COVID-19 with heart disease
Maya Trotz
Like many of you, I have been learning alot lately about COVID-19, and healthcare resources around the world. This page summarizes the sources of information that I’ve gone through that I have found useful as an academic, an environmental engineer, someone in Tampa, Florida, and someone from the Caribbean region. Firstly, this blog shared by Corrie Scott, is a good place to start as I do have heart disease, and am likely reacting to this pandemic differently than many I know, “Dear Immuno-Compromised People, A Message To You In These Unsettling Times.”
As a black woman in the US, and one who works in East Tampa, a majority African American community in Florida, I often look at health data from the standpoint of disparities. The evidence thus far shows that COVID-19 is more detrimental to older adults, and populations with heart disease, diabetes, and lung disease. Younger adults are not immune, and a March 18th, 2020 study from the CDC shows that they are accounting for high levels of hospitalizations. Obesity, hypertension, are also being discussed in terms of risk factors. While, I know that East Tampa residents show higher prevalence of these diseases compared to the rest of Florida, I decided to find data for the Caribbean region as I am from there, and have research projects in Barbados and Belize. In addition to risk factors, resources like number of nurses, doctors, hospital beds, personal protective equipment, and ventilators, are some of the other things to consider, bearing in mind that all of these are differently abled to respond to COVID-19. For example, a hospital bed in a well isolated room in one of many local hospitals, is different from a hospital bed in a small room in the main hospital serving an entire country. This video provides webinars on COVID-19 response in low resource settings.
Now that you have some background on where I am coming from, let’s get to the information online. Some of this will be in chronological order based on time posted, however, the first few links are for pages that I often visit.
Firstly though, a wake up call to the gravity of this situation. My colleague Peter Vikesland, shared this post on Twitter on March 1st, and it woke me up to How the Horrific 1918 Flu Spread Across America, and how similar things could play out with COVID-19. On that same day Florida declared the first two cases for the state, one in my county. If you’d rather see a video, my colleague Jim Mihelcic sent this link from PBS on the 1918 Flu.
Since I first wrote this blog, I’ve also been documenting things that my civil and environmental engineering students might be interested in as a part of a group project. Please find those themes at this link.
These posts of the trauma faced by persons in China and Italy, should help drive home the point that we have to reduce our chances of infection right now as our health systems cannot treat us all at once. Posts from persons who are ill, but cannot get tested, or that arrive at the hospital ill prepared to see them, are increasing each day. Stories of health care workers in the US who are making their own protective equipment, is our reality until more resources are mobilized to protect them. Nurse Fortunate Atwine in Uganda provided her reality on March 20th during the Mass General Durant Technical Panel on COVID-19 response in low resourced settings.
Presidential Awardee for Excellence in Mathematics and Science Teaching (PAEMST), Tiffany Talbot Oliver, posted on social media that her husband is recovering from an infection, and is immuno compromised. In stressing that we should do all we can to manage COVID-19, she recommended this video from March 19th with Facebook’s Mark Zuckerberg and Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases in the US. Posts from persons about things that were done in China to protect health of families, are things that we should consider as the virus begins to hit our communities.
Dr. Jimmy Fletcher shared this video of Singapore’s Prime Minister , where he emphasized that every Singaporean life mattered. This attitude is welcome, as many seem ok with the fact that 80% of persons will have mild symptoms while only a smaller percentage will die. If I ran some numbers for Guyana where I am from, we are talking about roughly 20,000 people dying if we assume there are 800,000 people, of whom 80% will get the virus, and of that 80%, 3.4% will die. Given the country has higher risk factors for fatality, and less than 2 hospital beds per 10,000 population, one can imagine 3.4% would be higher. Add to that, the public system seems to have two ventilators. THIS IS NOT OK.
Even the protective gear that health care workers use show stark differences in vulnerability to infection as seen below. Check out the slides by Dr. Lin from Harvard on lessons learned from Wuhan. The 5 main Take home messages were:
- #1: Lockdown with Traffic Ban and Home-Quarantine Helped but was not enough
- #2: Centralized Quarantine worked!
- #3: A good proportion are community cases: Testing, Testing, Testing
- #4: A Multi-pronged Approach is needed (Large scale screening using symptoms (with/without testing kits), Increase testing capacity, physical distancing/home quarantine, Centralized quarantine for confirmed and suspected cases, symptomatic cases and close contacts (asymptomatic)
- #5: Protect the Four Vulnerable Groups (healthcare workers, elderly, children, and those at home with confirmed or suspected cases)
- #6: These Protection Strategies Worked! Full protection, stringent safety protocol, training.
I should add that even travel and quarantine are not all the same either. Check out this Twitter Thread of Lucas Hensel who traveled to China on March 18th.
Secondly, we each need to play our part at staying home, avoiding crowded spaces, and seeking medical care via phone or online where possible (see the CDC’s recommendations for preparing for COVID-19 or the Barbados Guide for Preparing for COVID-19). The late Prof. Hans Rosling from Gap Minder, explains why staying home reduces the spread of the virus. He contributed data mapping solutions during the Ebola epidemic, himself moving to the center of the epidemic as it occurred. The number of persons who are infected by 1 person will vary based on measures taken to reduce exposure, cultural habits, etc..
Also, a really good piece written by Harry Stevens with models showing how limiting interactions slows the rate at which we need medical care can be found here, “why outbreaks like coronavirus spread exponentially, and how to flatten the curve.” Again, hospital beds, ventilators, and protective gear like masks and gloves for hospital staff, are very limited.
Imperial College released a study on March 16th, “Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand.” Based on their model for the US, school closings, physical distancing, and household quarantines, are all needed to ensure the hospital capacity can accommodate the number of ill persons. After an initial lull, however, the virus will emerge again, and they recommend a staggered approach of repeating the lock downs once bed capacity hits a certain number. This would continue until we find a vaccine, or a treatment.
On March 19th, Tomas Pueyo presented another look at modeling the situation, and put it in a post titled, “Coronavirus: The Hammer and the Dance.” In that article, he offers solutions that we must implement to manage COVID-19, and drives home the point that data collection, and analysis must be used to help us make better decisions. As an example of the kind of data one would collect to help reduce the number of people one person infects, he recommends tallying the ability of each non-medical intervention on reducing that number
For many of us who are new to this epidemiological lingo, Brandon Ogbunu, Senay Yitbarek and Pleuni Pennings made a video about the two numbers most often used to describe the new coronavirus outbreak: R0 and the case fatality rate. They also talk about why we should and how we can “flatten the curve.”
I follow Twitter pages of the World Health Organization, Center for Disease Control, Florida Department of Health, University of South Florida, the Caribbean Public Health Agency, and you should find those that are handling COVID-19 where you live.
I also follow Max Roser on Twitter, and recommend that you read his thread on “What’s ahead: two possible futures. Very different futures. Let’s call it Pandemics, Fast and Slow.” He is one of the creators of the ourworldindata.org site that pulls together alot of the global information (e.g. WHO, JHU) into one place for us to explore. Must emphasize that I found this data rich site from a friend Na La, an artist in Barbados.
Coronavirus Disease (COVID-19)
by Max Roser, Hannah Ritchie and Esteban Ortiz-Ospina
Before I get too far, here are some other twitter threads that I follow:
Dr. Lindsey Marr is a Civl and Environmental Engineering Professor at Virginia Tech with expertise in airborne disease transmission. There is debate over whether the virus is airborne, and a recent WIRED article in which she is quoted describes this challenge in terminology as used by different fields, and what it means for those giving care and the type of protective measures they should take. Follow her to get up to date research findings, and even view research presentations.
Dr. Liz Specht is the Associate Director of Science & Technology
@GoodFoodInst who shared a twitter thread on March 6th that went viral. It uses math to discuss the limiting factors for COVID-19 care in the US. It’s also discussed in the video below from minute 13.36.
Dr. Joseph Allen is an Assistant Professor, and Director of the Healthy Buildings program at Harvard. He co-authored Healthy Buildings: How Indoor Spaces Drive Performance and Productivity. His almost daily tweets provide discussion on a range of COVID-19 topics.
Dr. Jimmy Fletcher (FB Page) is an MP in St. Lucia who held the portfolio of Public Service, Information, Broadcasting, Sustainable Development, Energy, Science and Technology from 2011 to 2016. He has been sharing thoughts on COVID-19 management strategies for the Caribbean that are very much on point.
Dr. Charles Haas is the Head of Civil, Architectural, and Environmental Engineering at Drexel University who works on risk assessment. Many of his tweets highlight the knowledge gaps around COVID-19, and areas where more understanding is urgently needed. He also participated in a Water Research Foundation webinar on COVID-19 on March 12th (I discuss this webinar later on).
Prime Minister Andrew Holness of Jamaica. To date, he is the most active of the Caribbean leaders on Twitter in terms of sharing information on COVID-19.
Dr. Tom Inglesby is the director of the Johns Hopkins Center for Health Security. His recent tweets speak of the federal effort needed in the US to assist medical care facilities and implement efficient logistics to reduce burden of hospitals trying to purchase on own, as well as ensuring the right supplies get to the right place at the right time.
Dr. Xihong Lin is a Professor of Statistics who works on biostatistics, data science, genetics etc. at Harvard University who shared slides on COVID-19 response in Wuhan.
Dr. Shelly Miller is an Environmental engineering professor at UC Boulder who studies sources/health impacts/control of urban and indoor air pollution. Many of her tweets discuss effective measures to reduce virus loads in the environment in hospitals and elsewhere.
Dr. Megan Murray is Professor of Global Health at Harvard University who specializes in infectious disease. Early on she published Coronavirus FAQs by Dr. Megan Murray, and keeps updating it. In that article she emphasized the importance of understanding the impact on/of children, and more recently, she has started to ask questions on immunizations that children may have that others don’t.
Dr. Vivek Murthy is the 9th Surgeon General of the United States, and the Author of TOGETHER: The Healing Power of Human Connection in a Sometimes Lonely World.
Dr. Vindhya Vasini Persaud is an MP in Guyana and medical doctor who has been sharing useful guidances on COVID-19 management on her page, as well as commentaries.
Dr. Andy Slavitt is the founder of United States of Care, and a former Medicare, Medicaid & ACA. He tweets about government response needed to address COVID-19, and along with 15 health care leaders has published a message for all Americans, state/local leaders, and health care workforce: Read “The best thing everyday Americans can do to fight coronavirus? #StayHome, save lives” on USA Today.
Dr. Chris Tufton is Jamaica’s Minister of Health and Wellness who provides numerous updates with respect to transportation, water, pharmacies etc.
UWITV is the official Twitter account of the University of the West Indies, TV. Their feed is constantly updated with good information on COVID-19, and they have links to panel discussions held on the topic (See video here, and discussed later).
Now to other resources that I have found online.
Coral restorer Austin Bowden-Kerby has been posting on social media since January, recommending that Fiji isolate itself. They did so on March 20th, 2020. The Marshall Islands did so a while ago, and stopped flights from China as early as January 26th, 2020. Anyway, Austin shared this really informative YouTube playlist that is always updated (now up to episode 36 on Coronavirus): MedCram — Medical Lectures Explained CLEARLY.
A friend shared this video with me that she got from a nursing professor at the University of Iowa. Dr. Osterholm is Regents Professor, McKnight Presidential Endowed Chair in Public Health at the University of Minnesota who CNN Calls, “The disease expert who warned us.”
March 8th: Temperature and Latitude Analysis to Predict Potential Spread and Seasonality for COVID-19 was a study published by a team, including a colleague Dr. Fernando Miralles-Wilhelm.
March 9th: COVID-19 — Partnering in the Caribbean’s Response was an excellent panel hosted by the University of the West Indies. Dr. Justin Ram — Director of Economics, Caribbean Development Bank (CDB, shared information on how COVID-19 could impact Caribbean economies, and also discussed things that can be done to increase resilience at this time like more online work and service provision, telemedicine, and easements for payments for mortgages, utilities etc.. Prof. Clive Landis, Pro Vice-Chancellor Undergraduate Studies discussed finding local solutions like the manufacture of hand sanitizer (at the time NY was already manufacturing its own). See the panel’s video here with FB interactivity or view on YouTube.
March 10th: DREXEL University, Dornsife School of Public Health hosted a special panel where speakers discussed what’s known about COVID-19 and public health approaches to combat the spread of the virus. Prof. Charles Haas was in the audience, and at 1:19:27 into the presentation, he suggested to one the panelists that the virus may be airborne. That panelist had earlier said that it was not airborne. During the discussion, the panelist agreed that that was possible and that indeed more studies are needed. Check out Linsey Marr’s Twitter page for more on this, but I think 10 days later WHO has now said the COVID-19 virus is airborne. The take away here is that everyone is learning very quickly about this disease, and the research community with its diverse skillsets, is sharing and being heard.
Moderator:
Michael Yudell, professor and chair, department of Community Health and Prevention at Dornsife
Speaker Panel:
- “Human Rights Considerations in the Global Response to COVID-19” by Joseph Amon, PhD, MSPH, clinical professor, department of Community Health and Prevention, director, The Office of Global Health at Dornsife
- “The Role of U.S. Health Departments in Responding to Infectious Disease Crises” by James Buehler, MD, clinical professor and interim chair, department of Health Management and Policy at Dornsife, former health commissioner of Philadelphia
- “COVID-19 — Clinical Characteristics, Transmission, and Diagnosis” by Esther Chernak, MD, MPH, FACP, associate clinical professor, department of Environmental and Occupational Health, director, Center for Public Health Readiness and Communication at Dornsife
- “What We Know About the Epidemiology of COVID-19 (And What We Don’t)” by Michael LeVasseur, PhD, MPH, visiting assistant professor, department of Epidemiology and Biostatistics at Dornsife
- “Drexel’s Management of COVID-19” by Annette Molyneux, PhD, assistant vice president, Student Life, director, Counseling and Health at Drexel
March 12th: The Water Research Foundation hosted a webcast to provide technical updates and information on Novel Coronavirus with experts in infectious disease control, virology, water engineering, outbreak epidemiology, pandemic trends, and risk emergency response. To access the recording and the powerpoint slides, you have to register your email: Access the webinar here.
Speakers:
- Peter Grevatt, PhD, CEO — The Water Research Foundation
- Dr. Charles Haas — Drexel University, WRF Academic Council (Moderator). Established taxonomy that COVID 19 refers
to the disease, and SARS-CoV-2, 2019-nCoV and COVID-19 refers to the virus. The WHO guidance on safe management of drinking water and sanitation services applies to COVID-19 outbreak with no extra measures needed — disinfection works. - Jonathan Yoder — Water Preparedness and Response at the Centers for Disease Control and Prevention. Some useful links on disinfection were highlighted: www.cdc.gov/coronavirus/2019-ncov/community/home/cleaning-disinfection.html and https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
- Dr. Rasha Maal-Bared — EPCOR Water, Chair of the WEF Waterborne Infectious Disease Outbreak Control (WIDOC) Working Group of the Disinfection and Public Health Committee. COVID-19 is an enveloped virus, and is therefore most susceptible to environmental conditions and disinfection than a suite of other bacteria and viruses. Fecal-oral transmission is possible, but likelihood seems low. However, all surfaces contacted by wastewater should be disinfected.
- Dr. Mark Sobsey — Gillings Schools of Global Public Health, University of North Carolina Chapel Hill and Dr. Lisa Casanova — Georgia State University. Previous studies on coronaviruses show that temperature and humidity influence survival on surfaces (less survival at 25oC vs 4oC, and 50% relative humidity vs 20% or 80%). In water, survival of surrogate coronaviruses can be days, and again this is lessened at 25oC vs 4oC. Solid waste with COVID-19 should be handled as Category B Medical Waste, however it was unclear how this applied to individual homes and sanitary worker exposure. Informative slides on appropriate disinfectants for water and surfaces, and emphasis on research gaps.
- Dr. Kyle Bibby — University of Notre Dame. Evidence suggests that COVID-19 is found in feces, but uncertainties exist on survival rate in wastewater, and disinfection effectiveness of wastewater.
- Dr. Dan Deere — Water Quality Specialist at Water Futures, Australia. Water and wastewater concerns from the industry/practitioners led to a global effort to share information with each other, and with the public to better handle unanticipated consequences (disposal of sanitizers and wet wipes down toilets, especially as toilet paper ran out in places). Questions were raised on safety of wastewater operators during the webinar, and personal protective equipment was stressed, as well as expecting plant operations with minimum staff. Presentation shared good resources for the water and wastewater sector.
Moderator:
Lola Olabode, MPH, BCES — The Water Research Foundation
About the hand washing and hand sanitizers. So, soap and water is always the better option provided you do it correctly: See directions here. Hand sanitizers are on back order in many places, so here are some links that a friend Karen Curry Moran and her husband Jim Mihelcic (my colleague) recommended so that I could make my own: https://www.thespruce.com/make-your-own-homemade-hand-sanitizer-60614
On Personal Protective Equipment/Testing etc. Challenges.
I found DIYs for face masks that my colleagues say are better than nothing. The key is to block passage through the filter. Here’s a study that used a 100% cotton T-shirt: Simple Respiratory Mask.
Swabs are used to take samples from the nose or throat that are used in test kits. These, however, are in limited supply; cotton and wooden sticks are not recommended in replacements. As Coronavirus Testing Gears Up, Specialized Swabs Running Out
Many companies and labs have developed tests for COVID-19 virus. This thread describes testing methods. While those are ramping up in the US, Germany, Taiwan, China, South Korea are examples of places with approved test kits that are taking international orders — this could be useful for places like the Caribbean. See link for various approved test kits here.
The links below are just news items that have across my radar over the last few weeks.
January 30th: Deaths surpass 200, and state department struggles against travel to China.
February 10th: Jamaican Isolated After Symptoms Progress Amid Coronavirus Concern
February 20th: Coronavirus: Two passengers on quarantined cruise have died from COVID-19
February 28th: Cuba girds against Covid-19
February 29th: Expansion of testing in US
February 29th: Policy makers and gender, a Twitter thread.
March 1st: CARICOM Press Conference on COVID-19 (the larger cruiselines were present, however many have suspended operations for now)
Marc 9th: Barbados prepares quarantine space
https://www.facebook.com/watch/?v=501712623837968
March 9th: Amy Proal shares her experience in Boston, and the challenges associated with getting tested for COVID-19.
March 10th: Harvard moves classes online
March 10th: Jamaica records first case
March 12th: Belize Press Conference
March 16th: NIH clinical trial of investigational vaccine for COVID-19 begins
March 20th: Vice Chancellor’s Forum — COVID 19 — Caribbean Unity or Plurality
