Peter Katona, MD, FACP, FIDSALAEPF Board Member

Peter Katona is a Clinical Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles. He is an Adjunct Professor at the Fielding School of Public Health and an Instructor at Louisiana State University. He is active at the National Center for Biomedical Research and Training (NCBRT) and the Academy of Counter-Terrorist Education Expertise in Clinical Infectious Diseases & Internal Medicine, specializing in Epidemiology, Public Health Medical Informatics, Biotechnology Terrorism, Biological Weapons, and Biowarfare.

Here’s what is currently relevant:

• No accurate statistics are available due to too much fluidity.

• We are seeing 4 epidemics at same time: (1) disease, (2) psychological frenzy (initially of the unknown, then later sheer dread), and xenophobia (3) recession, (4) infodemic (China claims the US started it, the US blaming them for the BSL-4 virology lab near their wet market, deceit, keeping it a secret.)

• The hardest hit countries are Italy, Iran, and potentially the US, coming up. The best responses have been China, South Korea, Taiwan, Hong Kong, and Singapore. An outlier is Japan, with a low number of tests, infections, and deaths, and good hot spot eradication and despite lax social networking.

• Contagiousness and lethality compared to the seasonal flu: the flu sees 4 million cases per year and 500,000 deaths, worldwide. Pandemic flus every few decades see 720 million cases and 50 million deaths, but in flux.

• Clinical studies in China indicate that pollution, COPD, smoking lead to higher death rates.

• 2+ week delay in transmission before an individual is counted as a case.

• High risk groups include those 60+, those with chronic diseases, health care workers, first responders, essential workers, and those taking medications (particularly lisinopril), as well as poor, underserved, and homeless populations.

• How will we handle the mistakes we’ve already made, which include: slow response, personal protective equipment shortages, and testing delays. (Follow up question: do travel bans delay or correct these shortages?)

• Current situation: 70 million people in the United States have been given stay at home orders. Cases are doubling every three days, as we are in the exponential part of the epidemic curve. We are seeing a shortage of personal protective equipment (masks, vents, people) and health care workers/first responders. There is fragility in social distancing/quarantine/sheltering in place. We need more tents, drive-throughs, and testing. Travel bans are escalating.

• An innovative vodka maker is making hand purifiers using their ethanol.

• What’s needed: we need to act quickly—not necessarily with draconian measures, but ensuring good compliance. We need to flatten the roller coaster curve by implementing school closings, quarantines, lockdowns, sheltering in place, hand washing, and more testing. We need to emphasize a quick response to pockets of outbreak, learn from other countries, and ensuring that we have consistent and correct messaging as we coordinate local, state, and federal resources and personnel. Sick leave and free care should be implemented, as well as ramping up military and ships, surface cleaning, and car-based testing. We need to telecommunicate for work, discourage hoarding, and encourage more food delivery and takeout.

• We must flatten the epidemic curve or else see a roller coaster like the Spanish Flu.

• Simulations and modeling are valuable but political, similar to climate change.

• How bad will it be for how long? CONTAINMENT Ro<1 → MITIGATION Ro>1. It may be too late to prevent this scenario and the outbreak will last a few months, subside, and then come back with the warm weather. It’s important to act now.

• Therapeutics and a vaccine are in development. The worst case scenario will see 50-70% of the world’s population infected, according to Merkel.

• Small outbreaks can be stopped by very rapid contact tracing, geographic boundaries, and local travel restrictions.

• We need to balance criticism of past actions by both the US and China. We should focus on what we can do moving forward.

• Once a medical plateau is reached, a financial turnaround happens.