3. Fix the testing mess
Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected.
In China, those seeking a test must describe their symptoms on a telemedicine website. If a nurse decides a test is warranted, they are directed to one of dozens of "fever clinics" set up far from all other patients.
Personal in head-to-toe gear check their fevers and question them. Then, ideally, patients are given a rapid flu test and a white blood cell count is taken to rule out influenza and bacterial pneumonia.
Then their lungs are visualized in a CT scanner to look for "ground-glass opacites" that indicate pneumonia and rule out cancer and tuberculosis. Only then are they given a diagnostic test for the coronavirus - and they are told to wait at the testing center.
The result take a minium of four hours: in the past, if results took overnight, patients were moved to a hotel to wait - sometimes for two or three days, if doctors believed retesting was warranted. It can take several days after an exposure for a test to turn positive.
4. Isolate the infected
Instead of a policy that advises the infected to remain at home, as the Centers for Disease and Prevention now does, experts said cities should establish facilities where the mildly and moderate ill can recuperate under the care and observation of nurses. Wuhan created many such centers, called "temporary hospitals," each a cross between dormitory and a first-aid clinic. They had cots and oxygen tanks, but not the advanced machines used in intensive care units.
People originally resisted leaving home or seeing their children go into isolation centers with no visiting rights - just as Americans no doubt would. In China, they came to accept it. They realized they were keeping their families safe. Also, isolation is really lonely. Its psychologically difficult. Here, they were all together with the other people in the same boat. They supported each other.
5. Find the fevers
Because China, Taiwan and Vietnam were hit by SARS in 2003, and SOuth Korea has grappled with MERS, fever checks during disease outbreaks became routine. In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even restaurant to get a temperature check. Washing your hands in chlorinated water is often required.
In China, having a fever means a mandatory trip to a fever clinic to check for coronavirus. In the Wuhan area, different cities took different approaches. Cellphone videos from China show police officers knocking on doors and taking temperatures.
6. Trace the contacts
Finding and testing all the contacts of every positive case is essential, experts said. China's strategy is quite intrusive: to use the subway in some cities, citizens must download an app that rates how great a health risk they are. South Korean apps tell users exactly where infected people have traveled.
Contacts generally must remain home for 14 days and report their temperatures twice a day.
7. Make masks ubiquitous
American experts have divided opinions about masks, but those who have worked in Asia see their value. There is very little data showing that flat surgical masks protect healthy individuals from disease. Nonetheless, Asian countries generally encourage people wear them. In some cities in China where masks are compulsory, the police even used drones to chase individuals down street, ordering them to go home and mask up.
The Asian approach is less about data than it is about crowd psychology, experts explained. All experts agree that the sick must wear masks to keep in their coughs. But if a mask indicates that the wearer is sick, many people will be reluctant to wear one. If everyone is required to wear masks, the sick automatically have one on and there is no stigma attached.
Also, experts emphasized, Americans should be taught to take seriously admonitions to stop shaking hands and hugging. The "WHO elbow bump" may look funny, but it's a legitimate technique for preventing infection.
"In Asia, where they went through SARS, people understand the danger", Dr. Heymann said. "It's instilled in the population that you've got to do the right thing."
8. Preserve vital services
Federal intervention is necessary for some vital aspects of life during a pandemic. Only the federal government can enforce interstate commerce laws to ensure that food, water, electricity, gas, phone lines and other basic needs keep flowing across state lines to cities ad suburbs. mr. Trump has said he could compel companies to prioritize making ventilators, masks and other needed goods. Some have volunteered; the Hanes underwear company, for example, will use its cotton to make masks for hospital workers. He also has the military; the Navy is committing two hospital ships to the fight. And Mr. Trump can call up the National Guard.
High-level decisions like these must be made quickly, experts said. "There is no choice. We must do all in our power to fight this," said Dr. David Nabarro, a W.H.O special envoy on Covid-19 and a veteran of fights against SARS, Ebola and cholera. "I sense that most people - and certainly those in business - get it. They would prefer to take the bitter medicine at once and contain outbreaks as they start rather than gamble with uncertainly," he added.
(Source: The New York Times - to be continue)
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