Emotional Well-Being During the COVID-19 Crisis for Health Care Provider...

Healthcare Personnel and First Responders: How to Cope with Stress and Build Resilience During the COVID-19 Pandemic

Providing care to others during the COVID-19 pandemic can lead to stress, anxiety, fear, and other strong emotions. How you cope with these emotions can affect your well-being, the care you give to others while doing your job, and the well-being of the people you care about outside of work. During this pandemic, it is critical that you recognize what stress looks like, take steps to build your resilience and cope with stress, and know where to go if you need help.

Mechanisms in neurobiology which help physicians and caregivers to deal with covid-19 patients.

Recognize the symptoms of stress you may be experiencing.

1. Feeling irritation, anger, or denial
2. Feeling uncertain, nervous, or anxious
3. Feeling helpless or powerless
4. Lacking motivation
5. Feeling tired, overwhelmed, or burned out
6. Feeling sad or depressed
7. Having trouble sleeping
8. Having trouble concentrating

Tips to cope and enhance your resilience.

Communicate with your coworkers, supervisors, and employees about job stress.
Talk openly about how the pandemic is affecting your work.
Identify factors that cause stress and work together to identify solutions.
Ask about how to access mental health resources in your workplace.
Remind yourself that everyone is in an unusual situation with limited resources.
Identify and accept those things which you do not have control over.
Recognize that you are performing a crucial role in fighting this pandemic and that you are doing the best you can with the resources available.
Increase your sense of control by keeping a consistent daily routine when possible — ideally one that is similar to your schedule before the pandemic.
Try to get adequate sleep.
Make time to eat healthy meals.
Take breaks during your shift to rest, stretch, or check in with supportive colleagues, coworkers, friends and family.
When away from work, get exercise when you can. Spend time outdoors either being physically activity or relaxing. Do things you enjoy during non-work hours.
Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting and mentally exhausting, especially since you work with people directly affected by the virus.
If you feel you may be misusing alcohol or other drugs (including prescriptions), ask for help.
Engage in mindfulness techniques, such as breathing exercises and meditation.
If you are being treated for a mental health condition, continue with your treatment and talk to your provider if you experience new or worsening symptoms.

Stress and Coping

Stress during an infectious disease outbreak can include

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Worsening of mental health conditions
• Increased use of alcohol, tobacco, or other drugs

Self assessment and inventory.

People who may respond more strongly to the stress of a crisis include

Older people and people with chronic diseases who are at higher risk for severe illness from COVID-19

Children and teens

People who are helping with the response to COVID-19, like doctors, other health care providers, and first responders

People who have mental health conditions including problems with substance use

Pre-existing conditions

High risk categories...age, chronic illness, emotional wellness

Note: Self assessment can be very difficult. Due to peer pressure, shaming and self esteem issues it is very easy to be in denial.  Ask for help when you feel overwhelmed and/or inadequate.  Others are experiencing these feelings as well. Sharing is caring.

Hopefully this post will help those on the front lines of the covid pandemic.

Please consult with a trusted professional before acting on information in this post.

Stay safe !

The Golden State Awakens

According to Guidelines from the CDC and Governor Gavin Newsom California will begin to stir on Friday from it's self-induced coma.   Restarting the economy will be a great challenge rivaling the shortage of PPE and ventilators.

Perhaps some background music will help us all

After weeks of waiting, some California businesses can reopen Friday. But it's complicated. Here are 5 things to know about the reopening.

California will move into the first new stage of its reopening plan at the end of this week, and some retail businesses will be allowed to open back up for customers as early as Friday — assuming they comply with new health guidelines, Gov. Gavin Newsom announced Monday.

The state has made enough progress in its efforts to contain, trace and test for the new coronavirus to allow retailers to reopen for curbside pickup, Newsom said. The businesses able to reopen this week include clothing stores, bookstores, music and toy stores, sporting goods stores and florists — which will be able to open in time for Mother's Day on Sunday, the governor pointed out.

Manufacturers and other logistics companies that make up retail supply chains will also be able to reopen, he said. On Thursday, the state will announce guidelines that the reopened businesses must follow to ensure social distancing. In the past, Newsom has said those requirements may include temperature checks at the door and fewer tables inside.

This step means that California is entering Stage 2 of its gradual, four-part reopening plan, which Newsom laid out last week. The timeline for moving into each stage will depend on the state's ability to ramp up testing for the coronavirus, begin widespread contact tracing of people who've tested positive, and protect vulnerable residents, Newsom said.

Here are five things to know about Monday's announcement: 

This graphic from the governor's office shows the metrics that officials will use to decide whether the state is ready to lift more restrictions. (Office of Gov. Gavin Newsom)

1) Some businesses can reopen.

The only businesses allowed to reopen Friday are "low-risk" retailers that can open for curbside pickup, to minimize person-to-person contact. This includes clothing stores, bookstores, music and toy stores, sporting goods stores and florists — which will be able to open in time for Mother's Day on Sunday

Manufacturers and other logistics companies that make up retail supply chains can also reopen, Newsom said.

2) Many more cannot.

Offices, shopping malls and dine-in restaurants will not be permitted to open this week, even though they were included in Stage 2 of the initial reopening plan.

Higher-risk venues like gyms, hair salons and churches, which include more person-to-person contact, won't reopen until the state enters Stage 3 of its plan.

And mass gathering places like concert venues and sports stadiums will stay closed until the state has access to drugs that treat COVID-19 — a development that may take months or longer.

3) Some counties can lift orders sooner. Others can keep theirs stricter.

Some California counties, which have seen relatively mild outbreaks of COVID-19, can now develop their own containment plans in which they lift restrictions sooner than the rest of the state, Newsom announced Monday.

These counties, some of which had already started defying the statewide order, can move further into Stage 2 by allowing restaurants and other hospitality venues to reopen. But the counties' plans must be certified by the local health officer and county supervisors, Newsom said.

On the other hand, regions like the Bay Area, which have stricter stay-home rules than the statewide order, are free to keep the stricter limits in place.

4) Stay-home orders could come back.

Reopening the state doesn't mean the virus will no longer be a threat. Hospitalizations have stabilized, and the state has expanded its health care capacity enough to treat a surge of patients, but people will keep getting sick until there's widespread access to a treatment for COVID-19.

That means stay-home orders could be reimposed if virus cases spike again, Newsom said Monday. Last month, he described this as a "toggling back and forth between more-restrictive and less-restrictive measures."

It's one of many reasons why life after the crisis will look much different than before. Restaurants will reopen but may have temperature checks at the door, along with fewer tables inside, officials have said. Face masks will likely remain common. And mass gatherings won't happen for the foreseeable future.

5) More testing and tracing are coming.

One reason for cautious optimism: state officials say they have ramped up their ability to trace and test for COVID-19 — two metrics considered among the most important for containing the disease.

California is now testing 30,000 people each day for the disease — exceeding its goal of 25,000 by the end of April, Newsom said Monday. It eventually hopes to test 80,000 people each day.

Meanwhile, the governor announced a new program that he said will train 3,000 tracers per week, adding to an existing workforce of more than 2,800 tracers who work in 22 counties across the state. The "academy," developed in partnership with UC San Francisco and UCLA, will open Wednesday and aims to eventually train at least 20,000 contact tracers.

As the state considers when to further lift restrictions, officials will keep an eye on a number of metrics, including the rate of COVID-19 hospitalizations, the availability of personal protective equipment for health workers, the health care system's ability to handle a surge in patients, and the ability to continue tracing and testing for the virus

The Harsh Future of American Cities - in the Covid-19 era

Reality Check 101

Life will never return to normal.  It's the 'new normal'. 

During the next year our life will change once again. Most evident will be the increased level of background noise and automobile traffic. It will be many years until we move forward to a new reality.

Significant attribution to Steve Levine


History has unfolded in waves of profound depths
followed by the relief of buoyant times, only for the depths to return
with unsentimental speed. The French Revolution and the Reign of Terror
gave way to Paris’ jolly Incroyables and Merveilleuses, young men and
women who dressed ostentatiously and had a cathartic frolic — for about
four years until Napoleon took power. After World War I and the pandemic
Spanish Flu, the Roaring ’20s carried Berlin, London, and New York into
a new age of hilarity. But then came the global Great Depression.The hope in U.S. cities is that Covid-19 and the economic downturn will end with another delirious release — a rash of buying by exultant consumers, a new economic boom, and a return to work.

But alongside the displays of liberation, and for years after, American
cities and towns seem likely to see untold scars of both the pandemic
and the depression-like recession.
On the nation’s current trajectory, one of the most probable post-Covid
future scenarios in our cities is stark austerity, with empty coffers
for the very services and qualities that make for an appealing urban
life — well-paying jobs, robust public transportation, concerts,
museums, good schools, varied restaurants, boutiques, well-swept
streets, and modern office space. There will be hopping pockets of the
old days with adjustments for pandemic safety, but for years, many
businesses could be shuttered and even boarded up, unable to weather
Covid-19 and the economic downturn. Joblessness will be high, and many
of the arts may go dark.

 American cities and towns seem likely to see profound scars of both the pandemic and the depression-like recession.

  

“In the Midwest, we have been pushing density — the rehabilitation of downtowns, smaller apartments in the core, the joy of being in a city,” Quinton Lucas, mayor of Kansas City, Missouri, said in an interview. “This completely arrests that development.” However, in this author's opinion small cities and rural areas may rebound. The longstanding effect of social distancing and isolation will contribute to a new form of socialization. Unaccustomed to quiet and solitude along with the sharp uptick of televideo conferencing and visual social groups, people will thrive. They will have learned the power of the internet, something our younger citizens (even boomers) already realize.

The 2010s started with a surge in city living, especially for millennials. They flocked to urban cores after the financial crash and injected them with vigor. But even before the coronavirus, the rush had tapped out. For the last couple of years, the top cities have been losing population, including New York, Los Angeles, and Chicago, according to Brookings. The exodus has struck even San Francisco County, the capital of Silicon Valley. Who has been leaving, and where have they been going? A lot has been the same millennials now a little older and taking up residence on the outskirts of smaller metropolises like suburban and exurban Atlanta, Dallas, and Denver, where new jobs and affordable homes can be found.

How COVID-19 will change the nation’s long-term economic trends, according to Brookings Metro scholars

     COVID-19 will transform the world, but changes might accelerate familiar trends

• Innovation and hybridization in food and retail will expand
• Low-wage workers are facing a housing crisis
• Will inequality increase among older Americans?   
• The pandemic crisis may also disproportionately impact:
• Low-income older adults who do not own their home outright
• Older Americans age 50 to 65 with no health insurance
• Older business owners in industries that were highly impacted in the pandemic
• Black and Latino or Hispanic older Americans
• Gen Z will affect how cities rebound from the COVID-19 pandemic
• COVID-19 will accelerate structural declines in microbusiness employment
• The country will finally address the digital divide
• 
  
  

The Harsh Future of American Cities - GEN:

When pandemics collide - HIV v. COVID19

Although many jurisdictions in the United States and other countries think it is time to wind down prevention,. the prevalence of Corona virus is endemic in many communities. Yes, that means the virus is still present, even though acute infections are diminishing. There is a worldwide pool of virus particles. 

The image above is. that of  Coronavirus

The image below is that of HIV

Although anatomically they appear very similar their pathophysiology is very different.  HIV attacks lymphocytes known as CD T cells.  Coronavirus attacks pulmonary tissues as well as other organs. It is not yet as well known the specific pathophysiology of Covid-19. Much more will be forthcoming in the next 6-12 months.

One pandemic virus has been a major topic in global health for almost 40 years, the other was discovered just 4 months ago, but, as SARS-CoV-2 infections have now been reported in most African countries, HIV and COVID-19 are on a collision course. Although we have learned a remarkable amount about SARS-CoV-2 in a short time, its potential impact on people living with HIV and on health systems in settings with high HIV burdens is becoming a major concern.

In Nigeria, as reported in a Feature by Paul Adepoju, the threat of SARS-CoV-2 is already having an effect on HIV and tuberculosis responses as patients choose to social distance by not going to health-care centers to collect drugs. Patients with tuberculosis in Ibadan have been reluctant to travel to collect drugs owing to the overlapping symptoms of tuberculosis and COVID-19. Indeed, clinical diagnosis of COVID-19 will be complicated by the high prevalence of tuberculosis, Pneumocystis pneumonia, and cryptococcosis associated with high burdens of HIV—all of which may have respiratory or imaging characteristics that overlap with the new disease. For care providers in the region, this will be a challenge not yet experienced in other settings.

The responses to COVID-19 in low-resource, high HIV burden settings will necessarily be different from those in the high-resource settings largely affected so far; but a history of adapting to diverse and shifting HIV epidemics in adverse conditions should enable creative solutions to SARs-CoV-2 across sub-Saharan Africa. As James Hargreaves and colleagues point out in their Comment, despite the differences between the viruses, the HIV response has lessons for the COVID-19 response.

One pandemic virus has been a major topic in global health for almost 40 years, the other was discovered just 4 months ago, but, as SARS-CoV-2 infections have now been reported in most African countries, HIV and COVID-19 are on a collision course. Although we have learned a remarkable amount about SARS-CoV-2 in a short time, its potential impact on people living with HIV and on health systems in settings with high HIV burdens is becoming a major concern.

Organizations including UNAIDS, UNICEF, and the International AIDS Society have begun to issue guidance and advice on how to deal with COVID-19 in high HIV burden settings. The Global Fund to Fight HIV, Tuberculosis and Malaria have also urged recipients to divert surplus funds to prepare and respond to COVID-19. We do know, however, that the response to SARS-CoV-2 is compromising HIV programs. As global travel and transport are disrupted, drug supply chains are jeopardized. In a Comment, Weiming Tang and colleagues highlight the contributions of non-governmental organisations stepping in to ensure consistency in HIV care during the SARS-CoV-2 pandemic.

At the time of writing, sub-Saharan Africa has reported relatively few cases: several thousand in South Africa and just tens or hundreds in other countries. However, these numbers are probably substantial underestimates owing to limited testing capacity. A unifying factor of the countries that have managed to suppress SARS-CoV-2 outbreaks rapidly is large-scale testing and contact tracing. Where those facilities are not possible, sentinel testing to identify the worst affected areas might be one solution to make the most of limited resources.

South Africa acted rapidly by imposing a lockdown, banning the sale of alcohol, and taking homeless people into facilities where they could be observed and where substance-use issues among the homeless can be managed. But social distancing is not always possible; many people in high HIV burden settings live in densely populated, cramped housing with limited access to sanitation. To help reduce transmission, Kenya has banned public gatherings, made the wearing of masks mandatory in public, imposed curfews, and set up isolation and quarantine centers for people who test positive for SARS-CoV-2 and their contacts, respectively.

Multimonth dispensing of antiretrovirals has been a topic of interest in recent years: in Kenya, South Africa, and elsewhere, provision of 3 months or even 6-month supplies of antiretrovirals at one time as a response to COVID-19 is becoming the norm to reduce clinical contacts and to facilitate social distancing.

WHAT PEOPLE LIVING WITH HIV NEED TO KNOW ABOUT HIV AND COVID-19

When pandemics collide - The Lancet HIV:

My Corona – Logging the symptoms of COVID day by day

Covid19 is not just another flu or flu-like illness. 

The story linked here from a blog by a patient who has Covid19, a. young healthy person without any pre-existing conditions.  He may have been lucky however it is still not over after several months.

I am very fortunate.  I am a retired physician who also has several serious heart conditions.  Suffice it to say I needed to have a cardiac pacemaker inserted several months ago.  I am much better now and did not realize how ill I had become until it became difficult to just get out of bed and go to the front door. Although I can function much better I know that if I get the 'virus' I would probably die. 

Most of you are younger, healthy, and feel immortal. Living in denial is common.  We all are in denial to think you cannot get covid19. What is more serious is that most people think it is over.  It is not.  Do not feel reassured when authorities (politicians) state it is safe to not shelter in place or forget about social distancing and/or sanitizing.

Officials in my neighborhood are talking about one or two more weeks of the strict program, and then gradually loosening restrictions. They say they are following scientific advice or protocols from public health authorities.  As a former physician, I tried to be as scientific as possible in my clinical decisions. My experience has been statistics are misleading.  If you are the one in a thousand who contracts covid19 statistics mean nothing.  The key is don't get it, don't gamble with your life and keep a cool head about finances and business decisions.

Be prepared....here is your list:

I realize I don't have to work and I am immune to financial pressure.  For others the decision is overwhelming, you may or may not have dependents, who you protect, a wife, and a home.  Material things can unduly influence critical and. sometimes life-saving decisions.

Others will say it is now safe to resume a normal life. You will read about a restaurant opening, with adjusted seating distances to ensure social isolation.  Today I walked to the supermarket..a foolish move since I have someone who could shop for me. I made an unwise decision to stop at the donut shop to satisfy my addiction to comfort food (a raisin cinnamon roll).  I rationalized it since I had not had the yummy carb-loaded dough, sticky frosting, and raisins. I saw several people without masks. I have a new name for "The Walking Dead".  I went home where I was greeted by my eldest son.  I knew what I had done. Shame on me. To make matters worse I have a son who has cystic fibrosis, a son who is a miracle of his own having lived to be over 30. years old thanks to breakthroughs in cystic fibrosis treatments.

Fascination breeds preparedness, and preparedness, survival. Peter Benchley – Author of Jaws

My eldest son brought me back to reality in a firm and kindly way.  My advanced years (78) and poor health suddenly made me know that my son was now wiser than I am. He was firm with me and told me if I did that again he would petition a court for him to become my guardian.  That got my attention.

Age and infirmity sneak up on all of us, and pandemics do not stop for age or stupidity.

Make up your own mind.  You know what is best for you and don't let anyone convince you it is safe to re-socialize. Especially a man who said we should drink bleach or spray Lysol in our mouth.

Listen to the guidelines, but wait and think about it.  It is far from over. Your employers are in worse shape than you financially, they want to save their business, you should want to save your life, and your family.

A story unfolds as told by a covid19 survivor

This virus is fickle. It makes is difficult to gauge what can be classified as a marked improvement. Symptoms come and go by the day. They worsen or improve in an instant. Recently, the days started to bifurcate......................

One group member asked, “If you can remember, what was your VERY FIRST symptom?” The results surprised me. Based on way more responses than I could bother counting, sore throat seemed to have been cited more frequently than fever or dry cough. This isn’t something I’ve read online or seen on television. This was one individual at a time saying what really happened to them...........

Essentially all of the members moved beyond thinking about testing for the virus. A big percentage of them never got tested for a variety of reasons (many like me on doctor’s advice) or tested negative but have displayed every symptom for a week or more — clearly some false negatives. A positive test would only seek to affirm what they already know. At this point, there is nothing they can do with the information that the test provides

Accurate antibody testing information is critical right now

She left them at the top of the steps and backed away. My five-year-old brought me a rainbow-striped egg, a clever frog with a bright red tongue that you can move, and a purple bunny with a fuzzy nose and googly eyes. “I’ll see you when the virus is gone and you can come downstairs. I love you. See you later.”

Every other sentence from her begins with ‘when the virus is gone, I’m going to…’. She’s not even sad about it. What a strange practical reality for a small child.

The virus isn’t going away this weekend and daddy won’t be coming downstairs, sweetheart. I know it is disappointing for her and my older daughter because they wanted to do ‘Easter things’ with me and of course, I wanted to do the same.

The doctor told me, not surprisingly, that I need to stay the course — rest, relax recover. And as always, if anything worrying progresses, don’t hesitate to call. The advice in the media is all over the shop regarding when you are safe to be around family again. His guidance was to wait until I’ve had three consecutive days of significant reduction in symptoms before I can join them..........

A friend recommended that I get a pulse oximeter

The illusive pulse oximeter

My wife is my rock and the people in my town are amazing. They have flooded her with texts, calls, emails, and anonymous care packages (please…I’m not fishing here) to help get through this......


Please stay safe and well.


“I have hardly anything in common with myself and should stand very quietly in a corner, content that I can breathe.” 
― Franz Kafka

Is it over?

What will it be?  Which side will you on?







My Corona – Logging the symptoms of COVID day by day:

Covid-19 Pandemic Likely to Last Two Years, Report Says -

Video of Anthony Fauci M.D.

 Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, says he's "almost certain" coronavirus will return in the winter, but he's optimistic researchers will develop a vaccine. He speaks to David Rubenstein, host of "Peer-to-Peer Conversations."

The coronavirus pandemic is likely to last as long as two years and won’t be controlled until about two-thirds of the world’s population is immune, a group of experts said in a report.

Because of its ability to spread from people who don’t appear to be ill, the virus may be harder to control than influenza, the cause of most pandemics in recent history, according to the report from the Center for Infectious Disease Research and Policy at the University of Minnesota. People may actually be at their most infectious before symptoms appear, according to the report.


After locking down billions of people around the world to minimize its spread through countries, governments are now cautiously allowing businesses and public places to reopen. Yet the coronavirus pandemic is likely to continue in waves that could last beyond 2022, the authors said. 

Where do we go from here?

I think the American public is distinguishing today between government officials like Fauci, Birx, Centers for Disease Control and Prevention Director Robert Redfield, Food and Drug Administration Commissioner Stephen Hahn on one hand, and politicians on the other. Their trust in government direction and leadership may be solid while politicians, rightly or wrongly, are looked at as another tribe. Hopefully, leaders in both political parties will look at what Edelman has shown about their tarnished brands and whether craven or not, at least position themselves so they appear allied with science and the desperate needs of citizens today rather than an opponent of it.

CORONAVIRUS NUMBERS AT A GLANCE

Covid Case Map of U.S. by County

Global Map of Covid. Cases

There are 3,247,648 reported cases of coronavirus cases around the world. 230,615  have died from the virus. 61,547 have died in America.

 The U.S. is reporting 1.053,036. Spain 239,639. Italy 205,463. 166,628 cases in France. 166,443 in the U.K. 120,204 in Turkey, Russia is now reporting 106,498 cases. Iran 94,640. China 83,944. 16,117 in Pakistan. 3,037 in Bahrain. 2,954 cases in Thailand — where daily infections have stayed in the single digits for four consecutive days. 

 New York is reporting 304,372  cases. New Jersey 116,365 cases. Massachusetts 60,265. 50,538 in Illinois. 48,870 in California. 46,458 in Pennsylvania. Iowa is reporting 7,147 cases. 6,950 in Alabama. 6,520 in Wisconsin. 5,136 in Minnesota. Nevada reports 5,025. 

With testing capabilities now at the center of the national reopening debate, the U.S. has conducted 6,065,570 coronavirus tests. 124,449 in the US have reported full recoveries from COVID-19.

WASHINGTON WATCH

US intelligence agency says COVID-19 “not manmade or genetically modified.” The top U.S. spy agency in a rare public statement Thursday said it agreed with "the widespread scientific consensus" that the coronavirus was "not manmade or genetically modified," but also said it was investigating whether it emerged from a laboratory in Wuhan, China. (The Hill)

Pentagon moves to increase the production of coronavirus testing swabs. Pentagon spokesman Lt. Mike Andrews said in a Wednesday statement, Puritan Medical Products “will quickly establish a new manufacturing facility capable of doubling its current monthly output of 20 million to 40 million swabs." (The Hill)

 A bipartisan group of lawmakers back efforts to expand telehealth services for seniors. Lawmakers on both sides of the aisle are throwing their support behind efforts to expand telehealth services, especially for elderly patients, to help combat the coronavirus. Speaking at The Hill’s first virtual event on Wednesday, Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) highlighted how telehealth allows elderly patients to receive proper medical care and checkups during the pandemic while staying at home. (The Hill)

What you need to know about the COVID-19 vaccine | Bill Gates

It is not very often when a politician deflects powerful business interests to do the right thing for his constituents.  However, in California Governor Gavin Newsome has done that. He extended the lockdown for California until mid-July.  This at the least will allow for an accurate testing program to begin. It is essential that we not resume normal activities until we know scientifically what the coronavirus penetration in our communities. In California, there was only one rural county without the virus present. 


Back to work returning to work will take place gradually and not across entire states or the entire country.  President Trump is throwing the country under the bus by his ridiculous statements. We are fortunate that some Governors are enforcing more reasonable steps in their states and following scientific protocols to protect their citizens responsibly.

These remarks which follow are from The Gate's Notes, a blog written by Bill Gates, former CEO of Microsoft and now co-head of the Bill and Melinda Gates Foundation. Gates is one of the supporters to eliminate AIDs and Ebola in Africa.  His knowledge base comes from global experience with epidemics, and his success rate of dwelling those two catastrophic illnesses o humanity.  Cool heads must prevail across the world. 

Our problem in the United States is not a unique one.  Countries with far fewer resources make our situation look easy.

Humankind has never had a more urgent task than creating broad immunity for coronavirus. Realistically, if we’re going to return to normal, we need to develop a safe, effective vaccine. We need to make billions of doses, we need to get them out to every part of the world, and we need all of this happen as quickly as possible.

That sounds daunting because it is. Our foundation is the biggest funder of vaccines in the world, and this effort dwarfs anything we’ve ever worked on before. It’s going to require a global cooperative effort like the world has never seen. But I know it’ll get done. There’s simply no alternative.

The world is creating this vaccine on a historically fast timeline.

Dr. Anthony Fauci has said he thinks it’ll take around eighteen months to develop a coronavirus vaccine. I agree with him, though it could be as little as 9 months or as long as two years.

Although eighteen months might sound like a long time, this would be the fastest scientists have created a new vaccine. Development usually takes around five years. Once you pick a disease to target, you have to create the vaccine and test it on animals. Then you begin testing for safety and efficacy in humans.

Safety and efficacy are the two most important goals for every vaccine. Safety is exactly what it sounds like: is the vaccine safe to give to people? Some minor side effects (like a mild fever or injection site pain) can be acceptable, but you don’t want to inoculate people with something that makes them sick.

Efficacy measures how well the vaccine protects you from getting sick. Although you’d ideally want a vaccine to have 100 percent efficacy, many don’t. For example, this year’s flu vaccine is around 45 percent effective.

To test for safety and efficacy, every vaccine goes through three phases of trials:

• Phase one is the safety trial. A small group of healthy volunteers gets the vaccine candidate. You try out different dosages to create the strongest immune response at the lowest effective dose without serious side effects.
• Once you’ve settled on a formula, you move onto phase two, which tells you how well the vaccine works in the people who are intended to get it. This time, hundreds of people get the vaccine. This cohort should include people of different ages and health statuses.
• Then, in phase three, you give it to thousands of people. This is usually the longest phase, because it occurs in what’s called “natural disease conditions.” You introduce it to a large group of people who are likely already at the risk of infection by the target pathogen, and then wait and see if the vaccine reduces how many people get sick.

After the vaccine passes all three trial phases, you start building the factories to manufacture it, and it gets submitted to the WHO and various government agencies for approval.

This process works well for most vaccines, but the normal development timeline isn’t good enough right now. Every day we can cut from this process will make a huge difference to the world in terms of saving lives and reducing trillions of dollars in economic damage.

So, to speed up the process, vaccine developers are compressing the timeline. This graphic shows how:

In the traditional process, the steps are sequential to address key questions and unknowns. This can help mitigate financial risk, since creating a new vaccine is expensive. Many candidates fail, which is why companies wait to invest in the next step until they know the previous step was successful.

For COVID-19, financing development is not an issue. Governments and other organizations (including our foundation and an amazing alliance called the Coalition for Epidemic Preparedness Innovations) have made it clear they will support whatever it takes to find a vaccine. So, scientists are able to save time by doing several of the development steps at once. For example, the private sector, governments, and our foundation are going to start identifying facilities to manufacture different potential vaccines. If some of those facilities end up going unused, that’s okay. It’s a small price to pay for getting ahead on production.

Fortunately, compressing the trial timeline isn’t the only way to take a process that usually takes five years and get it done in 18 months. Another way we’re going to do that is by testing lots of different approaches at the same time.

There are dozens of candidates in the pipeline.

As of April 9, there are 115 different COVID-19 vaccine candidates in the development pipeline. I think that eight to ten of those look particularly promising. (Our foundation is going to keep an eye on all the others to see if we missed any that have some positive characteristics, though.)

The two priorities, as I mentioned earlier, are safety and efficacy. Since we might not have time to do multi-year studies, we will have to conduct robust phase 1 safety trials and make sure we have good real-world evidence that the vaccine is completely safe to use.

We have a bit more wiggle room with efficacy. I suspect a vaccine that is at least 70 percent effective will be enough to stop the outbreak. A 60 percent effective vaccine is useable, but we might still see some localized outbreaks. Anything under 60 percent is unlikely to create enough herd immunity to stop the virus.

The big challenge will be making sure the vaccine works well in older people. The older you are, the less effective vaccines are. Your immune system—like the rest of your body—ages and is slower to recognize and attack invaders. That’s a big issue for a COVID-19 vaccine, since older people are the most vulnerable. We need to make sure they’re protected.

The shingles vaccine—which is also targeted to older people—combats this by amping up the strength of the vaccine. It’s possible we do something similar for COVID, although it might come with more side effects. Health authorities could also ask people over a certain age to get an additional dose.

Once we have a vaccine, though, we still have huge problems to solve. That’s because…

We need to manufacture and distribute at least 7 billion doses of the vaccine.

In order to stop the pandemic, we need to make the vaccine available to almost every person on the planet. We’ve never delivered something to every corner of the world before. And, as I mentioned earlier, vaccines are particularly difficult to make and store.

There’s a lot we can’t figure out about manufacturing and distributing the vaccine until we know what exactly we’re working with. For example, will we be able to use existing vaccine factories to make the COVID-19 vaccine?

What we can do now is build different kinds of vaccine factories to prepare. Each vaccine type requires a different kind of factory. We need to be ready with facilities that can make each type so that we can start manufacturing the final vaccine (or vaccines) as soon as we can. This will cost billions of dollars. Governments need to quickly find a mechanism for making the funding for this available. Our foundation is currently working with CEPI, the WHO, and governments to figure out the financing.

Part of those discussions center on who will get the vaccine when. The reality is that not everyone will be able to get the vaccine at the same time. It’ll take months—or even years—to create 7 billion doses (or possibly 14 billion, if it’s a multi-dose vaccine), and we should start distributing them as soon as the first batch is ready to go.

Most people agree that health workers should get the vaccine first. But who gets it next? Older people? Teachers? Workers in essential jobs?

Another moral and ethical dilemma exists. Which countries will get the first doses of vaccine? History has demonstrated that the wealthy countries and people will be favored by sheer economics.  How would the United States deal with that? America has always stepped up to support WHO efforts for global health initiatives.  Are we up to that task now given our current economic collapse.  We cannot afford to say no because we would be harming ourselves. America has a very small percentage of the global population of over 7 billion human lives. A worldwide outbreak again would easily be transmitted to the U.S. unless and if we were willing to isolate our country from the rest of the world.

The world has other significant financial resources: The Gavi Vaccine Alliance Even social media platforms such as TikTok are donating considerable sums to the effort

Harnessing Social Media for the COVID-19 Pandemic

                              Milton visiting Galileo in the prison of the Inquisition. Credit: Tony Baggett Getty Images

Galileo's Lessons for Living and Working Through a Plague

The person who returns to work and finds someone in his or her household will have a never-ending sense of despair which will last far longer than any financial effects of being locked in. 

The consequence of prevention is much less than a severe or fatal illness.






Humankind has never had a more urgent task than creating broad immunity for coronavirus.





What you need to know about the COVID-19 vaccine | Bill Gates: