To the US | Study Germany’s and Taiwan’s Success to Form a Reopening Strategy

Why does Germany close dining and entertainment businesses only while France, Italy and Spain enforce nationwide lockdowns? Why are people in Taipei keeping daily life while Singapore closes schools and businesses and asks citizens to stay home till June 1?

The most important lesson we should learn from Germany is to stop being worried about the number of confirmed cases. Due to the coronavirus’ highly contagious nature and the country’s massive testing policy, Germany is certainly finding a lot of COVID-19 cases. The focus therefore ought to be mild cases’ quarantine and severe cases’ medical treatment. Germany did it right, so their domestic patients got well treated and they have been taking care of patients flown in from other European Union member countries.

While many countries have been calling for flattening the epidemic curve, as of April 13, Taiwan, with a population of 23 million citizens, reported 6 deaths from COVID-19 and only 273 patients who are still hospitalized. Taiwanese have been promptly wearing a mask since the middle of January even though many experts did not agree it could help at that time. Taiwanese government also coordinated mask manufacturers to increase productivity to meet people’s demands of purchasing masks. In contrast, most of western countries did not add wearing a mask into COVID-19 control guidelines until April.

It definitely makes a lot of sense that the governors who want to lift the restrictions do their researches on the experiences of those countries that have never place any restriction order during the pandemic to form a relevant and sustainable exit strategy. I am glad to see Mr. Governor Gavin Newsom tweeted California’s “flatten the curve” graph on April 11, which showed California has used “hospitalization rate” to replace “infection rate”, or confirmed cases, to monitor the epidemic curve. I would like to acknowledge California for its action of bringing COVID-19 control to a right track and to carefully thinking of its reopening plan.

Our organization, HSVG Mission, also want to remind that it is better to still suggest the elderly should spent most of time at home during the early stage of the reopening. People with underlying medical conditions, who have a relatively higher risk of developing severe illness once contracting the virus, should be told to thoroughly practice good hygiene and to pay more attention to having their chronic diseases under control.

Data showed more than 22 million Americans have filed for unemployment since state-mandated lockdowns have been enforced. The spike in new jobless claims is believed to result from the lockdowns that have kept Americans from their workplaces and forced many companies to shutter or to lay off employees. With wearing a mask in public as a careful precaution measure, healthy young and middle-aged adults should be allowed to resume daily routines as soon as possible to avoid households’ miserable financial consequences of workplace shutdown. Probably it’s time for some states to ease lockdowns or any other similar restrictions with a carefully-formed exit strategy.

To Taiwan | 給海軍一個機會 好好向美軍學習

標題為「給海軍一個機會  好好向美軍學習」的評析文章，台灣時間4月21日獲刊於《上報》：
https://www.upmedia.mg/news_info.php?SerialNo=85780

To Europe | The EU should learn lessons from Germany’s coronavirus protocols so life can return to normal

An analysis article titled "The EU should learn lessons from Germany’s coronavirus protocols so life can return to normal" published in Euronews on April 8, 2020 (Paris time):

The European Commission announced the concept of short-time work (reducing employees hours) on 1 April as an initiative of helping people keep their jobs and go back to full work as soon as the lockdown will be over. We would like to support this initiative and share our evidence-based analysis showing that healthy adults should be allowed to resume their daily lives as soon as possible to have a fully-operated system efficiently tackle the pandemic.

New data released in the US on Thursday 2 April showed 3.28 million Americans filed for unemployment benefits in the previous week. The spike in new jobless claims is believed to result from the pandemic control lockdowns that have kept Americans from their workplaces and forced many companies to shutter or to lay off employees. We all know that unemployment could not only affect people’s finances but also their ability of taking care of their health.

In addition, “stay home” orders in some states in the US have also affected certain senior care operations; for example, free meal delivery to the seniors were delayed or rerouted even though the elderly are actually a group of people who need extra care most during the pandemic. It is better that healthy adults are allowed to resume their routines soon to help the community get back to normal early.

According to a report published by Italy’s National Health Institute on 17 March, 96.3% of fatal victims in Italy were patients over 60 years old. 99.2% of Italy’s coronavirus fatalities were people with at least one chronic medical condition, such as hypertension, diabetes and heart disease. Based on the demographic, we suggest the system should have the vulnerable stay home and, more importantly, offer them extra care. Young and middle-aged adults without serious health conditions should keep their routines to maintain the community’s full operations and, in addition, to help many households avoid the miserable economic consequences of workplace shutdowns.

Only when the system is fully-operatation are we able to take good care of the vulnerable and to end the pandemic. It is worth to noting that Hong Kong and Taiwan seem to have contained the spread pretty well and Japan and South Korea have been seeing a good trend in calming down the epidemic. All countries mentioned above did not enforce a nationwide lockdown or issue “stay home” orders at all.

Germany has not shut down daily life either; only food and entertainment outlets have been closed since the end of March. Germany has been conducting intensive testing and strictly quarantines sick people and their contacts. It has also made its medical system ready for a pandemic. Therefore, as of 28 March, Germany has had around 53,000 confirmed cases and 395 deaths recorded. Its case fatality rate (CFR) is 0.7% while a collaboration of Hong Kong University and Harvard University estimated the overall CFR of COVID-19 would be 1.4%. More impressively, Germany has now started taking care of patients flown in from Italy and France.

What Germany is doing is actually following flu control protocols. Although COVID-19 is not flu, the coronavirus appears to be showing a highly contagious nature and “flu-like pandemic pattern” after so many countries around the world reported cases. Thoroughly following “modern” flu control protocols is therefore the most relevant and sustainable measure for most countries.

What does “modern” flu control protocols mean? The protocols should include a surveillance network that asks clinics and hospitals to report patients with flu-like symptoms for further virus testing and early advanced treatments. Furthermore, they also entail adjusting resource allocation to help the medical community get ready for a huge amount of patients to save the vulnerable, and reminding healthy people to practice good hygiene all the time as well as implementing home or institutional quarantine on sick people and their contacts to flatten the epidemic curve.

Lockdown probably worked well during the 1918 Spanish flu pandemic - but not now. Lockdown probably helped China, but it does not fit all countries. We are looking forward to seeing the European Commission helping its member countries to ease their lockdowns as soon as possible. We are also hoping the EU shows the world a good leadership and helps countries in other regions cope with the pandemic together in the near future.

https://www.euronews.com/2020/04/08/the-eu-should-learn-lessons-germany-coronavirus-protocols-life-can-return-to-normal-view

To Guam | When Guam's Total COVID-19 Cases Were Over 100

Guam reported the first three COVID-19 cases on March 15, 2020 and as of April 5 the total cases were over 100. After looking into the profiles of those confirmed cases released by Government of Guam, I actually think that the honorable Governor Lou Leon Guerrero could be more confident with the island’s COVID-19 control measures.

As a public health professional with solid epidemiologist training, I’d like to remind people on Guam that as of April 6, among 113 cases (Picture 1), there are 61 in stable conditions and 27 recovered. The percentage of the “61 plus 27” is 77.9% and it’s awesome! Keeping the number of hospitalized cases low at 21 comforts people who worry about the capacity of the island’s medical system, doesn’t it?

Picture 1

In addition, according to a report published by Italy National Health Institute on March 17 (Picture 2), 87.7% of fatal victims in Italy were patients over 70 years old. That means people over 70 have a higher risk of developing severe illness, or losing their lives, once they got infected. Please notice that, here on Guam, we have 14 over-70-year-old cases. It’s 15% only. It helps a lot when everyone of us really hope to avoid tragedies as possible as we can.

Picture 2

However, the percentage of cases of age 60 to 69 is 27.4%. This number should remind us that we need to offered extra care to the seniors in our community to help them prevent from contracting the coronavirus.

The report from Italy mentioned above also told us that 99.2% of Italy’s coronavirus fatalities were people with at least one chronic medical condition, such as hypertension, diabetes and heart disease (Picture 3). I believe the prevalence of those chronic disease is high on Guam. Our epidemic response has to include special preventive care for chronic patients as well to really flatten the curve and save the vulnerable.

Picture 3

Although COVID-19 is not flu, the coronavirus appears to be showing its highly contagious nature and “flu-like pandemic pattern” after so many countries around the world reported cases. It’s almost impossible to contain the spread. That is why Germany stops being worried about the big number of infected cases they found thru the vast testing and really pays attention to preventing severe illness and avoiding deaths. Guam may need to learn from Germany and keeps the good job we have done so far to take good care of the vulnerable in our community.