In this non‑interactive update, Dr. David Perlmutter reviews a newly published New England Journal of Medicine study on the aerosol and surface stability of SARS‑CoV‑2, highlighting that the virus can remain infectious for up to 24‑36 hours on cardboard and for many hours on stainless steel and plastic, raising concerns about package handling. He then explains the concept of “flattening the curve,” illustrating how interventions such as school closures, case isolation, household quarantine, and social distancing for those over 70 can extend ICU capacity and reduce peak demand. Using a New York Times analysis, he compares the epidemic trajectories of several countries, noting that aggressive behavioral measures in mainland China and South Korea have markedly flattened their curves, whereas Italy, Spain, Iran, France, and the United States have not yet peaked. Throughout, he stresses that behavioral public‑health actions, not new medicines, are the primary defense against rapid spread, and he urges vigilance regarding surface transmission when receiving deliveries.
Chapters
Well, hi everyone, Dr. David Perlmutter here. This is coronavirus update number 11, and unlike our previous updates, this one will not be interactive in real time. You're certainly welcome to post your comments, but I've got a lot of information. I've created a presentation for you today that really deals with 2 very, very important topics that I really think need attention. So it's my hope that with today's presentation we can gain some understanding as to why things are increasing as rapidly as they are. Why is this coronavirus spreading so aggressively in our country? And I'd like to turn to a publication, in fact, that came out today in the New England Journal of Medicine, and it is called Aerosol and Surface Stability of SARS-CoV-2 as compared to SARS-CoV-1. As you all know, we are in the midst of a SARS-CoV-2 infection, and what the researchers wanted to determine in this paper that again came out today was how long is the virus infective on various surfaces. And what they did was they compared new data on the new virus, CoV-2, compared with previous data of SARS-CoV-1 and looked at various surfaces to determine how long could the virus remain infective. And I'm going to walk you through this. I think the comparison is interesting, but for our purposes, we're just going to focus on the, the new virus, the new coronavirus. And first, let's look at cardboard. What did they find? They found that there is a reasonable likelihood that 24, 36 hours out there could still be infection generated by this virus on the surface of cardboard. Now why I think this is really important is because today there was a report in USA Today that actually talked about that we don't have really much to worry about when we're getting our packages from Amazon, for example, because, you know, they're packed and then it may take 3 or 4 days for that to be delivered. Yeah, all well and good, but they are handled by the delivery person and put on your front porch, and you might just pick that up 15 minutes later. They could be contaminated. What else did the New England Journal of Medicine study show us today? And that is that look at the viability of the coronavirus on stainless steel and certainly on plastic many, many hours later. So what did they conclude? These findings echo those with SARS-CoV-1, the previous SARS infection, in which these forms of transmission were associated with nosocomial spread and superspreading events. They provide information for pandemic Mitigation efforts, meaning that if we want to mitigate, if we want to do our best to slow this down, we have to consider that this virus remains viable on various surfaces for days at a time. So what I'm saying is keep it— keep that in mind when you're anxiously awaiting that Amazon package. It finally comes and you grab it after it's been deposited on your front porch. 15 minutes before. Now, we're hearing a lot these days about so-called flattening of the curve. I'd like to walk through what this means and then look at how we're doing and think about why this may be important. So what exactly is meant by this idea of flattening of the curve? And really, what it's getting to is the idea that if we can just prolong the number of people that are going to require critical care or intensive care unit beds, we might have a better shot at being able to deal with them. And if you look at first the red line, that is the number of critical care beds occupied per 100,000 population, the availability, if you would, the surge critical care bed capacity. Now, where do we stand if we do nothing? Well, we are going to be really very much away from that ability to have critical care beds for people. But can we flatten this curve out? Yes, we can. What happens, for example, when we close schools and universities? Good news, that happened early on for the most part. That's, that's a good thing. Beyond that, What happens if we isolate cases? We begin to flatten the curve. And what happens if we not only isolate cases but we put the entire household under quarantine? Further flattening of the curve. And then what happens if we not only isolate cases, home quarantine, but mandate social distancing of individuals who are greater than 70 years of age? Well, then we flatten the curve even more dramatically. The point that I'm making here is that all of these things that you're seeing are behaviors. This is not developing some new and exciting medication. This is playing more defense than it is necessarily offense. It's keeping the disease from spreading because look, if you look at this, even under the best-case scenario, when we do all the things, we case isolate, we home quarantine, and we social distance, we still have a pretty significant difference between the availability of critical care beds and what we've been able to do even with our best efforts. So, you know, it can happen though. 2 days ago on March 19th, this article appeared in the New York Times, Which Country Has Flattened the Curve for Coronavirus? Again, published on March 19th. They looked at a variety of countries and determined what is their slope. Looking at Italy, Spain, Iran, France, and the United States, you see that the slope isn't anywhere near peaking out and coming down again. So, in other words, not peaked out, and we don't expect this to happen for quite some time. On the other hand, when you look at, for example, mainland China, They've instigated some incredible public health measures, mandating behavior that has absolutely brought this down dramatically. And not only mainland China, but look at South Korea. These are behavioral changes that have been instituted. They've not developed a magic cure here. This is behavior. And look at the outcome, especially Interesting when we look at the comparison then between the slope of the curve of South Korea and the United States. So we've got some really good science here that's telling us that our behaviors matter a whole heck of a lot. You know, I've said this before, the best defense is a good offense. We don't have an offense here, but we know that defense is a game we can play. By taking the ideas of keeping ourselves away from others very, very seriously. And also keep in mind the New England Journal of Medicine study that was published today talking about the viability of this virus on surfaces. So keep that in mind when you're buying things, when you're bringing things into your home, because it looks like that may be an important vector in terms of transmission. Thanks for joining me. I'm Dr. David Perlmutter. I'll see you guys tomorrow.
