Social Distancing and Enhancing Cleaning

Tomas Pueyo has an excellent article about how early shutdowns reduce the spread of coronvirus COVID-19.

Each day earlier action on social distancing can a 40% reduction in disease spread. Hourly hand-cleaning is an enhancer of social distancing and will get us let us get back to re-open a bit earlier and safer. Hourly hand cleaning might achieve a 70% reduction which would be the equivalent of nearly two days of early aggressive social distancing (social distancing is ultra-strict travel restrictions and shutdowns. All people following self-quarantining as close as possible).

Tomas shows that Taiwan, Hong Kong, Singapore, Japan, South Korea (other than the super-spreader church) and SARS impacted countries acted very early and are seeing over ten times better containment.

China did pretty well. They had 1800 teams of 5 people each tracking and containing the contacts of every infected person that was identified. Everybody they got interacted with, then everybody those people interacted with, and isolating the bunch. That’s how they were able to contain the virus across a billion-people country.

The US administration’s ban on European travel is good: It has probably bought us a few hours, maybe a day or two. But not more. It is not enough. It’s containment when what’s needed is mitigation.

Taiwan has had the best procedures which will be reviewed in a follow-up article.

The countries that are prepared will see a fatality rate of ~0.5% (South Korea) to 0.9% (rest of China). Countries that are overwhelmed will have a fatality rate between ~3%-5%.

Containment Has Mostly Failed – We are in Mitigation

Mitigation requires heavy social distancing. The few countries that are able should still try to strive for Taiwan’s containment procedures. Taiwan is the containment model and Wuhan is the mitigation model.

Lower the transmission rate from 2.5 to 2.2, maybe 2 if we stop getting within ten feet of people and stop touching surfaces without cleaning the surface or washing hands. Getting transmission below 1 for a sustained period of time is needed to stop the epidemic.

We must skip forward to Wuhan style shutdown and aggressive contact tracing. This means national guard applied to contact tracing. 10,000 cases means about 10 million people tracking down contacts and isolating them. The manpower effort could be reduced using technology and process improvement.

We need to have hourly hand cleaning and hand washing.

Calls to Action

Mobilize national guard for contact tracing and isolation of contacts.
Skip forward to the Wuhan model of mitigation. It is about 2-3 months of serious disruption but better 100% disruption for 2 months than an ineffective 80% disruption for 2 months and then 6 months of 100% disruption.
Hand cleaning once an hour needs to be part of the consistent and simple messaging.

SOURCES – Tomas Pueyo article, JAMA and other references, Brian Wang analysis
Written By Brian Wang

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