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User Info	Here It Comes; entered at 2021-07-22 10:47:50
Cvdoc Posts: 562 Registered: 2009-06-11 Washington, DC	And yes. It was Farrs Law. Here is something I wrote last year. Farrs Law: In Action Since 1840 In 1840, Farr set out his theories on the smallpox outbreak. (https://babel.hathitrust.org/cgi/pt?id=n.... ). His numerous observations then are still valid and should guide our thinking on the epidemiology of all infections and especially Covid-19. Farr showed that epidemics rise and fall in roughly a bell-shaped curve (a normal distribution) shape. Farr demonstrated that once peak infection has been reached then it would roughly follow the same symmetrical pattern on the downward slope. However, under testing and variations in testing regimes means we have no way of knowing when the peak of infections occurred in any given pandemic. Due to these variations he proposed we should use the data on deaths to predict the peak. There is a predicted time lag from infection to COVID deaths (https://www.worldometers.info/coronaviru.... Once peak deaths have been reached we should be working on this assumption that the infection rates is falling in the same progressive steps. As with other infections, death rates are lagging indicator for infections and should guide the planning of the next steps for reopening those societies that are in lockdown. Farr also explained the problem with density in epidemics. In situations of high-density the course of infection may be prolonged. Specifically for Covid-19, mortality may be extended in confined populations (e.g., in nursing homes and hospitals) particularly if distancing cannot occur and if stringent measures to prevent onward infection are not instituted. In the previous SARs outbreak, a lack of isolation facilities allowed infection of patients admitted to the same wards for other reasons: many admissions as is the case now did not have typical signs of SARS, which led to worsening of infection control. (https://www.ncbi.nlm.nih.gov/pmc/article.... In Covid-19 neither Canada (https://www.mcknights.com/news/81-percen.... nor the United States (https://abcnews.go.com/US/coronavirus-fa.... learned the lessons that Asia did with SARS. In the second phase of the 2002-3 outbreak in Toronto transmission occurred mainly within health care settings (https://www.ncbi.nlm.nih.gov/books/NBK92.... Hospital workers were placed under 10-day work quarantine, avoided public places, close contact with friends and family, and wore a mask whenever public contact was unavoidable to prevent transmission. 17 years later this lesson was also not learned. Again, a small number of cases, which do not follow the expected geometric progression, then a sudden explosion. When reporting is actually done we see patterns where a huge percentage of the first infected reports are in hospitals. Medical workers in hospitals are a tiny fraction of the entire population and yet they often make up 1/5th to a 1/6th of the original infected population sample and drive the second wave. This has happened repeatedly, beginning in Wuhan. (https://www.fox9.com/news/1-in-5-covid-1.... Singapore identified this immediately and stopped the madness by mandating washing of hands with soap and water, not so-called sanitizers, before and after each contact with a person or thing that could potentially be infected. By doing that they dropped the infection rate of their hospital staff to a statistical zero and almost immediately thereafter the outbreak there was under control. They still get a case here and there, but the simple fact is that it isnt that easy for social transmission of this bug to take place, except through super-spreading events. (https://www.newyorker.com/news/news-desk.... (https://www.cdc.gov/coronavirus/2019-nco.... Singapore couldnt have stopped transmission to health care workers without mandating strict hand hygiene standards. We have repeatedly seen this pattern where you have a case here and there, a few people show up in the hospital and then the sudden exponential explosion occurs after failing to follow the predicted geometric progression for weeks and it happens in city after city. Social distancing doesnt stop or reverse it and neither do stay at home orders, even when backed up with the threat of fines or worse. We have long known that medical workers, including doctors and nurses, do NOT wash their hands in hospitals generally. They are also exempted from lockdowns. Healthcare workers in New York used the public transportation and indeed contact tracing showed that infections in New York City tracked that transportation system. (https://www2.nber.org/papers/w27021). The only other way to stop this type of transmission is to arrange so all Covid patients go to hospitals where nobody is allowed in the building unless actively ill, in which case they cant leave until not, or proved seroconverted by antibody test and thus immune. This Sanatorium model was utilized in Wuhan, but would never have been tolerated in the West. Farr also illustrated that those who are the most mortal die out, and in a pandemic are those in most need of shielding (https://www.cdc.gov/coronavirus/2019-nco.... In the midst of a pandemic, it is easy to forget Farrs Law, and think the number infected will just keep rising, it will not. Just as quick as measures were introduced to prevent the spread of infection we need to recognize the point at which to open up society and also the special measures due to density that require special considerations. But most of all we must remember the most important message Farr left us: What goes up must come down. 2021-07-22 10:47:50