March 2020: So You’re NOT Going to HIMSS…

Dateline, March 05, 2020: Due to concerns over the COVID-19 Coronavirus, HIMSS has been cancelled. What happens next? Mike Farahbakhshian explores. Suggested drink pairing: 1978 Darroze Domaine La Poste Armagnac; while it’s a bracing 96 proof, it still does not contain enough alcohol to be a hand sanitizer, so you’re better off sipping it in your germ bunker.

No HIMSS, No Problem! Well, Actually… Lots Of Problems.

Well, Useketeers, it’s March, and Surprise: HIMSS 2020 is Cancelled! That’s good, because who wants to go to Orlando to mill around in an exhibit hall in a suit? Except it isn’t good, because it seems my doom-and-gloom predictions about the COVID-19 Coronavirus have come to pass and then some. As feared, misinformation and information suppression is the order of the day. An unqualified Mike Pence has been put in charge of a Coronavirus task response, bypassing career professionals with actual epidemiological expertise. Distressed by the statement by director of NCIRD Dr. Nancy Messonier that COVID-19 spread in the US would be an inevitability, POTUS attacked Dr. Messonier due to her relationship to Rod Rosenstein and directed that all COVID-19 messaging would be vetted through him. Meanwhile, POTUS is lying on national TV, openly disputing facts based on unsubstantiated hunches, specifically contesting the World Health Organization’s revised fatality rate of 3.4%. (To compare, the regular flu has a fatality rate of 0.1%.)

It should be noted that the fatality rate is tied to what we currently know about the virus. There’s a very good breakdown for the rationale here. In fairness to POTUS, given the fact that there may be many, many mild or asymptomatic cases, it’s entirely possible the fatality rate is lower. Yet until we know this, we cannot make a data-driven decision. This thread is educational and shows the danger of what something this communicable and infectious can be to our Healthcare system, even with a low death rate. Either way, hunches are not a substitute for data when dealing with infectious diseases. Neither are conspiracy theories. POTUS and his supporters are promoting the ludicrous belief that the Coronavirus concern is somehow a hoax meant to damage Trump’s political prospects.

The first deaths on US soil were matched with the understanding that community spread has been going on for some time. The stock markets are tanking as the global supply chain is impacted. Even worse: your dogs might be getting the Coronavirus too! Meanwhile, President Trump is promoting vastly unrealistic timelines for development of a vaccine, even after being told in real-time by NIAID Director Anthony Fauci that the timeline is closer to 18 months factoring in safety testing and clinical trials. Nevertheless, POTUS persisted with this incorrect, inaccurate, false messaging, despite being repeatedly corrected by experts. Meanwhile, at least one US Senator is promoting a conspiracy theory that COVID-19 is a Chinese biological weapon run amok (it’s not). These conspiracy theories are as dangerous, if not more dangerous, than COVID-19, and they are increasing in frequency and outlandishness. This is the worst case scenario that I mentioned in last month’s column.

Policy, Conspiracy and Bureaucracy: The Triple Threat

So, domestically, we are reacting to COVID-19 with incompetence, politicization, lying, and conspiracy theories. How about overseas?

I’m sad to say things are even worse, with Italy and Iran being new hotbeds of COVID-19. Given Italy’s relatively central location in the EU, and Iran’s central position in the Middle East, this does not bode well and makes containment practically impossible at this point. It’s especially bad in Iran, with senior leadership being infected, including one in ten members of Parliament. Disinformation and misinformation are pretty bad. More religious Iranians are licking religious shrines to … I don’t know, find out how many licks it takes to get to the Tootsie Roll center? More secular Iranians are being flooded with an equally ridiculous conspiracy theory that COVID-19 is an American biological weapon; so are the Chinese, and the Chinese Government is doing nothing to stop this conspiracy theory. You know the misinformation has gone out of control when there is a Wikipedia page devoted exclusively to misinformation related to COVID-19. It should be noted that these conspiracy theories, both domestic and foreign, are being promoted by governments – the same governments that should be containing this pandemic. If you hear a state-sponsored conspiracy theory, know this: it’s simply a way of shifting blame from their own incompetence.

As an amusing aside, the Iranian conspiracy theories are being promoted by the head of the Revolutionary Guard, who is named – I am not making this up – Hossein Salami. I guess you can say he’s a bit … salty about the whole situation. (Rimshot.)

The outlook for testing for COVID-19 is equally grim. Stateside, we are caught in an interagency turf war. It is detailed in this complex Twitter thread, but here are the highlights:

• The CDC has developed a quick test for COVID-19 that hospitals can use.
• However, since HHS has declared COVID-19 a public emergency, hospitals need FDA permission to use these tests.
• Neither CDC nor FDA have given hospitals permission to run these tests, so right now CDC’s lab is the only one that can process the results.

Meanwhile, South Korea has developed simple self-use tests and drive-through testing stations. This isn’t a matter of technology, it’s a matter of policy. In theory, VP Pence has provided guidance for accelerated testing that should remedy this problem. However, given that CDC barred an FDA expert from the premises due to a “scheduling misunderstanding,” I do not hold out any hope for this problem to be solved anytime soon.

It’s almost as if we learned nothing from China’s faltering lessons. Normally, I love being right about my hot takes coming true, but this is one time I really, really wished I were wrong. But hey, at least you don’t have to go to HIMSS, right?

Thou Shalt Not COVID Thy Neighbor

All the suggestions I made about accurate truth-in-reporting and providing incentives for better patient behavior in last month’s column stand; I recommend you refresh yourself if you were too busy packing for HIMSS to read. On the ground, here are a few common sense things you can do to combat the spread.

• Quit buying masks. Even the Surgeon General says so. Even the CDC admits masks will not help you under the circumstances you think they will. Most masks are meant to protect the patient from coughing droplets out. The remainder are used by providers, but are single-use when seeing patients. If you have a mask, and keep using it over and over, the particulate matter will just build up on the outside and over time increase the chances you will get infected.
• Seriously, quit buying masks. Even the N95 masks that everyone wants need to be properly fitted. They won’t work with facial hair. Quit buying masks.
• Wash your hands for at least 20 seconds with warm water and soap. Warm water and soap denature viruses. You don’t need antibacterial soap because COVID-19 is not a bacterium. Hand sanitizers are useful in a pinch but too much will cause dry, cracked skin which increases the surface area for COVID-19 to land. As the good folks of Round Rock, Texas said in their educational campaign, “Wash your hands like you just got done slicing jalapeños for a batch of nachos and you need to take your contacts out. That’s like 20 seconds of scrubbing, y’all.”
• Public officials are going to tell you not to touch your face, but then they touch their face while saying that. So while that is a best practice you should follow, we both know you won’t. Try to minimize touching your face. Wash your face like you’ve just touched it after slicing jalapeños, y’all.

• 

  Maximize your distance from sick people. If you’re an introvert like me, maximize your distance from everyone. Stop shaking hands. Fist bumps and elbow bumps may be better, but ideally there are other ways to signal solidarity without even touching.

• Needless to say, avoid conventions like the now-cancelled HIMSS. If you want to simulate the experience of HIMSS, just wait next to your coffee machine for 45 minutes before pouring your first cup.
• Stock up on supplies you would get at a pharmacy. Since pharmacies will soon be filled with Coronavirus patients, minimize your trips there, if possible, by front-loading all your first aid, beauty, and OTC medical supplies.
• While you’re there, get your flu shots. Right now COVID-19 disproportionately affects the elderly and those with comorbidities. Pneumonia resulting from a bad flu would give COVID-19 a weakened body to further damage.
• If you are sick, stay home. If you think you are sick, go to a doctor. As long as the fatality rate is as high as it appears to be, this is not a disease to “power through.” Full stop.

What About Health IT, specifically?

Glad you asked. Here are a few Health IT specific suggestions that our little community can employ to help slow the spread of this disease:

• Tele-all the things. Telework if you can. IT is great that way. If you need to speak to a provider, use telemedicine offerings.
• Game the supply chain. It’s tempting to use Amazon and Doordash for everything while you’re holed up in your germ bunker. Yet know the following two ugly truths: the global supply chain is inexorably tied to China, and the foodservice/gig economy is a sector that isn’t very forgiving of calling in sick. So, your attempt to have everything delivered may result in very long waits because of Chinese lockdowns, or your pad thai being delivered by a virus-shedding gig driver who cannot afford a day off to get checked for COVID-19. Use this knowledge wisely and try to source what you can, where you can, from locations you can trust to deliver on time.
• Keep abreast of public health information. We’re the Federal Health IT community, so we’re not going to fall victim to Uncle Boomer’s Facebook Disinformation Campaign, now… are we? No, we are going to trust in good data curation and strategic communication from trusted experts. Bookmark these two pages: the CDC COVID-19 page, and the WHO COVID-19 page. Check them frequently. Aunt Karen’s advice about colloidal silver and essential oils may be complete garbage, but you can always trust good old Doctor WHO.

  

Things Will Get Worse

You are likely to be infected by COVID-19. Current predictions indicate that within the coming year, 40-70% of the world may be infected by COVID-19. The good news is, for most of us, it will be like a cold or flu. The bad news is, with this fatality rate, it’s going to mean a lot of death worldwide.

Consider this thought experiment. Let’s charitably say that Meaningless Use has one hundred readers. (If only.) Even with the low-end rate of 40% infected worldwide, that means 40 of you will contract COVID-19.

What does that mean? Well, for 39 of you, it means you will have a pretty crappy cough or fever. Maybe some aches and pains. Yet, with a 3% fatality rate – lower than the WHO’s official numbers presently –  one of you will succumb to the disease.

Let that sink in for a second.

I don’t have answers for what comes next. Yet if we work together, calmly and with purpose, we can do what we can to contain this threat. Stay on point. Don’t give in to conspiracy theories. Demand competence from our elected and career Government officials. We have a lot of work to do.

But hey, at least you didn’t have to go to HIMSS.

For more insight on this evolving epidemic, see this interview with Coalition for Epic Preparedness Innovations, Dr. Richard Hatchett.