The Morning Jolt

Health Care

The War on Coronavirus Advances on Five Different Fronts

A medical officer checks devices at an emergency hospital, handling coronavirus disease in Jakarta, Indonesia March 23, 2020. (Antara Foto, Hafidz Mubarak/Reuters via Indonesia Out)

Today on the menu: the different forms the world is utilizing to battle the coronavirus, from massively stepping up respirator production to creating treatments for those with the virus.

The Five Fronts

There’s no getting around it: The news is grim, and it’s going to be grim for a while. You can choose whatever metaphor you like; I prefer to describe this as the coronavirus bombing Pearl Harbor and leaving our medical Pacific Fleet in ruins. We never sought this fight and most of us were oblivious to the threat as it gathered. Now, after suffering our first shocking losses, we know we have no choice but to fight this lethal enemy. We don’t know how long this fight is going to last. We know we are certain to suffer casualties. But we have no choice but to fight this virus with everything we’ve got; unchecked coronavirus would not destroy America, but it would inflict unbearable losses and alter it irrevocably.

Perhaps it is worth remembering Winston Churchill, May 13, 1940:

I would say to the House, as I said to those who have joined this government: ‘I have nothing to offer but blood, toil, tears and sweat.’

We have before us an ordeal of the most grievous kind. We have before us many, many long months of struggle and of suffering. You ask, what is our policy? I can say: It is to wage war, by sea, land and air, with all our might and with all the strength that God can give us; to wage war against a monstrous tyranny, never surpassed in the dark, lamentable catalogue of human crime. That is our policy. You ask, what is our aim? I can answer in one word: It is victory, victory at all costs, victory in spite of all terror, victory, however long and hard the road may be; for without victory, there is no survival.

A plan for final victory is already taking shape. The United States of America, and the rest of the world, are attacking this threat on five key fronts.

Discovering and developing the vaccine.

Coronavirus is probably going to be a factor in our lives until late 2021. This doesn’t mean the current conditions will continue for another 18 months, just that we need to be prepared for the discovery, manufacturing, and distribution of a vaccine to take that long.

Yes, it is possible we could get lucky and the vaccine will be widely available before then. You probably saw the news of the first experimental vaccine trials that began last month. The good news is that at least 44 different projects to develop a vaccine are in development around the world. There are probably more great medical minds, with more resources and equipment and funding, attacking the coronavirus than have ever been thrown at any health problem ever before in human history.

(The Chinese government claims it will have a vaccine by April for emergency situations. But we all know China lies.)

Stanley Plotkin invented the rubella vaccine in 1964. He told Science magazine, “There may be advantages to having more than one anticoronavirus vaccine because if — and it’s a big if — one needs millions of doses, asking a single manufacturer to produce enough for the world is unlikely. One is going to need multiple manufacturers and if there are multiple effective vaccines so much the better. I am not arguing for the selection of a single coronavirus vaccine unless there are difficulties with others.”

Expanding hospital capacity.

You’ve been hearing about “flattening the curve,” in an attempt to keep the number of cases below the threshold of the medical system’s ability to treat everyone. There’s a horizontal line on the chart used to visualize this that represents “medical system capacity.” But that line doesn’t have to remain flat. The right moves can increase the capacity of our medical system.

Seattle already has two hospital tents on soccer fields.

In New York, they’re starting:

Four 250-bed federal emergency hospitals will be built in the Javits Center over the next 7 to 10 days.

The hospitals are being built by the Federal Emergency Management Agency. Construction material for the hospitals had already started to arrive as Cuomo spoke. Each of the hospitals will be 40,000 square feet and be staffed by 320 federal staff members.

Cuomo also said 30,000 retired healthcare workers are answering the call and have enlisted to help in New York’s coronavirus response.

All across the country, local and state leaders are looking at closed hospital facilities and either reopening them or preparing to reopen them.

Philadelphia is contemplating reopening Hahnemann University Hospital. In California, Long Beach Community Hospital is reopening. In New York, DeGraff Memorial Hospital in North Tonawanda may reopen. The New Jersey Department of Health is working to re-open Inspira Medical Center Woodbury in Gloucester County. This country has 155 closed rural hospitals.

Each one of those adds a couple hundred more beds — and capacity to handle non-coronavirus health care that cannot be delayed.

Making more masks.

Mask production is expanding: “3M has ramped up production of N95 respirators and doubled its global output to nearly 100 million per month; in the United States we are producing 35 million respirators per month.” Fiat Chrysler will start manufacturing face masks in the coming weeks and expects to be able to create 1 million per month. (One unnerving detail: “The automaker confirmed to TechCrunch that production capacity is being installed this week at one of its factories in China.”)

Those homemade ones might help somewhat, but they are not really a suitable substitute for health-care workers and others likely to be exposed to the coronavirus.

Making more ventilators.

America’s auto-making factories to the rescue!

Ford said it will work with 3M to produce a new kind of Powered Air-Purifying Respirator for healthcare workers. A PAPR has a clear mask that fits over the face. Air is drawn in through a tube connected to a pump that filters the air. The PAPR will be made using parts from both Ford and 3M, the automaker said, including fans used in the Ford F-150’s optional ventilated seats.

Ford said it is exploring the possibility of producing the device at one of its Michigan factories. 3M will also make the respirators at its own factory, Ford said.

The automaker also said it will work with the United Auto Workers Union to assemble clear plastic face shields that protect people from possibly infectious bodily fluids. The Ford-designed masks are being tested at Detroit-area hospitals. They could be used by healthcare workers, but also others, such as store clerks, who must regularly deal with the public.

Ford is also using 3D printers at its Advanced Manufacturing Center to create disposable air-filtering respirator masks. Once approved, Ford said, the company could initially 1,000 masks per month but hopes to increase production as quickly as possible.

Finally, something that might make that GM bailout worthwhile:

General Motors said last Friday that it was going to work with Ventec Life Systems to help increase its production of ventilators for hospital patients. On Monday, the two companies announced that Ventec “is now planning exponentially higher ventilator production as fast as possible” as a result of the partnership.

Also notice this detail from a March 22 announcement from Food and Drug Administration, which suggests that one possible solution is on the bedside tables of millions of Americans.

Continuous Positive Airway Pressure (CPAP), auto-CPAP, and bilevel positive airway pressure (BiPAP or BPAP) machines typically used for treatment of sleep apnea (either in the home or facility setting) may be used to support patients with respiratory insufficiency provided appropriate monitoring (as available) and patient condition.

It’s hard to get a sense of how many CPAP machines are out there, but one manufacturer, ResMed, said in 2018 it had millions of patients. One company estimates 5 million Americans use CPAP machines.

Making more treatments for those who have coronavirus.

I can’t believe I have to say this, but do not eat fish tank cleaner to prevent coronavirus.

Right now, the Food and Drug Administration is investigating two drugs that are approved to treat other diseases (chloroquine and hydroxychloroquine) and another, more experimental drug (remdesivir). Around the world, 40 studies for coronavirus drugs have begun but are not yet recruiting for clinical trials and 49 are recruiting.

With progress on these five fronts, we can gradually lift the social distancing, shelter-in-place, lockdowns, and those loosely enforced curfews. In time, as the country adjusts, state and local governments will reevaluate whether all of these restrictions makes sense for every area. For example, right now, California is in lockdown, meaning everyone is expected to stay home except to get food, care for a relative or friend, obtain health care or go to an “essential job.” But as of this writing, 16 counties have no reported cases (mostly rural ones).

ADDENDUM: Thank you to Michael Brendan Dougherty for the kind words on the most recent edition of The Editors, and thanks to Kevin Holtsberry for his high praise as well.


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