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‘The virus will be back’: Preparing for the second wave of Covid-19

Epidemics of infectious diseases can be unpredictable but they often come in waves. History has left hard lessons showing that a virus can quickly return – and with deadlier force.

Just over a century ago, the three-wave Spanish flu pandemic that claimed at least 50 million lives, killed more people in the more virulent second wave in the autumn of 1918 than in the first that spring, including in Ireland.

Public health responses during that pandemic were complicated by the fact that the world was at war. Regional inaction and the increased movement of people as the war drew to a close deepened the severity and death toll in 1918 and 1919.

Now, as Ireland reopens from a severe lockdown imposed to flatten the curve of infection and death, the risk of coronavirus infection rates rising again remains high with the increased interaction and movement of people. The risk is particularly high given that a vaccine to eradicate Covid-19 is some time, possibly years, away and seroprevalence studies which measure past rates of infection show little “herd immunity”, leaving large swathes of populations still susceptible to the virus.

The two-month steady descent from Ireland’s peak of deaths and infection in mid-April has allowed the country to move into the second phase of lockdown relaxations and accelerated the Government’s plan to reopen society and the economy. This will, inevitably, put more people in closer contact with each other and raise the possibility of new infections increasing again.

In the early stages of the pandemic, public health specialists were able to predict how infections would soar in an unmitigated scenario, where, based on the reproductive rate of a highly transmissible disease, one Covid-19 case would infect four or five others.

Now, even the experts admit they cannot predict how the virus will spread if it returns.

“I honestly don’t have a crystal ball on this one. I don’t know what we’re going to learn about this virus over the next six months,” Prof Philip Nolan, chair of the modelling advisory group on Covid-19, told the Oireachtas special committee on the pandemic response on Tuesday.

Opinion is divided on how an increase in infections could come or indeed whether it is even likely. The State’s chief medical officer Dr Tony Holohan has said that a second wave is “not inevitable”. He said he hoped the reopening could proceed “without seeing a change in the level of disease that causes us either to have to pause or go back on some of the [lockdown] measures we have used”.

“This virus will almost definitely come back again. It is not a case of ‘if’ it is almost guaranteed that it will be a case of ‘when’,” says Prof Sam McConkey, infectious diseases specialist at the Royal College of Surgeons in Ireland.

Given the prevalence of the disease in countries such as the United States, Rusia and Brazil, McConkey believes the virus will be circulating in the world for the foreseeable future, possibly for between five and 10 years, and that the State has to become better at keeping coronavirus out and, if it is discovered again in the community, identifying it quickly and managing its suppression again.

“If we do a really good job, it might be a second ripple rather than a second wave and there might be a second and third and fourth ripple. We might deal with it better. If we do a really bad job, it will be a second tsunami and then we have learned nothing,” says McConkey.

1 Tracing and testing

The view of most public health and medical specialists is that the second wave will be different.

The past three months of lockdown have been so traumatic for people and caused such an upheaval in their lives that the response the next time around, should the virus return, has to be less severe and managed differently.

“There are two issues: one is when it will happen and the other is how big it will be. With a little bit of luck it will be just a wave, not a surge, and that it will be entirely manageable.”

Among the advantages heading into any potential second wave is that there is now a greater understanding of the virus, how it spreads and presents itself clinically in sick patients.

In March the State struggled to test people for Covid-19; it has since built a capacity to test up to 15,000 people a day for the disease, turning around tests from swab to result in 1.2 days on average, and taking three days to trace contacts of the newly infected.

Some believe the rapid Covid-19 alert and surveillance system may need to go further.

McConkey says the State may need to extend checks to second- and third-degree contact tracing, similar to how Facebook generates contact suggestions for friends of friends and friends of friends of friends. He uses the example of his wife potentially getting infected and people he works with being her second-degree contracts and having to self-isolate.

“The aim there is to try to control the resurgences of the disease really thoroughly and in a way that prevents it spreading into the general population again, through more extreme isolation and control of the people in the immediate vicinity of others who have it, but then at the same time have more relaxation on the general population,” he says.

Few expect a return to full lockdown or “phase zero” should the virus return, not because of the likely public anger to such a response, but because there may be strong evidence that the risk of transmission of the virus is lower in creches and primary schools, for example.

“We used a big sledgehammer when we locked people into their homes,” says Motherway.

“It would be very hard to lock people down totally again but hopefully over the next few weeks we will learn which bits of those public health measures did the most to reduce the curve and which bits can be applied without interfering with our economic life as much as we have,” she says.

From his position on the modelling advisory group, Nolan said this week that “the management of the second wave will be different” and that there could be “more targeted measures introduced to control the future outbreaks before the sort of blanket measures that we have seen”. Contingency plans will be needed, he said.

In Asia, large second waves were averted by such targeted, quick actions. Nationwide lockdowns being replaced by ones on regions or sectors and the partial reimposition of restrictions.

“The lesson for Ireland here is that we must remain vigilant for new cases,” said David Higgins, an analyst with consultancy firm Carraighill which tracks and compares new Covid-19 cases against first-wave peaks. “We cannot rule out some restrictions being imposed again.”

2 Being vigilant about indoors and alcohol

Two issues identified as posing the greatest danger for a return of the virus are indoor crowds and alcohol. The State’s chief medical officer has warned about house parties – events that can combine the two.

“Alcohol is a distance inhibitor because it doesn’t take more than one or two drinks for us all to say, ‘Ah sure I’ll be grand, I’m only here for 10 minutes’,” says Favier.

“By three or four drinks, everybody is everybody’s best friend and everybody’s sharing a corner of the bar along with bottles, glasses, food and cutlery,” say the doctor. “That is the biggest one we have to negotiate: the impact of alcohol on our social inhibitions and our ability to self-monitor.”

In South Korea, a cluster of new infections was discovered in early May after weeks of almost no fresh cases and traced to Seoul’s nightclub district as social distancing was relaxed. Some 90,000 people were traced for contacts and almost 300 infections were linked to the clubs. The infection of more than 100 people was linked to a single person attending three clubs over one weekend.

3 Being sensible about individual behaviour

Personal responsibility and individual action – from adhering to physical distancing and respiratory etiquette to early awareness of symptoms and contacting a GP quickly – is seen as essential to building an early-warning system that could help avoid a second wave.

“All of us with sniffles, coughs or fevers should be getting our Covid-19 tests,” says McConkey. “Then if it does start to spread in Ireland again, we will see it at a very early stage, rather than waiting until there are thousands of cases.”

The low prevalence of the disease makes individual, preemptive action essential.

The reopening of society means public health officials can no longer rely on the few simple rules that applied during the lockdown for the multitude of risk scenarios facing the public.

“We have to rely on people’s individual decision-making and good sense in order to reduce the risk,” says Pete Lunn, head of behavioural research at the Economic and Social Research Institute.

“People need to be alert to and understand situations that are more risky than others and act to reduce the risk of transmitting the disease.”

4 Preparing the hospitals

The risk of a second wave of the Covid-19 pandemic coinciding with an outbreak of other infectious diseases, such as seasonal flu or measles, raises the potential for a “double wave”.

Doctors want the prepandemic “baseline” of 250 intensive care beds across the State’s hospitals doubled permanently and more isolation units to segregate Covid and non-Covid cases over the winter.

“You can’t do that in one season but they need to start making significant plans,” says Motherway, whose term as president of the Intensive Care Society ended last week.

Unlike during the first wave, when hospitals suspended non-Covid care to create capacity to cope with the pandemic, the acute care system must have plans to tackle a second wave of Covid-19 along with managing surgeries and accidents that were not happening in the first wave.

“We only got one shot at the first wave where we could just suspend everything. You can’t do that a second time. It is just not going to be tenable,” says Favier.

“The big challenge now with any surge is that we now have to run non-Covid work in parallel with Covid and our hospitals will really, really feel that strain. I would have more concern about that than we did in the first place with how many ventilators we had.”

She says there is now no situation that carries zero risk from Covid-19 and hospitals “need to find workarounds and doing the new normal” and to move beyond “this paralysed, rabbit-in-the-headlights of Covid” that is preventing the return of some regular healthcare.

5 Preparing the nursing home sector

The sector worst hit by the pandemic is the one facing the biggest challenge from a second wave. Many nursing home staff were forced out of work having contracted Covid-19, leaving care facilities struggling to cope with a virus that killed many elderly residents.

McConkey believes care homes will need at least 20 per cent extra staff for “surge capacity” for a second wave. This will inevitably result in some privately-run homes not being economically viable and the larger nursing home groups being able to staff-up more quickly and to cope better.

“Nursing homes have been chronically under-staffed for several years. They are going to have to start cherishing their staff as the most important thing they have,” says McConkey.

Given the risks to nursing homes from Covid-19, staying prepared generally, not just for a second wave, is essential to beating the virus, with increased focus on stringent restrictions on visitors, social distancing, hand hygiene and the wearing of personal protective equipment.

Regular, mass testing of care homes – or even batch testing of all nursing home staff and residents before testing individuals to identify the positive cases – is considered critical to being able to isolate Covid-19 cases and protect the most vulnerable group to the coronavirus disease.

Appetite for risk

Predicting how or when a second wave might emerge is even more unclear than preparing for the first wave because it comes down to the risks members of the public are willing to take.

“Some people will take more risk, some less. That is the nature of humans. They differ in how much risk they could take whereas before we just knew we had to get the number of cases down,” says behavioural economist Pete Lunn.

“The world has become more complex and then you are also in a far more complex set of rules for governing the behaviour so it has become much more messy and hard to predict.”

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Tips for Traveling With IBS /Crohns Disease

Don’t let your IBS symptoms keep you from seeing the world or visiting relatives. With planning and perseverance, you can have a wonderful vacation.

Visions of vacations dance in many heads at this time of year. But if you’re one of the estimated 58 million people in the U.S. with irritable bowel syndrome (IBS), the idea may sound torturous.

It’s bad enough to worry about recurring symptoms of bloating, gas, stomach cramping, constipation, or diarrhea when in your own hometown. What about when in unfamiliar territory?

Plus, your digestive system may be so finicky that any changes in routine may aggravate symptoms.

Such worries prevent many people from taking out-of-town trips. In a survey of 1,000 Americans, 28% of respondents with IBS-like symptoms avoided travel at least once in the past year, reports the International Foundation for Functional Gastrointestinal Disorders (IFFGD).

Nonetheless, IBS patients need not be deprived of holiday travel.

“If it’s something that you’re really looking forward to doing, by all means, do it,” says Nancy Norton, the IFFGD’s president and founder. “We talk to people (with IBS) all the time who have been apprehensive about traveling, but they go and let us know they’ve had a wonderful time.”CONTINUE READING BELOW

With courage, preparation, and determination, it is possible to explore new places with IBS. Perhaps the trip, if relaxing, could even have a therapeutic effect.

Of course the hassles of travel, such as lost luggage, unhappy kids, or a bout of traveler’s diarrhea, could work against that. But even then, you may be able to use the same stress management strategies used for daily pressures at home.

Stress busters include eating a well-balanced diet appropriate for your IBS, getting enough sleep and exercise, meditation, and doing something enjoyable.

Reducing stress may, indeed, be one of the crucial elements to a good retreat.

“There’s definitely a benefit to taking a vacation, but people need to plan it so that it’s not too stressful,” says Sheila Crowe, MD, a gastroenterologist and spokeswoman for the American Gastroenterological Association (AGA). “Don’t feel like you have to see all the sights in the city. Maybe just enjoy a leisurely breakfast, and then only see two sights instead of four.”

It’s important to do things you want to do rather than things you feel you ought to do, such as visiting everything and everyone, says Crowe. Resist over-planning and leave room for spontaneity. Yet plan enough so that you know there are safe places to go to the bathroom.

Here are a few more tips from the experts on how to ease travel with IBS:

Before Your Trip

  • Choose a destination that you will enjoy. “Anyplace calm and relaxing is probably good,” says Edward Blanchard, PhD, professor of psychology at the State University of New York at Albany. He says a frenetic, multicity tour of Europe might be more difficult for IBS patients.
  • Check travel advisories for different parts of the world. This is a smart thing to do even if you don’t have IBS. The CDC web site (www.cdc.gov) has a traveler’s health section. It contains information about disease risks (such as travelers’ diarrhea), vaccinations, and other prophylactics. Make sure to visit the site well before your trip as some immunizations take weeks to become effective.
  • Ask a lot of questions. Knowing the who, what, when, where, and how of your journey can help avert stress and anxiety. Allow enough time to get to places to avoid rushing and to have time to assess a situation. “The less surprised one is, the better,” says Leslie Bonci, MPH, RD, author of the American Dietetic Association Guide to Better Digestion. “The only surprises should be delightful surprises because you’re in a beautiful place, or you discover a fantastic buy on silver.”

Some questions to ask include:

  • Is there an early check-in for the hotel if I arrive in the morning?
  • Is there a late check-out if I need one?
  • Is there a refrigerator for my own snacks in the hotel?
  • Is there a restaurant on the premises? What is on the menu?
  • Are there grocery stores and restaurants in the area?
  • Will I be able to request special meals in the plane, hotel, or restaurant?
  • Investigate the bathroom situation. Is there a toilet on the bus? Are there designated times when airplane passengers cannot leave their seats? Will I need special coins or to buy toilet paper at certain restrooms? The answers to these questions could help better plan lavatory trips.

Some IBS patients request aisle seats rows closest to the bathroom. Others feel more comfortable driving to their destination so they can stop as many times as they want. When driving, or out and about in an unfamiliar place, it may help to know the location of the nearest bathroom.

Norton says people have checked the Internet for bathroom diaries and have mapped out the location of large chain bookstores with restrooms. Palm Pilot users have used Vindigo, a high-tech directory service.

  • Learn how to say key words if traveling to a foreign country. Besides knowing how to say ‘Where’s the bathroom?’ it will also help to be able to ask the locals things like: ‘Can you make (a dish) without …’ and ‘I can’t tolerate. …’ You fill in the blanks with your particular food sensitivity or intolerance. This may mean going to a local library, a university, or private companies such as Berlitz for consultation on language, says Bonci.
  • Be up front with your travel companions. The destination may not matter as much if people are honest with tour guides and travel buddies. “People have gone through bus tours of Europe, and they let (guides) know in the very beginning that if they needed to stop for a restroom, they would appreciate it,” says Norton, noting that people are usually very understanding.
  • Pack essentials. Bring a carry-on bag with extra clothes, medications, fiber supplements, bottled water, and snacks. You will want all of this with you in case your luggage gets lost and when there are no good food choices in transportation terminals. For emergencies, it will help to have handy your doctor’s contact information and possible sites for medical care at your destination.

During Your Trip

  • Premedicate. For a long trip, it’s a good idea for IBS patients with diarrhea to take antidiarrheal medicines such as Imodium or Lomotil if they know they can tolerate it, says Crowe. Some people become too constipated with the drugs.

Crowe says IBS patients need to pay attention to their symptoms and to bring their usual medications and fiber supplements. “You want to have them in the plane or train, where you can’t purchase these things,” she says, noting that some destinations may also not have these drugs readily available.

There are travelers, for example, who experience gas with changes in altitude. For these people, Crowe recommends bringing antiflatulents such as Gas-X. Other drugs that might give relief, depending on symptoms, include antacids, prescription antispasmodics (such as Levbid and Bentyl), and laxatives (such as Lactulose and MiraLax).

Visit your doctor to find out the appropriate treatment for you.

  • Keep meals as consistent as possible. Try to keep to the same serving amount and to the same number of meals. Many people end up miserable because they don’t eat or drink enough, they gorge, or they eat foods that aren’t agreeable to their systems.

“Somebody might say, ‘Hey, I didn’t snack because I’m in a hotel room and there’s nothing available,'” says Bonci. To this, she offers the following solution: Bring healthy snack foods you can tolerate, such as nuts, crackers, trail mix, a sports bar, or yogurt. They are better options than the fare offered in vending machines and transportation hubs.

  • Watch your food and drink choices. To keep hydrated, opt for bottled water or Gatorade instead of carbonated beverages. It’s better to buy liquids and other edibles from a hotel restaurant or grocery store instead of small fruit stands. Americanized guts may not be able to tolerate some foods in these places, says Bonci.

If you decide to try a new food, experiment in small amounts, and try only one new thing per day, advises Bonci.

However, Norton says vacation isn’t a good time for people to experiment. “Stick with foods you’re comfortable with,” she says.

  • Don’t despair if IBS symptoms flare up. “I would invite people to think of vacation as almost like a scientific experiment,” says Mary-Joan Gerson, PhD, a clinical psychologist in private practice in New York. “That gives people a sense of control.”

She suggests IBS patients ask themselves, ‘What kind of IBS person am I?’ Then try to learn something from the answers.

In addition, Gerson says vacation is the perfect time to experiment with meditation and its healing properties. “If you start a simple type of meditation a week before (vacation), you can shift into that state at a moment’s notice, even for 5 minutes somewhere, whether at a beach or pool-side,” she says.

Bonci recommends different foods, depending on the symptoms. Chamomile tea has an antispasmodic effect for stomach cramping. For constipation, she suggests traveling with fiber supplements or a box of ground or milled flaxseed. The dietary supplement can be sprinkled on salads, cooked vegetables, or cereals.

To ease diarrhea, try fruit pectins such as Sure-Jell or Certo. “Fruit pectins are used to make jelly – to make jelly gel – but they also have a wonderful effect of slowing the emptying from the gut,” says Bonci.

Oatmeal can apparently do the same thing. The good news is that both oatmeal and fruit pectins come in small, easily transportable packets.

While on vacation, it is, indeed, important to look out for your personal needs with IBS. After that, just try to take whatever comes your way in stride.

Remember, traveling with any ailment takes some effort, but with IBS, it is entirely possible to take an out-of-town journey, and have fun. But make sure you first check in with your doctor for appropriate treatments.

Bon voyage!

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Hand Sanitizer Will Be Hard to Find for a Long Time

Weeks ago, Americans went to great lengths to buy up all the hand sanitizer they could find. This sudden bum-rush on hand sanitizer has wiped out supplies across the country to the point that liquor makers are making their own. Unfortunately, this lack of supply could continue to impact consumers and businesses alike for sometime, reports Bloomberg.The link to buy Hand Sanitizer is in my bio

Right now, the chemical compounds needed to make the gel for sanitizer are in very short supply. But interestingly enough, the long-term shortage of hand sanitizer might not only due to a lack of ingredients. A big issue is that the plastic bottles in which the sanitizer is packaged are in very short supply.

When hand sanitizer is made and ready to be shipped out, it’s understandably going to healthcare facilities. As a result, consumers and businesses who desire the product have to scavenge for what is left.

The link to buy this pruduct is in my bio

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