infections:

At this point US is past containment stage to care. Our containment efforts like travel restrictions won’t reduce the number who get infected in the US but may slow the spread.

How many in the US already have the virus?  No one knows.

The number of known cases in US is artificially low as we have only tested few.

We are way behind other countries in testing for COVID-19. About 10,000 people in US has been tested so far. In contrast South Korea 10,000 are tested daily

We in the US are currently where Italy was one to two weeks ago.  There is nothing to indicate we will be substantially different.

40-70% of the US population might be infected over the next 12-18 months.  After that level you can start to get some protective immunity in the community (herd immunity).  Unlike flu this virus is entirely novel to humans, so there is no latent immunity in the global population.

Seasonal flu’s average kills 50,000 Americans per year.  Assume 50% of US population gets COVID-19, that’s 160 million people infected.  With 1% mortality rate that's 1.6 million Americans who will die over the next 12-18 months. Hopefully this number will be much less. 

The fatality rate is in the range of 10 times that of flu assuming no drug is found effective.

From over 72,000 cases in China we know the death rate varies hugely by age.  Over age 80 the mortality rate could be 15%.  (see attached graph and table)

We don’t know whether COVID-19 is seasonal but if it is and subsides over the summer, it is likely to roar back in the fall as the 1918 flu did.

We can only tell you two things definitively: It’s going to get worse before it gets better.  And we'll be dealing with this for the next year at least.  Our lives are going to look different for the coming year.


What should we do now?  

One can be infectious before being symptomatic.  We don’t know how infectious before symptomatic but know that highest level of virus prevalence coincides with symptoms.  We currently think folks are infectious 2 days before through 14 days after onset of symptoms.

All ages have more or less the same infection rate, but children and young adults are less likely to have symptoms or be seriously sick, but they still can transmit.

How long does the virus last on surfaces? Hours to days depending on surface type  

The virus is very susceptible to common anti-bacterial cleaning agents:  bleach, hydrogen peroxide, alcohol-based hand sanitizers

Do the basic hygiene, hand washing and avoiding touching face.

Stockpile your critical prescription medications.  Many pharma supply chains run through China.  Pharma companies usually hold 2-3 months of raw materials.

Pneumonia and flu shots might be helpful.  Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.

Anyone over 60 should try to minimize interactions in large groups. Minimize air travel and no cruises for the next 2 months then reevaluate.

Three routes of infection

1) Droplet transmission. 2) Hand to mouth/face. 3) Fecal oral route possibly.

What about testing to know if someone has COVID-19?  

There is not enough testing capacity to be broadly useful. Why?

Currently, the only way to determine that a person has COVID-19 is a PCR test.  No other test can yet distinguish COVID-19 from flu or from the other dozen respiratory bugs that are circulating.

The PCR test requires kits with reagents and requires clinical labs to process the kits. 

While the kits are becoming available, the lab capacity is not growing.  

The leading clinical lab firms, Quest and LabCorp have capacity to process 1000 kits per day.  For the nation.

How well is society preparing for the impact?

Not well. Public Health systems have been severely weakened for some years.

 Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand.  Wuhan built 2 additional hospitals in 2 weeks.  Even so, most patients were sent to gymnasiums to sleep on cots

Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis.  They do not have the capacity to sustain for outbreaks that last for months

Where do you find reliable news?


The Worldometers site offers constantly updated epidemiological data:

https://www.worldometers.info/coronavirus/coronavirus-cases/

The New York Times and BBC are good on scientific accuracy.

New viruses emerge every few years:  SARS, Ebola, COVID-19.  

There will be other new epidemics. We don’t know when and which agent it will be.

The worst impact of pandemics like COVID-19 will be in the countries with the least resources, Africa.


© Howard Topoff 2011