Temperature Scanners Everywhere

'Why did Singapore’s containment strategy work, in such a high-density location?  Their program is mostly symptom/temperature checking-based'

It does seem like having symptoms really ups how infectious you are
"while we are learning that there are people who can shed COVID-19 virus 24-48 hours prior to symptom onset, at present, this does not appear to be a major driver of transmission. " WHO

'Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads. ' CDC

Singapore is doing twice a day checks for some people
'All employers should require their employees to check their temperature at least twice daily, check for respiratory symptoms, and for those unwell to visit a doctor immediately.' During SARS they did something similar 'Singapore became the so-called country of thermometers: temperature monitoring was made mandatory in schools and temperature screening was instituted at entry to public buildings.'

In China 'In every business I enter (whether that’s a restaurant, supermarket, or retailer), someone takes my temperature and asks me to write down my phone number. Taikooli, the large outdoor mall by where I live, has blocked off most entrances to corral people into temperature check zones'

Airport screening does not work as it only catches you if you are sick at just the right moment so the checks have to be regular.

 What is the most efficient way to get peoples temperatures checked twice a day? Non-Contact Infrared Thermometer are cheap ($10). Paying people to hold them is expensive. Grabbing a thermometer others have grabbed sounds unhygienic. And trusting people to measure themselves expects a lot from them. But a thermometer held on a stand that checked people, that's cheap. Some logging would probably be necessary but lets work out the basic concept first.

Would twice daily temperature checks reduce R0? The idea is to reduce the period of time someone with symptoms is not isolated.
If so is there a way to set up a machine to check your temperature so they do not have to be manual?

Pandemics and the Internet

My last point pointed out how many people died in the flu pandemic in Ireland in 1918.

To take the example of Japan according to Gapminder 1918 had a huge drop. The other big drop is the is the second world war with all the bomb dropping and shooting that involved.

David Eagleman has an interesting point here about how the internet can help prevent and reduce epidemics.

"The internet can be our key to survival because the ability to work telepresently can inhibit microbial transmission by reducing human-to-human contact. In the face of an otherwise devastating epidemic, businesses can keep supply chains running with the maximum number of employees working from home. This can reduce host density below the tipping point required for an epidemic. If we are well prepared when an epidemic arrives, we can fluidly shift into a self-quarantined society in which microbes fail due to host scarcity."

Eagleman has a good short video on his thesis

The long term effects of a sudden switch to everyone avoiding each other for a month or two could be huge. These would include

Education: How schools help spread influenza has been studied. 'School closures during the 2009 influenza pandemic: national and local experiences'. If all the schools were closed for a few months and people would move to Khan Academy and other online education sites. After this period a switch back to a fully non online world won't happen

Telecommuting: In a similar way online telecommuting would become much more popular. After a quarantine lite period the use of online project management and other telecommuting tools would become mainstream.

Shopping: If you don't meet people in school or at work you meet them in the shops. Deliveries of shopping would be strongly encouraged in the event of a pandemic. They should probably even be sponsored. Shops would not get as popular again once everyone got used to online shopping.

Banking: No one likes queuing in the banks at the best of times. Even ATMs would become horrible grubby in a pandemic world. Everything including social welfare payments would try and avoid using the fomite that is cash.

Telemedecine: People with the influenza need to be kept away from people who are sick. People with other illnesses will have to be dealt with remotely to avoid them coming into contact with people with influenza.

Public Events: Public events parades, cinemas, bars and museums would be closed. By their nature these involve people. If public events are made cheaper to attend virtually that will reduce the need for people to meet up. By this I mean if Sky Sports is made free for a few months people will be less annoyed no fans are allowed attend the football game.

There are many people without access to the internet that would not be helped by the use of digital technologies. Hopefully the use of digital technologies will help focus more of the traditional public health effort on them.

When the next pandemic happens the internet will reduce the consequences. Many industries will also change but the main thing is to avoid the 50 to 100 million the last pandemic killed.

Swine Flu

There has been a worrying outbreak of swine flu. there is a good description of it here. The new scientist has another article on the issue here.

The pandemic ventilator project here says

So what do we know? First the people that are dying are not the typical elderly and very young. They are mainly healthy young and middle aged adults. The death rate seems fairly high, perhaps as great as 10%. Death rates early on in a pandemic however are very difficult to pin down, as we really do not know how many people were infected but in fact had very mild symptoms and were not counted. The virus is spreading to many geographical locations quickly. The WHO has already stated that it’s first line defense against pandemic outbreaks, which is containment, is no longer possible. The reason that there are no major travel restrictions imposed by governments is not that they think the threat is too minor, but that it is past the point where travel restrictions will help. What is still unknown is how severe it will eventually be, and how readily it will spread.

There is not much information in this post. All I am trying to do is point out some sources of useful information on this new flu outbreak.

Cheer up things could be worse

Chicken Licken has nothing on the news these days. Everyone is talking about "perfect storms of bad economic data" and "the worst possible recession imaginable", stuff like that. This recession is bad(pdf), much worse then most people currently believe. It is at the point where those hoarding gold are overly optimistic, they should be hoarding rice.

However you have to be really lacking in imagination to think that a complete collapse of the banking system hyperinflation of fiat currency and abandonment of all social services provisions are the worst economic event you can imagine.

Here are a collection of things that are much worse.

These sorts of inevitable disasters come round anywhere from every 100 years to 50,000 years or so
1. A Flu pandemic which killed 5% of world population.
2. Canary island volcano falling into the Atlantic.
3. Yellowstone volcano exploding
4. Rapid onset new ice age

Not inevitable but fairly likely
1. Thermonuclear war.
2. Intelligent robots that try kill us all (surely this is overdue at this point)
3. Bioterrorism of some mix of aids, smallpox, anthrax and athletes foot.

So cheer up on a geological scale this is minor. Yellowstone could explode then you’d really have problems.

Grim Thoughts

Who should get the few mechanical respirators that can mean the difference between life and death?

Why should you care about ventilators? Lets do the sum based on
How likely something is (In the next 50 years say)
How bad it is
How much you can do about it

So to take large meteorite strike of earth
Not very likely in the next 50 years
Massively bad
Not much. Ask that your tax money goes into investigating it is about all.

Take a bad car crash
Pretty likely
400 people a year in Ireland so not likely to wipe out society
Lots. Seat belts, speed limit, don’t drink and drive

Influenza Pandemic

Very likely
Very bad. !918 had over 50 million deaths.
A bit. At a personal level live healthy and maybe stock up on face masks. Ask that your tax money goes into investigating it. And I believe you can make real research steps.

Can you make a respirator to keep people breathing? Can you train up to care for people on respirators from your current skill set. Can you access medical records on the last influenza pandemic to help assess the general power of certain cures?

By this I mean that in the 1918 epidemic Americans found

Only one therapeutic measure, transfusing blood from recovered patients to new victims, showed any hint of success.

George Whipple
Did any researchers from other countries confirm this result?

It could be that ventilators are not the choke point in delivering care in an influenza pandemic the choke point could be something you know about. So think about it and see if there is anything you can do.

Ha Ha, I am not dead

A H5N1 pandemic has not happened yet so we should just forget about it?
Steps by public health car workers have meant that an influenza pandemic has not occurred. It does not mean that no influenza pandemic will occur.
As Dr Seuss put it “to us their gift was time”

Homemade ventilator 3

Could existing ventilators be modified to increase the availability of ventilation?
This paper “A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge” suggests that four people could use a single ventilator in a disaster situation

This blog suggests that the number of ventilators would need to be doubled to cater for a pandemic would be an extra 200,000 in the US. This would triple the current number. The paper above suggests it might be possible for current ventilators to cover this shortfall.

All these ventilators need to be manned by skilled personnel. These medical staff will themselves be affected by the flu pandemic. So the numbers of skilled staff to operate and repair ventilators and to nurse pandemic patients is still a constraint.

Homemade ventilator 2

Seems like this idea is actually being pursued by some one who knows what they are doing.
Pandemic Ventilator Project
They use a bellow design. I wonder how this is superior to a fan based system? The DIY Powered Respirator described here might be modified.
An estimate of the amount of energy required to breath is given here. Which back of the envelope is less then 20 watts. The fan in the DIY respirator is 13 watts so my sums are probably wrong.
So can a pc fan or a squirrel cage blower be made to operate for 3 seconds pumping 500 ml of oxygen into the lungs and then to allow this air to escape in 2 seconds? A microcontroller could be used to time this.

An alternative design is some sort of Iron lung. This gets around many of the nasty infection problems a putting a tube down your throat could lead to. However according to here
"This style of ventilator would be of no use in a flu outbreak, in as much as flu usually floods the lungs with fluids, and you have no way to remove the fluids."
So maybe homemade iron lungs are not the way to go?



Another thing that would be needed are sensors to
1. Signal when the machine failed to work correctly.
2. Signal when the patients gas exhalation or pressure were not normal.

Why might a DIY respirator be necessary? Some of the mathematics of ventilator shortage are on the Pandemic Ventilator Project site. And the cold numbers on survival rates without a ventilator are here.

Homemade ventilator

There was a Horizon program about flu pandemics on last night. They seem to come along about every 40 years and vary between a very bad flu season and killing 2% of the population.
One of the points made by the program was that ventilators can save lives in flu patients but that there is no excess capacity of ventilators as would be needed for a pandemic.
So could you make up a ventilator? Our lungs tidal volume is about 500ml[1]. We breath 12 times a minute. Air has to be pushed into your lungs but exhalation is passive.

So could you design a homemade ventilator, they seem like just a timed pump and a release valve to me? Other factors such as nursing levels are important but fundamentally without something to breath for them while they fight the illness many flu victims will die.


[1]http://en.wikipedia.org/wiki/Lung_volumes