April 28, 2020

Judge Sims Monday report:

April 27, 2020 – We’ve been notified of 4 additional cases today bringing our cumulative total to 83 COVID-19 cases in Harrison County. Removing the deaths & recoveries, we have 70 active cases.

Judge Sims recommends the following article by the respected author, Peggy Noonan:

What Comes After the Coronavirus Storm? 

Water Quality Could Be Altered in Buildings Closed During COVID-19 Pandemic. While restaurants, gyms, schools and other buildings are closed indefinitely to prevent the spread of COVID-19, the quality of water left sitting in pipes could change. In buildings nationwide, water left sitting for long periods of time could contain excessive amounts of heavy metals and pathogens that are concentrated in pipes, say researchers who have begun a field study on the impact of the pandemic shutdown on buildings. (NSF, 4/21/20)

In Race for a Coronavirus Vaccine, an Oxford Group Leaps Ahead

“…scientists (ENGLISH) at the university’s Jenner Institute had a head start on a vaccine, having proved in previous trials that similar inoculations — including one last year against an earlier coronavirus — were harmless to humans.

“That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.

“The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.

“Scientists (AMERICAN) at the National Institutes of Health’s Rocky Mountain Laboratory in Montana last month inoculated six rhesus macaque monkeys with single doses of the Oxford vaccine. The animals were then exposed to heavy quantities of the virus that is causing the pandemic — exposure that had consistently sickened other monkeys in the lab. But more than 28 days later all six were healthy, said Vincent Munster, the researcher who conducted the test.”

Live updates: House leaders abandon plans to return next week; U.S. coronavirus cases near 1 million—So if it’s too dangerous for the US House of Representatives to meet in disease ravaged Washington, why is Texas relaxingp crowd rules? I consider gatherings of people in Harrison County to be dangerous and will likely set up back in attempts to limit the virus spread. JHarris

Dr. Phillip Rozeman: Looking ahead with realistic expectations as we come out of COVID-19 (also on Facebook) I don’t know this Shreveport doctor, but I plan to look him up. This is a well thought out, realistic, assessment of what comes next in this area. JHarris

Over the last few weeks, we have watched the global pandemic and economic recession unfold on our television and computer screens. The phrase “flattening the curve” has become a part of most people’s vocabulary and tragic videos from hospitals and emergency rooms in New York City and Northern Italy are on all channels.

Prentiss Smith wrote in The Times, “People are afraid. People are anxious.” Those emotions are amplified by uncertainty about expectations. So what can we realistically expect over the next couple of months?

First, we can expect health systems will continue to provide relief to patients suffering from the complications of the COVID-19 virus. Leaders from Gov. John Bel Edwards down to health system leaders will continue to spend their time thinking ahead – anticipating problems and developing solutions. Local physicians will continue to modify treatment protocols based on the best thinking of experienced people across the globe. Pharmaceuticals and clinical research will continue to develop new treatments, testing, and vaccines for COVID-19.

We can expect to continue to put into practice some form of social distancing and protective face covering until an effective vaccine has been developed and people inoculated. These efforts are relatively easy and have been effective in reducing transmission of this and many other viruses. Social distancing has been effective in flattening the curve of the virus in our community.

We can expect different prevalences of COVID-19 in different regions of the country and significant differences in the number of cases in different neighborhoods within the same community. As a result, restart efforts will be done at different rates in different communities. The COVID-19 virus will not magically disappear and be replaced by a roaring economy by the end of May. We will have a new normal for a while. Absolute victory over COVID-19 will come only with a curative treatment, vaccine, or widespread immunity in the community.

We can expect a substantial reduction of complications of the virus if we concentrate significant efforts on reducing the spread of the virus in elderly people with chronic disease and people in high risk areas of our community. Aggressively managing high risk subsets (like done in nursing homes and the Caddo Parish Commission testing van to high risk neighborhoods) not only reduces risk in that subset but speeds the safe reopening of the economy and lowers the incidence of a second wave of COVID-19.

We can expect schools will open this fall. Children have a very very low risk of complications of the virus. We need to be ready with whatever resources to mitigate the transmission of the virus between children and elderly relatives and friends.

We can expect the development of benchmark health criteria to guide local decision-making in dealing with the health and economic crisis. These benchmark guidelines (new cases, COVID testing results, hospitalizations, ventilators) are vital to judge the speed of modifying stay at home, business opening, and social distancing policies.

We can expect loosening social distancing strategies could result in some rebound of the virus. Flattening the curve does not mean the curve goes away. The key in each community is maintaining these rebounds as small blips and not a significant wave that swamps the health systems. It is the reason for continued monitoring of health indicators; continued social distancing efforts; and continued willingness to be flexible and modify course as the future unfolds.

We can expect tension between efforts to control the illness and restart our economy. This tension between two very important issues is predictable and handling that tension will require leaders to acknowledge that personal perspectives are different. This difference in perspective may be based on everything from individual tolerance of risk to individual personal experience with the pandemic, health risk, and economic situation. As noted by Louisiana Sen. John Kennedy, we “need to save both lives and livelihoods.” We must do both.

We can expect widespread testing to be a focus in reopening the economy. Health officials and the U.S. Chamber of Commerce are calling for expanding testing. Right now, this robust and widespread testing strategy can’t be delivered as envisioned since there are not enough tests for everyone to have ongoing testing.

In addition, there are warnings from scientists over what tests are accurate as well as questions about the degree of immunity conveyed by antibodies. For now, we need to develop a plan that does not depend too heavily on testing everyone. We will implement the plan and monitor progress and add new testing provisions as they are developed.

We can expect there will be no silver bullet solutions for reopening the economy. Ripping off the band-aid is not the best approach. A graduated approach better serves our community. We can expect businesses, Chambers of Commerce, local government, faith-based and nonprofit leaders to have a big hand in implementing restart efforts. Along the way, consideration will be given to long-term reimagining efforts in our state and community. Could Shreveport-Bossier benefit from moving pharmaceutical and critical supply chain manufacturing back to the United States?

We can expect that the reinstitution of long-term strict stay at home and temporary business closure strategies will result in the same outcomes for the economy as noted in the initial use of this strategy. We simply cannot afford another round of massive unemployment. This means we have to work together to prevent a second wave of the pandemic.

In the meantime, we can expect doctors, nurses, and respiratory therapists to continue to care for those with COVID-19 with skill and compassion. We can expect small business owners to help their employees more than they can really afford to help. We can expect volunteers to work 18 hours a day at food banks.

We can continue to expect random acts of kindness to be numerous. People overcoming fear and anxiety. People expressing love for each other. People caring for each other. People working together. People building a greater future for our community and nation.

Dr. Phillip Rozeman is a practicing cardiologist. He is past board char of the Greater Shreveport Chamber, Blueprint Louisiana, and Northwest Louisiana Medical Society.

EXTENSIVE LIST OF NEW ENGLAND JOURNAL OF MEDICINE C-19 ARTICLES:

The following articles are now available on NEJM.org. For more articles and other resources on the Covid-19 outbreak, visit NEJM.org/coronavirus