COVID-19 - different containment approaches around the world - The Horse Forum
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post #1 of 1169 Old 03-04-2020, 03:05 PM Thread Starter
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COVID-19 - different containment approaches around the world

First off, I do not mean this to become a political debate or to cause hysteria. As I work in clinical research (30 years translating/editing pulmonology and general surgery studies/clinical trials), I have been interested to see the different approaches used at containing the virus and informing the public around the world. I mean no offense, and I do not intend to single-out any country or government.

I have no first-hand knowledge of what happened in China, but there seemed to be controlled information and disinformation until things got out of hand. Then, there was a massive control effort (or that is what we were allowed/supposed to see). If anyone has any other insight, I would love to hear.

As for Italy, our cousin and family live in a town of Padua, and three neighboring towns are under quarantine. Our cousin, MariCristi, is a teacher. She and her college-aged daughter have been at home since Feb 21st, as local schools and colleges were closed. Today, the closures have been extended to cover the entire country - no school and no university until March 15th, at least. Ennio, her husband, is a repairman. He continues to work in the area, in peoples' homes, with a mask and gloves. MariCristi and her daughter only leave the home to go to the supermarket every few days. All major public events have been cancelled, although certain sporting events continue to be held behind closed doors. Travel to Italy has nearly come to a standstill.

Here in Spain, the number of cases have started to grow, all related with tourism to Italy. So, of course, I am starting to pay more attention.

But, the difference between European countries like Spain, Italy, the UK, Germany, etc., is that we have nationalized healthcare. Again, I am not advocating one political stance, nor am I criticizing another. However, as healthcare is publicly controlled here (with fewer resources than in the US), it would seem that a standardized approach for containment would be more uniform, correct?

For example, our national healthcare administration has published a protocol for the public. As of right now, in the containment phase, this protocol includes:

1) If you suspect having COVID-19, you should NOT go to the doctor or hospital. You are to call 112 (our 911), and they will determine your risk. An ambulance will be sent to your home to take a throat culture.

2) You are to remain at home until the results are in. If positive, you should remain in a room separate from other family members.

3) You will receive daily phone calls by medical staff. If required (high fever, dyspnea, etc), you will be hospitalized.

Of course, this all sounds well and good, with the aim of keeping potentially ill patients at home and out of clinics, GP offices, the ER, etc. This should be effective as an initial containment procedure. However, at some point the system could be overloaded, and our system is a poor one.


Here comes the sticky part: what happens in a country like the US, where medical care is private? Are patients supposed to go to their GP, ER, local clinic? Is there a protocol for containment? And, what about individuals/families without healthcare coverage?


I would also like to hear from HFers from other countries as this thing progresses, like @SueC in Australia or participants from the UK and the EC countries. Information is knowledge! Or something close to it.
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post #2 of 1169 Old 03-04-2020, 03:20 PM
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I like the idea of sending an ambulance to your house to do a throat culture.

Even if we (United States) had nationalized health care, it would be administered by the states (I would guess) so even then the national gov't wouldn't be able to just send an ambulance to your house. I think it's not just that our health care is mostly (not entirely) private, but also that our country is just so large and is a federation of states (sort of) rather than a single entity that can just decree something and see it done.

In the US, many people without health care coverage will do what they usually do: not see a doctor because they can't afford it, or go to the emergency room.

The government could certainly make an announcement and advise people who suspect they may have it on what they should do. Who knows. I'm holding my tongue to not get political. But at least some guidance would probably be a good thing. Maybe it will be forthcoming. Again, who knows.

As for a protocol for confinement, you probably know more than I do, but my understanding is that we don't currently know a lot about how and when the disease is spread. I say this because of all of the cases that have popped up in the US where the person has no known relation to anyone who had the disease or had traveled to China or anything like that. Creating a protocol for confinement at this point is difficult because you just don't know. I also think that once this thing starts spreading more, confinement as an option will seem kind of pointless. If there's enough of it just floating around, then the genie is already out of the bottle and there's no point keeping just some people at home.

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Last edited by ACinATX; 03-04-2020 at 03:26 PM.
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post #3 of 1169 Old 03-04-2020, 03:38 PM Thread Starter
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Yes, I agree with your 'genie out of the bottle' analogy. Perhaps that is the situation that other countries are earmarking their resources for.
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post #4 of 1169 Old 03-04-2020, 03:39 PM
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Unfortunately, a huge portion of the American population has little or no paid sick leave, or work jobs where they are punished for taking sick days. These people will go to work sick because they have no alternative. Missing even a few days of work is a huge financial hit. Missing weeks of work is not even an option.

Many of these same people also lack access to affordable healthcare. They won't go to the doctor because they can't afford to, or because they are afraid the doctor will force them to stay home sick. Even a few days of medical care, with insurance, can run into the tens of thousands of dollars or more. Weeks of intensive care will bankrupt families-- even those WITH good insurance. Many families have little or no savings. A wage-earner home sick for weeks could mean losing everything. Most people working in food service, customer service, and many in healthcare are going to be those going to work sick because they have no choice. That's very concerning, as these are the people most likely to spread the illness if they DO work. The key to stopping the spread in most communities is going to lie with the minimum wage/ lower-paid workers scraping by to make ends meet who have no sick leave, no paid time off, and little or no insurance. That's frightening in and of itself. I worked in a nursing home for several years. I went to work sick with the flu, I worked with pneumonia, I worked with strep throat, and I worked a day after appendicitis surgery. Calling in sick just wasn't an option if I wanted to keep my job. Many workers are in that same boat. I now have a job with some paid sick leave, but not enough to cover weeks of time off, either. The long incubation period and long course of illness means that families could be looking at ill family members for 2-3 months... very, very few Americans can afford to take that amount of time off work to care for a spouse ill, then a child ill, then another child ill, then the other spouse....

As for containment, I think it's too late. There has been community spread among those with no ties to foreign travel, etc. It's likely been spreading in the US for weeks and because we aren't testing very many people, it's not known who is infected. Non-symptomatic people have shown to be positive for it. I predict an explosion of cases in the next week to ten days as people come down sick. The US instituted widespread quarantine efforts, closed schools, and banned public gatherings in 1918 for the Spanish Flu epidemic, and I would not be surprised to see that happen again. Unfortunately, most Americans can't just stay home and not work for 3 weeks. It's just not an option. That's one of the reason people are panicking and trying to avoid getting sick-- it's not just fear of the illness, it's fear of not being able to work for weeks, thus no money coming in. It's fear of closed schools requiring parents to find daycare for children. It's fear of overwhelmed healthcare systems and healthcare costs. Preliminary studies in China show that about 80% of the cases are mild; but 20% require additional medical care, hospitalization, etc. and that often runs into weeks of care. Our hospitals just cannot support 20% of the population needing care. Most are near or at capacity already with people ill from other causes. And 2% fatality rate is frightening, too, considering the seasonal flu this year is sitting at .1%. Nearly everyone has a close friend of family member with a chronic illness or underlying health conditions that could easily make COVID-19 deadly.

Last edited by SilverMaple; 03-04-2020 at 03:49 PM.
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post #5 of 1169 Old 03-04-2020, 03:39 PM
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Serbia here. We donít have any cases yet but I think the authorities were very transparent so far. A few suspected cases were immediately reported to the media, even before the test results were out. They did close the schools for a little while but reopened them since there is no danger at the moment.

The testing is similar, the patient phones emergency services and the ambulance comes out fully decked out in protective gear (so that looks a bit apocalyptic but I think it is a good approach) and administers the test.

In any case, as long as internet is functional there is very little chance of a cover-up. Twitter is flooded with photos of medical personnel in protective gear as soon as they step out of the ambulance.

The authorities have prepared extra facilities in isolated hotels. Interestingly, those same hotels were used as quarantine in the last outbreak of smallpox in Europe in the seventies and it worked - the epidemic never fully developed but they had the vaccine for it and managed to vaccinate and revaccinate almost the entire population within a few weeks.
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post #6 of 1169 Old 03-04-2020, 03:53 PM
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Good advice from James Robb, M.D., Fellow of the College of American Pathologists, posted 2/26/2020:

Subject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic.

Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.

The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.

Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves:
1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.
3) Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
6) Keep a bottle of sanitizer available at each of your home's entrances. AND in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands.
7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

What I have stocked in preparation for the pandemic spread to the US:
1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.
2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you - it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth - it is only to keep you from touching your nose or mouth.
3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.
4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY "cold-like" symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.

I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.

I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us! Jim

And a Doctor at Integris is recommending adults with no restrictions or contraindications should be taking 500 - 1,000 mg (1 gram) of zinc daily as a preventative.

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post #7 of 1169 Old 03-04-2020, 04:09 PM Thread Starter
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@Horsef , Serbia! beautiful country. Hope to make it some day.

OK, so I had seen that the EU had formed a Task Force, so maybe Serbia, as a EU candidate, is functioning on the same recommendations as Spain. The hotel bit is interesting. Our hospitals are always overflowing in the winter, so I don't know how they'll deal with the influx of the extra estimated 20%.


@SilverMaple , that is a scary scenario. I am freelance, so I completely understand living hand-to-mouth and without a guaranteed salary. I didn't even have maternity leave and worked lying down with the laptop on top of my stitched-up abdomen. For me, no work means not making ends meet. But, until I read your comment, I never realized that most people who are living on hourly wages and without medical coverage are service-industry workers. That is a whole different dynamic that I had not even considered. Very good point.
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post #8 of 1169 Old 03-04-2020, 04:16 PM Thread Starter
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@DreamCatcher , I have never even seen hand sanitizer here. I guess we'll use straight-up alcohol! Also, we have been told that the masks are useless, because as soon as you touch the mask with your hands, you have touched the virus. Here, they are recommending hand-washing and nothing else.
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post #9 of 1169 Old 03-04-2020, 04:26 PM
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That's very informative.


I am in Seattle. We have already had something like 9 deaths from the virus, but almost all were at a nursing home, I think, meaning the victims were quite old and frail to begin with.
The news of this node of outbreaks here put locals into a bit of a panic. Supermarkets are completely out of some food items, and certainly not a bottle of hand sanitizer to be found anywhere.

They may have restocked by now, I don't know. But it's big news here.


So far, a few schools have been closed when some students had fievers. Nursing homes are doubling up on sanitizing things. A few elected officials have made speeches to try and calm feelings. I think there is a phone number to call if you think you may have it, but they have already run out of test kits.


Basically, it's "if you think you are sick, stay home. Wash your hands a LOT!" That's about it from the government, so far.


Really, wash your hands a zillion times a day is your number one defense.
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post #10 of 1169 Old 03-04-2020, 04:37 PM
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Quote:
Originally Posted by Spanish Rider View Post
@Horsef , Serbia! beautiful country. Hope to make it some day.

OK, so I had seen that the EU had formed a Task Force, so maybe Serbia, as a EU candidate, is functioning on the same recommendations as Spain. The hotel bit is interesting. Our hospitals are always overflowing in the winter, so I don't know how they'll deal with the influx of the extra estimated 20%
Thanks! If you do make it, drop me a line and Iíll show you around.

I think we are following EU recommendations.

The communists knew a thing or two about marshaling millions of people into compliance. My mum was telling was telling us about the small pox outbreak. They each got a letter telling them where and when to show up for their vaccinations. There were no queues in order to prevent infection. If you didnít show up, the police came to get you - no ifís or buts. If you were in contact with the infected, you would be picked up by the police and transported into one of those hotels. No one complained. The infectious diseases hospital was fully quarantined, under military guard and no one went in or out for a month.

I read a book about it and apparently the outbreak started because one guy decided to use alcohol to wash his vaccination site because he didnít want to go through the post-vaccination flu-like symptoms. The reason he got his vaccine was because he was traveling to Mecca for pilgrimage and he was not allowed to travel there without vaccinations. The communists took those things seriously but there is always the human factor, even in communism.

I am guessing most of those old-time protocols from the communist era are not functional any more but I am sure there are still some doctors around who remember them and can organize a response in an emergency. Those isolated hotels worked well then so they are recycling the idea.
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