A very sobering piece published in NEJM Catalyst Innovations in Care Delivery (a new digital journal in the NEJM group) describes a catastrophic situation in a hospital in Bergamo, Italy, which has been overrun by COVID-19. We all have much to learn from this experience: about pandemic preparedness, response, and the key role of IPC at all stages of this pandemic.
As we move through the gears of the response to the COVID-19 pandemic, the UK has entered lockdown – total social distancing. I’ve had many conversations with friends and family about what’s going on and why these extreme measures are necessary. I’ve pointed everybody who’s asked to the Imperial College London modelling, predicting a rapidly overwhelmed healthcare system if the trajectory of the UK epidemic doesn’t change. And pointed them in the direction of these rather cool visualisations of the logic behind social distancing (by cartoonist Toby Morris and microbiologist Siouxsie Wiles):
“The course of an epidemic is defined by a series of key factors, some of which are poorly understood at present for COVID-19” (Roy Anderson Lancet, March 9th)
While several of the factors are obvious and come to mind immediately, others, might at this point be speculation or indiscriminate observations that need further scientific evaluation.
One of the latter category, might be the observation I would like to share in this post. One of the regions of the Netherlands that presently has one of the highest COVID-19 rates, is a region in the South of the country. To our knowledge there is only one thing unusual about that region; About ten years ago, the region was in the midst of the Dutch Q-fever epidemic. Could one of those key factors that we don’t understand and that may lead to area’s with exceptional high rates of COVID-19 be previous infectious diseases such as Q-fever, or more general a higher prevalence of previous long damage, due to infectious diseases?
Have a look at the graphs and please share your thoughts.
With thanks to my colleague Bert Mulder, Nijmegen
By Andreas Voss, Jan Kluytmans and Alexander Friedrich
As the surge of COVID-19 cases is hitting some of the Dutch hospitals hard, healthcare, in the areas being overwhelmed with cases, experience a shortage of PPEs and especially masks. In other Dutch regions with no or only a few cases, colleagues still believe that life is normal and PPEs can be ordered with a click on the computer. They look with awe at what colleagues in the midst of battling COVID-19 and shortages are facing. In addition, all healthcare-settings that do not usually use a lot of PPE’s (e.g. nursing homes and GPs), will be heavily understocked.
Still, infection control advice seems to be based on standard, safety-maximized procedures, thereby wasting valuable resources. As a consequence, HCWs in the Netherlands are still following these recommendations, by using FFP masks routinely, in low risk situations, while they should be saved for the high-risk procedures.
We believe that it is time to rethink our protocols, based on the fact that we still assume that COVID-19, in general, is based on droplet and contact transmission.
- Restricted and risk-based use of FFP masks
- Use of surgical masks for normal care of COVID patients
- Efficient and extended use of FFP masks and other PPEs
- Re-use of FFP masks
The UK government yesterday announced a far-reaching package of social distancing measures to suppress the spread of COVID-19. These are based on some Imperial College London modelling work, published here. The model predicts that the UK approach to mitigate the impact of the UK epidemic would indeed reduce the overall number of people affected and those who die, but would still leave hundreds of thousands dead in an overwhelmed healthcare system. In contrast, a more intensive suppression approach would be effective in reversing the epidemic trend and keep the number of new cases to a low level – in the short term, at least.
We know that respiratory viruses can be spread through droplets, occasionally aerosols, and contact routes (see Figure 1). But what is the relative importance of these transmission routes for the SARS-CoV-2 virus, which causes COVID-19? A new pre-print paper published yesterday provides evidence that the stability of the SARS-CoV-2 coronavirus is broadly comparable to the ‘original’ SARS coronavirus (SARS-CoV-1) on dry surfaces and in aerosols. This paper supports an important role for dry surface contamination and aerosols in the spread of SARS-CoV-2, and suggests that improved environmental persistence isn’t the key to the relative success of SARS-CoV-2 over SARS-CoV-1.
Figure 1: Transmission routes of respiratory viruses (from this review article).
In my country we stopped shaking hands, because of SARS CoV-2, and in a large region people are asked to work at home. Is that justifiable, in light of the evolving pandemic? The answer is YES, according to two publications that appeared yesterday. Continue reading