–The whole of Northern Italy has been essentially quarantined.

–My wife and I largely expect her conference later this month to be cancelled.  The society’s leadership was meeting this weekend to decide.  The biggest problem is that many academic medical centers are banning domestic travel as well (even trying to ban personal travel), so conference speakers are starting to cancel.

–Still planning on taking our birthday trip though. 

–Quest and Labcorp, the two largest commercial labs, are open for coronavirus testing starting Monday (at least one is–I assume the other is not far behind).  More hospital labs to follow soon.  The diagnostics manufacturers are rolling out the CDC and European assays as fast as they can.

–This will be a game changer in terms of understanding the threat of the disease (the true CFR).  Quest and Labcorp will run the test if a doctor orders it.  There will be no checklist (that I am aware of) for seriousness of disease, a short list of travel exposures etc. that has crippled testing by CDC and the state labs.

–I EXPECT THEY WILL FIND A -LOT- MORE CASES.  THE VAST MAJORITY OF THEM WILL BE MILD DISEASE, NOT REQUIRING A HOSPITAL, AND GIVE US A MUCH BETTER SENSE OF THE DENOMINATOR FOR THE CFR.  DO NOT BE ALARMED OR SURPRISED IF THERE IS A BIG “SPIKE” IN CASES EVERYWHERE IN THE US WITHIN THE NEXT COUPLE WEEKS IF MORE LOCAL CONTROL TESTING STARTS HAPPENING. 

–Again, clearing the bureaucracy to make the testing more widely available, and, more importantly, under the control of the sick patient and their doctor (and not a government checklist) is huge.

–What it will not do is stop Covid-19 from sweeping the nation.  That cat left the bag when China was surprised by its existence and it had crossed borders undetected in critical mass.  That’s why if you go back to previous emails, I said we are “watching country X closely for new cases.”

–To be even more clear, the only chance to stop a highly contagious respiratory infection like this is when it is in just a handful of patients you can isolate fast.  We passed that point sometime in January.  If we -could- stop a disease like this from reaching the shores and spreading like wildfire, we would not need flu shots.  We could stop the flu every year.  We can’t.

–Also of note: private or nationalized healthcare also doesn’t matter.  Clovid-19 is cutting through them all at about the same rate. Neither form can stop the flu from spreading either.

–What does matter is local versus central decision making.  Take the UC Davis case, which is continuing to repeat (by report) all across the country.  With testing only centrally available, if you are a physician with a high index of suspicion of Covid-19 in a patient, you have to first contact your state health department.  Assuming you check the right boxes there, and they have the test, only THEN can your patient get testing.  If they do not check the right boxes, you can try the CDC.  But remember, the UC Davis patient was checking the “wrong” boxes for 9 straight days.  With the test available either locally at UC Davis, or your local Quest or Labcorp collection site, a doctor with a high index of suspicion can just…get the test.  The issue here is skin in the game.  The physician with a high index of suspicion needs to know if she and her staff are at risk, if other patients are at risk AND how to treat the patient.  She is as invested in the test and its result as the patient.  Same for the local lab.  It’s worth it to them to know if the test is in their hospital, and thus their community, and they need to be worried about exposure.  Quest and Labcorp just fill a need to provide this service at low cost, and have collection sites EVERYWHERE in the US to be the local testing option of choice, if they can at all swing it.  But California’s state labs didn’t have the test ready, and had to refer the case to the CDC.  The CDC is in Atlanta.  They don’t know these guys in California.  If they call it wrong, that’s Sacramento’s problem, and won’t affect them in Atlanta.  They have far less skin in the game.  And who made their checklist?  Who was the one who made the wrong call to be so beholden to it, delaying diagnosis and treatment in the CDC?  No one remembers.  It’s the decisions of the conference call, where no one quite remembers who was there, and who specifically said what.  The benign neglect of highly centralized bureaucracy, where those making the decision at least -perceive- themselves divorced from its consequences.  It is far, far better for the decision to be made by those on whom the consequences will fall most heavily–and the best, and most responsive government, is that whom you know who they are, where they live, and can knock on their door without going too far out of your way.

–And again, -perception- of effectiveness of coronavirus response and containment is the goal of all governments right now.  Especially since their options to -be- effective themselves are relatively few, but draconian (like quarantines of entire regions), and otherwise the best they can do is just make sure enough tests and supplies are available and then let the healthcare system do the diagnosing and the treating one patient at a time.

–Continue to be mindful of the economic consequences as well (especially if the virus is merely the catalyst, and not the cause).  It is still prudent to have a few months expenses stocked away.

Love in the Time of Coronavirus:
Tito’s vodka, having to remind Twitter over and over that 80 proof vodka cannot be used as hand sanitizer:

Economic consequences of runs on Costco:

British Airways flight from Milan to London, March 5 2020:

https://www.businessinsider.com/coronavirus-airlines-run-empty-ghost-flights-planes-passengers-outbreak-covid-2020-3 (picture is from a different article, but same phenomenon)

<Paladin>