Provided by Tom Ulmet on March 10, 2020.

Trends, Thoughts, Facts

Current trend from WHO:
Below is the current one-day result of newly reported cases a week apart. This illustrates that containment is working in China and that the virus is making its first pass in other countries. 

  March 2, 2020 March 10, 2020
Total Confirmed Globally 88,948 (1,806 new) 113,702 94,125 new)
China 80,174 (206 new) 80,924 (20 new)
Outside China 8,774 (1,600 new) 32,778 (4105 new)

March 2:

March 9:

The March 10 report shows that in China and SAR’s, one-day new cases were identified in only in Beijing (1), Hubei (17), Guangdong (1),  and Hong Kong (SAR) (1). The next danger is that as the virus spreads around the world, it may mutate and re-enter China through people returning from infected countries. With relatively small numbers of new cases, mostly in social clusters with no wide outbreak in any region, we are moving closer to the government in China announcement of a possible opening date that would likely be at least two weeks from the date of announcement. 

Face Masks: On or Off
Due to previous experience with viruses, many in Hong Kong who ventures outdoors prefer to wear a face mask. In the US the opposite approach is taken. “While face masks are recommended in places such as emergency rooms, are they truly necessary in day-to-day life? Infectious disease physician and hospital epidemiologist at Tufts Medical Center Dr. Shira Doron doesn’t believe so. . . . She said most viruses do not spread through the air and that to catch a virus, you must be in extremely close proximity to a symptomatic person. Face masks do not protect against airborne viruses because they do not filter small air particles or seal the face. Face masks can be effective against close droplet transmission, which is when viruses are spread through actions like sneezing and coughing, Doron said, “There are no studies to confirm that a face mask in a public place is effective at preventing infection,” Doron said. Face masks are useful in hospitals, where many viruses are circulating in close proximity.” The difference of opinions is no doubt due to the experiences that people in Hong Kong have with many types of viruses with a dense population in smaller living spaces. It does help to explain why face masks are not required in China in less affected areas.

Dr. Anand Parekh of the Bipartisan Policy Center and former U.S. Department of Health & Human Services deputy assistant secretary for health from 2008 to 2015 said, “You should not be walking around with face masks. The individuals who need face masks are those who are infected, health care workers or those potentially that have been exposed. But if you are a healthy American, you do not need to be walking around with a face mask.”

Will the Virus Slow Down in Warmer Weather?
Have we gained any knowledge from previous viruses? In this simplified SARS summary of prior studies, researchers show that there is a significant increase in infections during colder weather and by the time May warm weather came around, it had almost disappeared. What might this mean with regard to COVID-19? First, although different, the make-up of the coronavirus is a 79% match with SARS and the genome sequence has a 93% match. MERS has a 50% match.


Click here for larger image

Four types of coronaviruses circulate annually. This research of COVID-19 compared with other bat viruses showed most similarity to SARS. In five gene regions (E, M, 7, N, and 14), the sequence identities were greater than 90%, with the highest being 98·7% in the E gene.  

Interestingly, it also showed that viruses do not totally die out, but that immune systems function must better in warm weather and humans are not as susceptible, except those in certain groups such as the aged, ill, infirm, smokers, and those with other diseases.

This suggests that the study of temperature related to the spread of SARS may be useful in predicting how COVID-19 will behave as temperatures increase. A similar study of MERS showed an increase of cases in lower temperatures and a decrease in spread in higher temperatures.

For example, “an increase of 1°C in air temperature was associated with an average reduction of 3·6 cases. This article concludes that “Air temperature might be a very important factor in the emergence and elimination of SARS.” And indeed it was, with SARS and MERS as well. This provides hope that warmer temperatures will see a great decline in numbers of cases.

With these things in mind, everyone should hope that containment efforts are strong enough to get us into warmer spring weather when immune systems are stronger and the virus cannot sustain itself as well. 

The Need for School Hygiene and Sanitization
This fascinating research showed that environmental surfaces, particularly indoors, are likely contributors to the transmission of viral infections. At 4°C, infectious virus deposited on stainless steel surfaces persisted for as long as 3 days at 50% relative humidity and up to 28 days at 20% humidity. At higher temperatures and humidity inactivation of the virus on metal surfaces was more rapid. This is why intense cleaning regimens several times a day of any surface used or touched by children must be implemented.

“Effects of Air Temperature and Relative Humidity on Coronavirus Survival on Surfaces”

Fear Factor Running High
When a virus breaks out and shows a high rate of spread, infection and hospitalization/death rate, the psychological impact of fear increases and results in emotional responses from people most impacted. This has now carried over into economic activity. The strong containment measures taken to control the spread of the disease also result in decreased economic activity.

China’s manufacturing purchasing managers’ index plunged to 35.7 in February from 50 the previous month, according to data released by the National Bureau of Statistics, much lower than the median estimate of economists. The non-manufacturing gauge also fell to 29.6, its lowest ever. Both were well below 50, which denotes contraction. This realization has now spilled over into the US where shortages of parts from China is slowing manufacturing of some key items and is affecting the stock market.

"As explained in a previous message, we are currently seeing two epidemics. An epidemic of infection and an epidemic of anxiety. Information and education are key factors in the management of infectious and contagious disease. It remains our opinion that given balanced and rational explanations of unfolding uncertainties, most people will be less anxious about the Coronavirus epidemic."

How Serious Is This
Obviously for 20% of the population above the age of 60 who contract the virus this is a serious and potentially life-threatening matter. However, for the other 80%, it may pass readily within 10-14 days.
“In the WHO Director General’s previous analysis, 80% of cases cause mild disease, 14% severe disease and 5% critical disease. The review shown below looked at outcomes in critically ill patients. The mean age in this cohort was 60 with 67% males. Thus it appears that the virus finds older people with low immune systems more susceptible to critical illness from the virus than other age groups.“ This means that 80% of those affected contract a mild form of illness and may recover well at home, provided they are isolated and do pass on the virus.

Fear and Demands                
When under pressure of extraordinary restrictions, people tend to make demands on others for the provision of normal services or to make up for the loss of them. This is true also in education and we must be creative in our thinking and responses to those who make such demands which may include making up classes missed after school, on weekends or extensions of the school year. Many of these things involve contractual agreements with our education providers, the classroom teachers. It is important to maintain open communication with teachers and include them in planning to find practical solutions to these kinds of demands.

For leaders, the next phase of reopening campuses will be filled with new challenges such as determining how many families will actually return and when, how to coordinate quarantine requirements with reopening times, examining options for make-up of classes even though online learning has taken place and preparing the staff and facilities for intense cleaning and maintenance routines. As these pressures build, talk to a neighboring Head and exchange ideas or simply commiserate and you will feel better.

For some inspiration, check out Kipling’ famous poem “If.”  It is an inspiring read in troubled times.  “If you can keep your head when all about you are losing theirs and blaming it on you; If you can trust yourself when all men doubt you, but make allowance for their doubting too; . . . . . etc..” With apologies for era related gender use . . . . .

Be patient, be strong, be confident, be safe! We will get through this!