Lisa Reynolds, MD
Coronavirus Update 4/7; Stay home, Testing, testing, testing, recovery
Tue 4/7/2020 noon
Oregon appears to be flattening the curve: Stay Home, Wash hands, Save Lives
More on: Oregon HB1 The Oregon COVID-19 Pandemic Recovery Act
Reminder: Virtual Town Hall Tue TONIGHT (4/7/2020, 7 pm, fb live or register for Zoom.)
Updated: Resource guide, including how to access benefits (state/fed). Updated today.
Lisa Reynolds MD
This is Lisa Reynolds, MD. Portland Pediatrician, mom and daughter. Candidate for Oregon HD36.
Coronavirus: The numbers
WORLDWIDE: 1.3 million confirmed cases, 77,000 deaths, 177 countries
US: 380,000 confirmed cases, 11,000 deaths;
WASHINGTON: 8400 confirmed cases, 372 deaths,
OREGON: 1132 confirmed cases, 29 deaths (the number of new cases is fewer)
75% of Americans under a Stay Home order
Important dates: First confirmed case in US 1/19/2020 (WA); first US death: 2/29/2020 (WA); first confirmed case in OR: 2/28/2020; first death in OR: 3/14/2020. Gov Brown’s Stay at Home order 3/23/2020.
Oregon update: Stay Home Save Lives is Working!
Institute for Health Metrics and Evaluation (IHME, Univ of WA): UPDATE: Oregon Peak disease (highest number of cases): April 21. If we continue with strict stay at home behavior, we will have enough ICU beds, hospital beds, and ventilators to take care of our sickest citizens. THIS IS THE GOAL. Total deaths: 171.
We are nowhere near loosening restrictions, which would cause a rebound and a rapid increase in the number of cases. 97% of Americans will have NO immunity to COVID-19 after this first wave. Stay home, save lives, wash hands.
The US, however, is in dire straits (but less dire than projections of last week)
IHME estimates that the US’s COVID-19 cases will peak on April 15. On that day we will need 141,000 hosp beds (we will be 40,000 beds short), 30,000 ICU beds (we will be 16,000 beds short) and 25,000 ventilators (short). THESE projections are lower and apply strict stay at home through May.
When can we loosen restrictions?
Testing, testing, testing. And then more testing. There are two categories of tests:
RT-PCR swab tests (nasal) for presence of COVID-19. This tests for presence of the virus itself- that is, active infection (and viral shedding/contagiousness). The test works by using reverse transcriptase (RT), which transcribes COVID-19 RNA (its genetic material) into DNA. Then a polymerase chain reaction (PCR) makes billions of copies of this DNA. The DNA “glows” if COVID-19 genetic material is present and is called positive for COVID-19.
Blood tests for presence of antibodies to coronavirus. Antibodies are proteins made by our blood cells to stop viruses and bacteria. Antibodies against COVID-19 indicate previous infection and recovery and suggest immunity to getting COVID-19 again. It is not clear how long immunity lasts. Furthermore, if the virus mutates, the original COVID-19 antibodies are no longer effective at preventing re-infection. Folks who are positive could re-enter society. This gives us important population information on how widespread the infection has been, especially as most folks who had COVID-19 were not tested for the disease (either because testing was not indicated or available or because the person never had COVID-19 symptoms [25% of people with COVID-19 show no symptoms]). The CDC is already conducting this testing.
What is the testing used for?
Positive RT-PCR: Isolate a person who has the infection. Trace his/her contacts and isolate them as well. This will slow transmission by decreasing who an infected person interacts with.
Positive Antibody test: This person has recovered from infection and should be able to re-enter society.
Oregon unemployment is currently at 16%, up from an all time low of 3.3% in early March. Oregon unemployment is expected to reach 20%. Our 30 year high was 11.3% unemployment in 2009.
Oregon schools are ramping up to provide virtual learning.
The CDC recommends that we ALL wear masks when out in public, to prevent spread of virus from asymptomatic shedding (ie one can be contagious even when one does not feel sick). This does not replace social distancing.
What I will do on day one in the legislature:
I will introduce House Bill 1: The Oregon COVID-19 Pandemic Recovery Act
Healthcare for every Oregonian. Governor Brown was correct to arrange for insurers to waive cost sharing for COVID-19 testing. “No one should have to ask if getting a COVID-19 test is something they can afford.” Try replacing “COVID-19 test” with insulin. With albuterol. With a consultation with a heart specialist. Do you see where I’m going with this?
Telehealth expansion, reimbursed similarly to in person visits.
Return to public life: Extensive testing (for presence of the virus [swab] as well as past infection and immunity to the virus [blood test for antibody]) to make sure we know who is contagious (and needs to stay isolated) and who is immune.
Future Vaccine: Detailed plans that we will deploy once a vaccine becomes available so we can inoculate all Oregonians safely and efficiently.
Economic recovery State funding needs to go up. Way up. This will require a massive Marshall Plan-like financial commitment. And/or a WPA project. [The Marshall Plan was a United States scheme to finance the rebuilding of European nations after WW2. It included $12bn in US investment ($128 in today’s terms and helped boost European economies to levels higher than they were pre-WW2). The Works Progress Administration was a Great Depression recovery program that employed millions in public works projects (including Timberline Lodge)]. Ways to finance Oregon’s recovery (because Oregon tax revenues are plummeting):
Direct federal dollars to Oregon/Oregon programs. (Federal debt.)
Although states are required to balance their budgets, there is some spending that is exempt from this restriction: capital spending on infrastructure projects and spending on federal programs like Medicaid and education. Federal Reserve can “buy” debt issued by state govt (repurchase every 6 mo). [The Federal Reserve is the central banking system of the US and its purpose is to alleviate financial crises.] [Source: State and cities are on the front lines of the coronavirus. The Fed needs to help them, Jeff Spross, The Week, 3/23/2020]
Oregon will need to consider selling bonds to raise money for massive investment, rebuilding, and support to all Oregonians that is not covered by the exemptions above.
Oregon can come back stronger and better than pre-COVID-19 conditions.
A Public Health System Modernization Plan with the logistics of building an Oregon arsenal of personal protection equipment (PPE) and ventilators.
Wifi/access to tech for every Oregonian.
Input from you: I am setting up a crowdsourcing way to get input on HB1. There is an opportunity to do things differently as we rebuild from the ruin of the pandemic. Let’s work on this together.
What you can do right now (it’s worth repeating):
Wear a mask in public (preferably a cloth hand made mask-save the medical masks for the medical providers).
Prevent yourself from getting sick. One infected person will infect 400 others in a month.
Wash your hands.Your hands carry almost all of your germs to the respiratory tract (leading to infection). Wash for 20 seconds with soapy water, including wrists and fingernails. Towel dry. IF you don’t have access to soap/sink, use hand sanitizer (thoroughly, as outlined for handwashing).
Before you leave your house.
When you arrive someplace
Before/during/after food preparation and eating
Before/after cleaning your home
Before/after diaper change
After shopping cart, sneezing, blowing nose, pet care, garbage.
Try not to touch your face (introduces germs from your hands to mucus membranes of eye/nose/mouth). Wash hands if you do. Use tissue to touch.
Clean your home. Here’s a great primer on cleaning high touch surfaces (door knobs, faucet handles, light switches, fridge door, etc).
Clean your phone (99.9% bacterial kill, like Clorox wipes)
Don’t spread (or receive) germs to/from others (in Oregon we say “don’t accidentally kill someone”). Remember you (& others) can shed virus without showing any symptoms. Viruses are smart. STAY HOME SAVE LIVES
“Cohort” with your household and NOT beyond that group.
When out for essential needs: Keep 6 feet of distance between you and others
Cover your sneeze/cough with kleenex (then toss then wash your hands). Or into your elbow (second best).
Continue to get exercise. From NYT: You can invest in home exercise equipment or smart-home exercise systems like Peloton or the Mirror, but that can get expensive. You can find a number of workouts to do at home for free. Beginners can try the Well Six-Minute Workout video series. We’ve got a guide to How to Start Working Out, the 9-Minute Strength Workout and Yoga for Everyone. Taking walks and jogging or running are safe ways to exercise outside, maintain your distance from others and keep you from going stir-crazy at home. Learn more about setting up a space in your home for exercise.
Have 90 day supply of medications on hand
Know where nearest hospital is and how to get there
Have your health insurance information/cards at the ready
Remember, this is a defining moment in our history. When we look back, we will talk about what we did and how we coped with the COVID19 pandemic of 2020 (if we do the right thing, it won’t be the COVID19 pandemic of 2020-2022). Let’s be kind to each other. Let’s check in with our neighbors. Let’s spend time as a family that we would not otherwise have (in real life or via video chat). We need to keep our kids’ brains stimulated, either through school based virtual learning or through resources we find on our own.