Archive for June, 2020

The “K” Factor and EU and USA Cases

Friday, June 26th, 2020

The K Factor

Ever heard of the “K” factor? Neither had I. But in yesterday’s Work Fitness and Disability Roundtable, Dr. Jennifer Christian’s long-running and valuable daily roundup of workers’ compensation medical news and musings, we were introduced.

Turns out the “K” factor could be tremendously important in helping leaders figure out how reopening the economy should proceed.

I thought Jennifer’s Roundtable post was so important I asked her if we could reprint it in the Insider. She gave permission, for which I’m grateful. So, here it is:

Hey, nothing like a fact-based “aha” to sharpen the mind and help point the way forward. A thought provoking article in New York Magazine (https://nymag.com/intelligencer/2020/06/coronavirus-meatpacking-plants-america-labor.html?utm_source=fb&utm_campaign=nym&utm_medium=s1&fbclid=IwAR0jnJXCeUx_zYVQuayha1XSMpMtjT-TSXIv7-RfIFNCDtlrz1hn558Da2w) on the reason for major differences between the COVID-19 experience in meatpacking industries in the USA and Europe brought up the “k” factor in the COVID-19 pandemic.  Ever heard of “k”?

Until yesterday, I hadn’t noticed (or paid attention to) any discussion about the implications for action of SARS-CoV-2’s  “k” factor. The “k” factor is an infecting organism’s observed dispersion behavior. Now is the time to start paying attention to the “k” factor because it points us straight to the main cause of the majority of COVID-19 cases: superspreading events in crowded indoor settings. We’ve all known that a lot of the cases have occurred due to spread on board ships, in prisons, hospitals, nursing homes, nightclubs and meatpacking plants – but to be truthful, I’m not sure we’d gotten the take-home message: SARS-CoV-2 is heavily dependent on crowded indoor spaces for its spread.

So, I did a bit more Googling and found a good Science Magazine article (https://www.sciencemag.org/news/2020/05/why-do-some-covid-19-patients-infect-many-others-whereas-most-don-t-spread-virus-all) that lays it all out quite clearly.  In addition to the R value (the mean number of subsequent new infections resulting from each infected individual), epidemiologists calculate how much a disease clusters. The lower k is, the more transmission is coming from a small number of people. The k value for the 1918 influenza pandemic was estimated at 1.0 – clusters weren’t too important. But during the 2003 SARS and 2012 MERS epidemics the vast majority of cases occurred in clusters, and their calculated k values were therefore low: 0.16 and 0.25 respectively.

In COVID-19, most infected people are not creating any additional cases. Adam Kurcharski from the London School of Hygiene & Tropical Medicine has conducted an analysis of COVID-19 dispersion and says, “Probably about 10% of cases lead to 80% of the spread.” A pre-print of his paper (https://wellcomeopenresearch.org/articles/5-67) has a calculated k value of COVID-19 at 0.1. Previous studies have pegged it just a tad higher than SARS or MERS.

There’s no point in trying to figure out which people are shedding the most viruses – though some of us clearly do disperse more bugs than others.  We professionals need to focus most of our attention on the places and types of events that SARS-CoV-2 needs in order to spread efficiently: loud and crowded indoor spaces, where people are cheek by jowl and raising their voices or breathing deeply: talking, singing, or shouting or aerobically exerting themselves. Ventilation and air flow in these settings also plays an important role.

Almost none of the clusters have resulted from outdoor crowded events.  Chinese studies of the early spread of COVID-19 outside Hubei province identified only one cluster among a total of 318 that originated outdoors. A Japanese study found that the risk of infection indoors is almost 19 times higher than outdoors. And here in the USA people who participated in (largely outdoor) Black Lives Matter protests have not been getting sick. (I also saw some data earlier saying that the virus is almost immediately disabled by sunlight.)

As the Science Magazine article says, the low k factor is …..”an encouraging finding, scientists say, because it suggests that restricting gatherings where superspreading is likely to occur will have a major impact on transmission, and that other restrictions—on outdoor activity, for example—might be eased.” So duh, let’s make the hierarchy of risk much more explicit. We need to make it crystal clear to the public (and patients and workers and employers) that the worst thing a person can do is participate in events in loud, crowded, and  indoor settings without rapid air turnover.

HOWEVER:  Many people are stuck. They live in crowded housing or congregate housing. The places where they live and work (ships, factories, office buildings, and medical facilities) already exist. People need to work, and winter is coming when we have to be inside.

I see this call to action: Are you, personally, confident that you are collaborating with all of the professionals whose input, cooperation, and contributions will be required? Think outside your silo. All of the various types of professionals who do event planning & commercial building design & engineering, industrial hygiene, HVAC, public health, and occupational health & safety need to join up and get deeply and rapidly involved in adapting / redesigning / re-configuring / re-engineering existing places and events to reduce the potential for superspreading.

A look at European Union and U.S. case statistics: Stunning

The following chart from the Johns Hopkins Tracker Project, printed in yesterday’s Statista Daily Alert needs no introduction or even analysis. It puts the period to Dr. Christian’s words.

 

It Bears Repeating: We Have Been Here Before

Friday, June 19th, 2020

In the summer of 1918, during the first wave of the Spanish Flu pandemic, American troops were at war in Europe’s killing fields. That was when Philadelphia officials decided they would hold a massive parade for the ages to promote Liberty Loans – government bonds issued to pay for the war. The City Of Brotherly Love organized an extraordinary spectacle: marching bands, women’s auxiliaries, Boy Scouts, soldiers and floats showcasing the latest innovation in warfare – floating biplanes built in Philadelphia’s Navy Yard.

That Philadelphia’s medical community thought this a very bad idea didn’t matter. That the nation was awash with flu had to be put aside in order to support the war effort. The flu could wait.

When two miles of parade marchers took their first steps on the morning of 28 September, some 200,000 people jammed Broad Street, cheering wildly.

The Spanish Flu had been circulating in America for six months at the time of the parade, and the flu, like COVID-19, loved a crowd. The flu couldn’t, and wouldn’t, wait.

Within 72 hours of the parade, every bed in Philadelphia’s 31 hospitals was filled. In the week ending 5 October, nearly 2,600 people in Philadelphia had died from the flu or its complications. A week later, that number rose to more than 4,500, with 200,000 more sick. With many of the city’s health professionals pressed into military service, Philadelphia was unprepared for this deluge of death.

City leaders closed Philadelphia, locked it down. But it was too late. Morgues and undertakers could not keep pace. Grieving families had to bury their own dead. Casket prices skyrocketed. And a rumor started to spread – The Germans did it.

History continually repeats itself. Tomorrow night we have a potential case in point when 19,000 followers of the Cult of Donald Trump will gather in the BOK Center in Tulsa Oklahoma. That the city’s medical officials have unanimously declared this a very bad idea doesn’t seem to matter. That the nation is awash with COVID-19 has to be put aside in order to support the election effort. COVID-19 can wait.

Campaign officials say they’ll take peoples’ temperatures as they enter and pass out face masks and hand sanitizer. But they won’t insist any be used and they won’t enforce social distancing. Can you, in your most far out imagination, visualize the camera shot of Donald  Trump at his podium with his amped-up ardent followers behind him, each six feet apart and all wearing masks?

Since 17 June, two days ago, Tulsa’s COVID-19 cases have risen 42%, going from 259 to 450. At one time, New York City had 450 cases.

As we have seen, this is not the first time in the midst of a pandemic people have been irresponsible and downright wacky.

Both President Trump and Vice President Pence have lately taken to declaring victory over the virus. You’d be hard pressed to find a single medical expert who agrees. We can only hope that somehow Trump’s medical experiment tomorrow night will not turn a very bad idea into a tragic one.

Today’s Class: Impeccable Timing 101

Monday, June 15th, 2020

No one will ever accuse the Republican Party of being overburdened with sensitivity. In two stick-in-the-eye moves just oozing with impeccable timing, the Grand Old Party is telling the world just what it can do with its Black Lives Matter folderol.

First, the GOP’s unquestioned leader, President Donald Trump, like a too long cooped up horse, has decided to resume his rallies, which for him seem to be better than crack cocaine. This week in Tulsa Oklahoma he and as many of his followers as campaign officials can cram into the 19,000-seat BOK Center will gather for a couple of hours of The Best Of Trump as if the COVID-19 pandemic had never happened, neither masks nor social distancing required. Reminds me of Ebenezer Scrooge discussing innovative methods to “decrease the surplus population.”

In the first of his two impeccable timing decisions, Mr. Trump announced he would hold his Tulsa rally on 19 June, known as Juneteenth, the date on which in 1865, the last of the South’s slaves were notified of their freedom under the Emancipation Proclamation. It would take until the following December and the 13th Amendment to officially abolish slavery in America.

Juneteenth is recognized as a state holiday or ceremonial holiday in 47 states and the District of Columbia (what are you waiting for Hawaii, North Dakota, and South Dakota?) and is the oldest celebration marking the end of slavery, dating from 1866.

According to the Associated Press, Trump was unaware of Juneteenth, let alone the significance of it to the Black community, when he announced his rally’s date. Consequently, he did not anticipate the blowback he would get. But get it he did. Even from his own supporters.  In a rare instance of backing down, he moved the rally to the next day, the 20th, still in Tulsa at the BOK Center.

But in America’s Black consciousness, Tulsa is known for a lot more than Juneteenth, as significant as that is. On another day in June, the 1st June day of 1921, Tulsa was the site of the worst race massacre in American history.

The day before, police had arrested a young black man by the name of Dick Rowland for allegedly attacking a white woman in a Tulsa elevator. Soon after Rowland’s arrest, rumors began to spread about a group of whites planning a lynching party. To protect Rowland, African American World War 1 veterans surrounded the jail holding him. There was a standoff with a mob of whites. Somebody fired a shot, and a firefight ensued. The much larger white mob pushed the black vets all the way to Greenwood, Tulsa’s black section.

Greenwood was the wealthiest black neighborhood in the country. Oil had made it rich. Racism was about to destroy it. Over the course of the day, 6,000 homes and businesses and 36 square city blocks were turned to ash. Pilots of two airplanes dropped turpentine bombs on buildings, instantly igniting them. Three hundred African Americans were slaughtered, most thrown into mass graves. Not a soul was ever prosecuted for anything. Then Tulsa, population 100,000, swept it all under the rug. Two generations later nobody knew a thing about it. It was never taught in schools, no books were written, no oral history passed down. It was as if it never happened.

Tulsa’s current mayor, G. T. Bynum, wants to take the rug up to see what’s hiding under it. He’s committed to investigating what happened and determining accountability. He thinks he’s found a couple of the mass graves and is having them excavated. The goal is to at least identify as many victims as possible through DNA analysis.

For the people of Tulsa, especially the black people of Tulsa, this is a deep, open, festering wound, and next Saturday Donald Trump will come riding into town on his big, very white horse to preach the gospel of Trump to 19,000 of his followers. It’ll be an interesting day.

There is one more incident of impeccable timing.

The Republican National Covention had been scheduled for North Carolina, but because North Carolina’s Democratic Governor Roy Cooper, concerned about the spread of COVID-19, would not guarantee a full house for the late August event, the Republican party has moved most of the convention to Jacksonville, Florida. The Coronation of Mr. Trump is set for the night of 27 August.

And, you guessed it, there is a black history story about 27 August and Jacksonville. It is known as Ax Handle Saturday.

The year is 1960 and the Jacksonville Youth Council of the National Association for the Advancement of Colored People (NAACP) is holding peaceful lunch counter sit-ins. Peaceful demonstrations. A group of outraged whites taking exception to this level of daring, begin spitting on the demonstrators and calling them names no one should ever be called. Then ax handles, mercifully without ax heads, suddenly appear along with baseball bats, and the demonstrators begin to get hit. Things go downhill from there. When it is all over dozens of young African Americans would be wounded in various ways. On a brighter note, nobody died, but that was probably blind luck.

To give you an idea of racial relations in Jacksonville at the time, a year earlier, in 1959, the year before Ax Handle Saturday, Nathan Bedford Forrest High School opened in Jacksonville, celebrating the memory of a Confederate General and the first Grand Dragon of the Ku Klux Klan.

The 60th anniversary of Ax Handle Saturday will be celebrated on 27 August in a park about a mile away from the convention at about the same time the balloons come down. Impeccable timing.

 

 

Racial Justice: If Not Now, When?

Monday, June 8th, 2020

Since the nonchalant murder of George Floyd our nation has galvanized behind the cause of equal justice for all. We have moved past the chaos of the first day or two to a too-loud-to-be-ignored-any-longer chorus peacefully demanding systemic changes in race relations. Now, the question of the moment is: What will come of this? After all, we’ve had demonstrations and protests when abominations like this have happened before. And afterwards, after the thoughts and prayers stuff, life goes on. Is this going to be any different? Personally, I think it will be.

Why? Let me tell you a story.

It is 31 January 1968. In Vietnam, it’s the most important holiday of the year, the Tet Lunar New Year. In years past, this seven to nine day holiday has been the occasion for an informal cease fire between North and South warring forces. But not this year. Since the previous autumn, the North Vietnamese military commander General Vo Nguyen Giap has been secretly caching weapons, ammunition and Viet Cong troops throughout the country. In late autumn 1967, in a brilliant move of military misdirection, Giap has North Vietnamese regular army regiments attack U.S. strategically placed Firebases in the highlands of central Vietnam. The ferocious  battle of Khe Sang is an example. As U.S. commanders concentrate on repulsing these attacks, Giap prepares to spring the Tet trap.

And in the early morning hours of 31 January, 70,000 Viet Cong troops attack all over the country.

The Tet Offensive takes South Vietnamese and American commanders and politicians completely by surprise, shocks the U.S. public and begins the slow erosion of public support for the war. The fiercest fighting happens in the city of Hue, the ancient capital of Vietnam. The Viet Cong capture Hue and hold it until they are finally driven out on 24 February by American forces. During the time they hold the city, the Viet Cong exact a terrible price. They go house to house arresting all people thought to be South Vietnamese sympathizers, including a convent full of Catholic Nuns. They massacre them all and throw them into mass graves. Five thousand people.

In three to four weeks, Giap’s forces are resoundingly defeated. He has spread them too thin. The Tet Offensive will prove to be a military disaster for the North, but, more important, it will become its biggest strategic victory. American and South Vietnamese politicians now realize the contest will be longer and much more deadly than they have anticipated, the mood of the American people begins to shift, and U.S. army Killed In Action increases to 500 per week.

And then, twenty days after the recapture of Hue, comes the most horrific and gruesome stain on America’s character during the entire war: The My Lai Massacre.

It is 16 March, and at the village of My Lai an American nerve-frayed platoon of the Americal Division under the command of 1st Lieutenant William Calley massacres hundreds of innocent civilians – men, women and children – as they run from their huts. Then they round up the rest of the village, line them up along a large ditch and shoot them all. According to Vietnamese records, they slaughter 547 people that day (the U.S. admits to only 304).

Calley had been ordered by his Company Commander, Captain Ernest Medina, to enter My Lai and kill the Viet Cong that Army Intelligence thought were hiding there among the civilian population. But there are no Viet Cong at My Lai that day. The Platoon troops don’t care. They kill everyone. And Calley, their commanding officer, stands by and watches. He does nothing to stop it.

Afterwards, Calley’s commanders in the Americal’s 11th Infantry Brigade will cover up the massacre by simply saying there wasn’t one. But the truth eventually comes out when American reporter Seymour Hersh breaks the story a year later (for which he will win a Pulitzer Prize). Calley is court-martialled, found guilty and sentenced to life in prison. President Nixon will reduce the sentence to three years and allow Calley to serve it by house arrest at Fort Benning, Georgia. The army also charges fourteen other people up and down the chain of command. All either have their charges dismissed or are acquitted at trial. Everyone seems to live happily ever after, even Calley, who doesn’t publicly admit any regret until 41 years later.

Why am I writing this? For two reasons. First, because the quality of leadership matters. All the leadership, top to bottom,  surrounding the My Lai massacre was horridly bad leadership, and, in the eyes of the public, leadership in many of America’s police departments is of a similar calibre. It is seen as suspect, at best, and despotic, at worst. Second, because the Tet Offensive and the My Lai massacre galvanized the American public into creating a movement that eventually became too powerful for politicians to resist and led to the end of the Vietnam war, a war that killed more than 50,000 Americans and millions of Vietnamese.

Today, we are in a similar situation of urgent morality. For hundreds of years, black children have been raised to fear whites, especially white police. “Don’t talk back, keep your hands on the steering wheel at all times, and never ever reach for anything.” Driving While Black is not fake news. The selection and training of police recruits continues to perpetuate this fundamental character flaw in the soul of America.

At the very least, what will reduce the worst in policing and increase the best is a thoroughly reimagined system of selecting and training new police officers. “Protect and serve” begins with empathy, actually seeing the people one is sworn to serve; actually listening to better understand them and their needs.

After My Lai, the army rebuilt its officer training programs. The Code of Military Justice and the Geneva Convention were given more attention. As we moved to an All-Volunteer Army, the selection criteria were rethought and enhanced. We have seen the benefit of that in our military’s improved conduct in Iraq and Afganistan. That kind of retooled selection and training has not happened in police academies. What has happened is more training in crowd control, more buying of military quality weaponry and a perpetuation of an us versus them mentality. These have been on stark display since the killing of George Floyd.

To change this will require sustained, dedicated and empathic leadership, which I’m guessing will not be coming from 1600 Pennsylvania Avenue, at least not in the immediate future. But the growing and forceful muilticultural demands for equal justice as vividly  demonstrated recently on the streets of America is a start, a start that urgently needs a finish.