Covid-19 : Supply Chains and Disaster Preparedness.
We here in Jackson Hole are way past starting a discussion on instituting disaster preparedness for the upcoming Corona Virus which is likely to pay us an unwelcome visit this year. I have discussed supply chains and how they impact life here in my blogs and in previous guest editorials and it is time to hammer this meme home again. There is no evidence the current administration in DC is taking the current world pandemic seriously beyond fatuous statements that the situation is” under control.” Clearly, nothing is under control and we in Wyoming will need to find local and state officials to formulate an intelligent response. I would like to offer a first take on what we should be doing right here and right now.
First: consider our vulnerability. We are 99% dependent on long supply chains for everything we use and consume here because our economic and corporate leaders decided decades ago to maximize efficiency and profit over buffers, inventories and redundancy. We have JIT(just in time) delivery of everything. And what is worse is that we are not at a nexus of supply chains like in Denver and Salt Lake.. We are at the TAIL END of the supply chains. Some of our supply chains are relatively secure such as in energy and others like food and medicine are at risk. The Novel Corona virus is unique in that it is long lived on dry surfaces, spreads easily because of a High R0( “R nought”) of over 2.5 meaning one carrier infects an average of 2.5 individuals. You need a R0 of less than1.0 for the virus to die out. Asymptomatic carriers can spread infection before they show symptoms and carriers can infect for periods greater than 14 days. You can be “REINFECTED” after the first episode. The disease is spread not only by aerosol droplets from victims coughing but from droplets landing on clothes and skin surfaces, credit cards, door handles etc. The disease varies in lethality but the aged over 70 and those with chronic disease are at great risk. Amazingly, children seem to be largely spared so far. There is no treatment beyond supportive and there is no vaccine and none in the near future. Testing is not being done in the US unless you visited China or came in contact with a documented victim. The first batch of only 200 test kits send out this month from the CDC to regional labs had many that were defective, The test may be unreliable with many “false negatives” even on people who later died of Covid-19. Research labs have to get permission from the government to try to develop new and better tests. These are grim facts to swallow. What then should we do now?
Swamp Cheyenne with calls and emails asking that our Governor set up a task force of experts. China has helped to show us some possible strategies:1. Keep people isolated to try to get the R0 below 1.0. 2. Keep critical aspects of the economy going such as food distribution and critical medical supplies. 3. Keep the infection rate low enough so that it doesn’t swamp our hospitals. 4. Establish stockpiles of masks, and medical supplies such as oxygen, pulse oximeters and portable respirators. We need gowns and hoods giving full isolation for our nurses and doctors. We have very few doctors and nurses trained in pandemic response techniques and few doctors know how to intubate and manage respirator patients. They are a vital link in any response and we must keep them healthy. We need decontamination agents and equipment and people who know how to use it. This little hospital has very few critical care beds. Perhaps more could be added in the OR or even in the large hotels in town. We may need emergency providers from the Fire and EMT community who are skilled in starting IVs and managing airways.
Members in the community need to be self sufficient. First and foremost they need stockpiles of food and water primarily long lasting non refrigerated items like grains, beans and rice. Every person needs to have a minimum of 1-3 months of food. The LDS church has long demanded that of its members and good websites abound. Both the Red Cross and the Dept of homeland security have good disaster plans online. Read them. We have no community food depots but we could easily set up such areas. If efforts such as this fail then most people will need a plan B which could include learning to live under quarantine or even evacuation. We may need to consider restricting tourism by turning back tour buses and restricting aircraft from hot areas or even entirely. Most people have the sense to self regulate by staying out of crowded venues like aircraft and buses, concerts and conventions, sports events and crowded bars, restaurants and churches and of course schools. Under this scenario the local consumptive, service and tourism based economy will be brought to its knees. Welcome to Wuhan, Iran and Italy where this is a current reality. Let the discussion begin!
This a guest editorial which our local newspaper has decided not to post,presumably because it is a booster of our Real Estate and tourism based economy and my letter casts doubt upon its viability in the medium term. The situation in the US is especially grim because of our dysfunctional, profit based health system with millions without insurance and many more millions with high deductibles and co pays. Having Trump/Pence in charge just adds another terminal layer of ignorance, denial and incompetence. The only way to manage and monitor this situation is at a national level with intelligent leadership. Testing needs to be FREELY AVAILABLE to everybody. The high cost of the tests guarantee that the spread will be exponential. South Korea does the tests for FREE. From a treatment standpoint there is little reason to be tested because there are no treatments beyond supportive, and supportive treatment could easily swamp the nations hospital beds and ICU beds. There are 931,000 beds in the US and only 94,000 ICU beds most of which are already occupied. I see this morning that Trump says he is not afraid and plans to continue with his political rallies. Let’s hope so.
Hugh Owens MD, Wilson.