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Severe respiratory pandemics
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WHAT IT IS
Pandemics are epidemics that cover the globe. There are formal definitions counting the number of continents.
Respiratory pandemics are those where the agent is passed on from person to person mostly via breathing. Flu, COVID-19 are the main instances of respiratory pandemics.
Pandemics cause 3D: disease, death and disruption.
- Disease can be acute or chronic, simple or complicated with other infections (which are called oportunistic).
- Death can happen more in certain age groups, or in certain health conditions such as preexisting diseases, overweight, pregnancy, etc.
- Disruption is caused by the disease itself if many people cannot work or need treatment at the same time. Likewise, by large numbers of death. Also, by fear of disease and death. By simultaneous needs for the same elements: diagnostic, treatment, vital. Finally, by feedback loops: if fear induces simultaneous buying, either by individuals or whole countries, that in itself may create scarcity where there was none. More extreme forms of disruption are of course conflict; pandemics would make preexisting issues worse.
Not all pandemics are severe. Those that cause great numbers of disease and death can be severe. Disruption, particularly if it causes disease and death secondarily, increases severity; an example is overwhelmed hospitals or populations scared to go to hospitals and suffering from other diseases. Finally, severity depends on preparedness and response: countries that don't have certain resources or that fail to coordinate rapid appropriate actions or learn from other countries' experience can have severe waves, at least initially, until they acquire the needed resources and learn to do better.
In a severe respiratory pandemic, as in a number of other situations, personal protective equipment (PPE) plays a relevant role. If the pandemic is severe enough, we will want more and better PPE.
General criteria for open source appropriate technology in PandemicOSAT.
LAYERS, TIMING AND FACILITATION
- Layers are used when no one single system is perfect. If we have say a perfect vaccine (one that is produced fast, 100% protective, 100% safe and available without friction to all humankind) then we can merrily multiply all the other interventions by zero.
- Timing is important in exponential situations, so if a virus generates cases in a multiplicative way (say 1 becomes 2 becomes 4 becomes 8 ... becomes 1024 becomes 2048 becomes 4096), then the sooner we act the better. It is more important if the multiplication is higher (1 becomes 3 becomes 9). Timing is specially important when our signal has delay: when we notice "deaths" and deaths happen weeks after the infections. Things are easier if we notice "fever" and it happens early in the illness.
- Interventions need to be facilitated (i.e. "made easy"). Masks, or instructions to make your own, need to be made widely available in suitable ways. Factors like doing the shopping for people who are in quarantine, paying them even if they are not working ("being quarantine is your job now, so thank you"), protection of those vulnerable to home violence, etc, are all bound to be needed at some point. Facilitation is seen as more humane and effective than enforcement, which is sometimes necessary but should be left as a second complementary option.
So, in summary, we want our interventions to be layered (or stacked), early and facilitated (made easy).
The prevention triad can be described using the acronym RIP: reduce, intercept, protect.
- Reduce means we try and decrease the number of opportunities for contagion. Each person is protected because there are less infectious people around.
- Scale can be very different. On a person-by-person basis, we can do individual isolation of a case. In groups, quarantine of a group of contacts can be done. For whole populations, lockdown of cities or whole countries has been carried out.
- Special settings can have their own flavor. In a classroom, having fewer students would count as reduction. In transport and offices, staggered workdays and timetables can all help in the overarching goal of having "less people in the same time and space".
- Timing and intensity are factors to be considered. The sooner the measures are introduced, and the higher the compliance, the more effective these measures can be.
- Intercept means we may have infectious and non-infectious people in the same space, but we place something in between to catch the virus.
- This can be lots of physical space around people, with a general 2-meter rule that really depends on the circumstances: indoors or outdoors, if outdoors direction of movement and wind (think of a cyclist following another cyclist), if indoors degree of ventilation, type of activity (exercise, talking, etc) and maybe other factors like temperature and humidity.
- It can also be done using barriers. These would be "room based" (a transparent wall), "furniture" (Excubator and a whole category of devices such as a perspex box for intubation of dentist or hairdressers), or "person based" (PPE).
- Given that air is a coloid that traps viral particles, and that sometimes space and barriers are used in combination because none is perfect, we could consider barriers to be solid air, or air to be a kind of "mostly empty" barrier.
- Protect means there may or may not be infected people around, and there may or may not be "things in between", but the susceptible person is herself better protected. This means vaccines but also general health, reduction of risk factors (losing weight, stop smoking - if they are found to make a difference), specific foods (again, if they help), etc.