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Sun Mar 22, 2020, 12:49 PM

What Hong Kong & Singapore's success is teaching us about the pandemic (hopeful)

Keeping the Coronavirus from Infecting Health-Care Workers
What Singapore’s and Hong Kong’s success is teaching us about the pandemic.

By Atul Gawande
March 21
New Yorker

snip

"Yet there are lessons to be learned from two places that saw the new coronavirus before we did and that have had success in controlling its spread. Hong Kong and Singapore—both the size of my state—detected their first cases in late January, and the number of cases escalated rapidly. Officials banned large gatherings, directed people to work from home, and encouraged social distancing. Testing was ramped up as quickly as possible. But even these measures were never going to be enough if the virus kept propagating among health-care workers and facilities. Primary-care clinics and hospitals in the two countries, like in the U.S., didn’t have enough gowns and N95 masks, and, at first, tests weren’t widely available. After six weeks, though, they had a handle on the outbreak. Hospitals weren’t overrun with patients. By now, businesses and government offices have even begun reopening, and focus has shifted to controlling the cases coming into the country.

Here are their key tactics, drawn from official documents and discussions I’ve had with health-care leaders in each place. All health-care workers are expected to wear regular surgical masks for all patient interactions, to use gloves and proper hand hygiene, and to disinfect all surfaces in between patient consults. Patients with suspicious symptoms (a low-grade fever coupled with a cough, respiratory complaints, fatigue, or muscle aches) or exposures (travel to places with viral spread or contact with someone who tested positive) are separated from the rest of the patient population, and treated—wherever possible—in separate respiratory wards and clinics, in separate locations, with separate teams. Social distancing is practiced within clinics and hospitals: waiting-room chairs are placed six feet apart; direct interactions among staff members are conducted at a distance; doctors and patients stay six feet apart except during examinations.

What’s equally interesting is what they don’t do. The use of N95 masks, face-protectors, goggles, and gowns are reserved for procedures where respiratory secretions can be aerosolized (for example, intubating a patient for anesthesia) and for known or suspected cases of COVID-19. Their quarantine policies are more nuanced, too. What happens when someone unexpectedly tests positive—say, a hospital co-worker or a patient in a primary-care office or an emergency room? In Hong Kong and Singapore, they don’t shut the place down or put everyone under home quarantine. They do their best to trace every contact and then quarantine only those who had close contact with the infected person. In Hong Kong, “close contact” means fifteen minutes at a distance of less than six feet and without the use of a surgical mask; in Singapore, thirty minutes. If the exposure is shorter than the prescribed limit but within six feet for more than two minutes, workers can stay on the job if they wear a surgical mask and have twice-daily temperature checks. People who have had brief, incidental contact are just asked to monitor themselves for symptoms.

The fact that these measures have succeeded in flattening the COVID-19 curve carries some hopeful implications. One is that this coronavirus, even though it appears to be more contagious than the flu, can still be managed by the standard public-health playbook: social distancing, basic hand hygiene and cleaning, targeted isolation and quarantine of the ill and those with high-risk exposure, a surge in health-care capacity (supplies, testing, personnel, wards), and coördinated, unified public communications with clear, transparent, up-to-date guidelines and data. Our government officials have been unforgivably slow to get these in place. We’ve been playing from behind. But we now seem to be moving in the right direction, and the experience in Asia suggests that extraordinary precautions don’t seem to be required to stop it. Those of us who must go out into the world and have contact with people don’t have to panic if we find out that someone with the coronavirus has been in the same room or stood closer than we wanted for a moment. Transmission seems to occur primarily through sustained exposure in the absence of basic protection or through the lack of hand hygiene after contact with secretions.

Consider a couple of data points. Singapore so far appears not to have had a single recorded health-care-related transmission of the coronavirus, despite the hundreds of cases that its medical system has had to deal with. That includes one case reported this week of a critically ill pneumonia patient who exposed forty-one health-care workers in the course of four days before being diagnosed with COVID-19. These were high-risk exposures, including exposures during intubation and hands-on intensive care. Eighty-five per cent of the workers used only surgical masks. Yet, owing to proper hand hygiene, none became infected."

More at link. Worth reading.
https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosam&stream=top

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Response to Amaryllis (Original post)

Sun Mar 22, 2020, 12:55 PM

1. The Spanish Flu ran 7-8 months in the US

Too early to consider anything at this point. Covid is 2 weeks and has ability to reinfect. We need to be cautious.

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Response to Throck (Reply #1)

Sun Mar 22, 2020, 01:11 PM

3. reinfection has been debunked so far; if had one you're immune

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Response to AlexSFCA (Reply #3)

Sun Mar 22, 2020, 03:38 PM

4. Very good news.

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Response to Amaryllis (Original post)

Sun Mar 22, 2020, 12:58 PM

2. Currently flaring again there

Due to influx of infected people from outside.

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Response to JCMach1 (Reply #2)

Sun Mar 22, 2020, 07:43 PM

5. And that's going to be the same problem in the US where some states

are doing nothing to stop the spread, so if NY gets on top of the situation, there's nothing to block an infected Red Stater from going to NY.

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Response to OnDoutside (Reply #5)

Sun Mar 22, 2020, 08:41 PM

6. and it will continue to do so until there is prophylaxis, or a vaccine...

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Response to JCMach1 (Reply #6)

Mon Mar 23, 2020, 03:39 AM

7. You're probably right if people don't get on board, there's not a whole lot else can be done,

except body bags of their loved ones.

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Response to Amaryllis (Original post)

Mon Mar 23, 2020, 04:06 AM

8. HK just completely sealed its borders, no in or out for at least 2 weeks, cases are surging again

this OP didn't age well it appears

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Response to Celerity (Reply #8)

Mon Mar 23, 2020, 04:31 AM

9. No kidding, new extreme measures, all coming in from Taiwan and Macao must be quarantined

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Response to Baclava (Reply #9)

Mon Mar 23, 2020, 04:54 AM

10. I see very little people on here who actually realise what a shitshow the US is about to become.

You still have tens of millions of fools running around like its full speed ahead with normal life. Here in many parts of the EU they are starting to say that at-riskers need to shelter in place for 12 more weeks at minimum and quite likely longer.

Now the medical workers are dropping like flies here as well. Spain is exploding along the lines of Italy. and we have vastly superior healthcare systems compared to the US in terms of beds and ventilators per person. Plus many of us have been in lockdown for weeks already.

I saw a pure gaslighting OP on here a few days ago that had some rando tweeter saying Italy was leveling off and all would be fine in a couple weeks. Laughable. And there were over 100 replies along the lines of 'Thank god, it is all going to be okay soon!'

SMDH

Now you have that fuckstick Trump saying he is considering lifting the harsh (they are so not harsh like many countries around the world) restrictions in 15 days!






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Response to Celerity (Reply #10)

Mon Mar 23, 2020, 05:09 AM

11. Reports now of NYC restaurants shutting down take out business, people go hungry, things go bad

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