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Swiss Cheese Approach to Pandemic Safety

Recently, I was thinking about pandemic safety and Swiss cheese. It’s an unattractive cheese, but it’s a good visual metaphor for a layered approach to infection control.

This ‘model of Swiss cheese’ has been around since at least the 1990s, when it was proposed as a way of thinking about how crashes happen. During a pandemic, it is squeezed into a different type of service, used to envision disease prevention instead of accidents.

In a pandemic as widespread as this one, no action can keep a person from getting sick. There will always be flaws in any approach. Washing your hands will not help you inhale the virus ̵

1; and wearing a cloth mask will not protect you completely if you are trapped in a stuffy room with an infected person. But put them together with some solid layers of ventilation and testing, and you’ve got yourself a game plan. (Or a really boring plate of cheese. Either way.)

The hope is that the gaps in one approach will be masked by the strengths of the other. Some classes have more holes than others and some, like vaccines, don’t yet exist.

The problem is that we seem to continue to be stubborn for a piece of solid cheese instead of accepting our flawed reality. In the United States, we just set a daily record, adding 99,000 cases a day to a current total of more than 9 million. At this point, we need everything, everything we have to give back everything that stole our lives.

It is not easy. We have been here for months and we are all extremely tired. We are ready to meet our friends, either go out without a mask, or exercise at the gym and instead we arrange the masks, the hand sanitizer, the filtration system, the ruler. Spirit and Zoom. Having one thing to do or remember instead of class that would be easier is to run through our long list of COVID calculations each day.

It’s even worse because each layer of Swiss cheese we’re wrapping ourselves just makes us safer. They still did not take us to safety. There is no easy application to assess ventilation in your home, no list of strict rules for forming a pandemic outbreak, no judge to rule when COVID disputes happen between friends, family or colleagues. The incredibly irritating answer to questions that seem pandemic-related is ‘it depends.’

Scientists are working to find a more specific answer. But research so quickly, it will still not be able to satisfy our deep thirst for certainty “in these uncertain times”. Until this is over, we’ll have to snack on all the layers we can, stacking all new interventions together until we find a matching match.

Here’s what else is happening this week.


A room, a bar and a classroom: how a coronavirus spreads through the air
This is a great visualization of how coronavirus can be spread in different environments and with different interventions. Not surprisingly, the more layers of prevention the better. (Javier Salas, Heather Galloway /nation)

Why shouldn’t you worry about the studies showing Coronavirus Waning antibodies
Lately a lot of people talk about antibodies. This story analyzes what was helpful in those studies – and what wasn’t. (Apoorva Mandivalli /The New York Times)

Low risk or dice? Two new reports paint different pictures of the dangers of COVID-19 in flight
“The risk (contracting COVID-19 on a flight) is low, but not zero,” said Christopher Sanford, founder of the travel medicine clinic at the University of Washington Medical Center. USA Today. “The answer is a big fat ‘it depends,’ ‘
(Dawn Gilbertson /USA Today)


Gilead’s Covid-19 is mediocre. It will be a blockbuster anyway.
Veklury, the drug was formerly known as Remdesivir was approved by the FDA last week. But approval is not as effective as many think. “FDA approval does not guarantee a certain level of benefit – all it says has some benefits,” said Aaron S. Kesselheim, professor of medicine at Harvard Medical School. The New York Times. The drug is not the silver bullet many had hoped for. But it will still sell very well. (Katie Thomas /The New York Times)

Regeneron interrupted the trial of antibody therapy in a seriously ill Covid patient
Both Regeneron and Eli Lilly have now stopped testing their antibody therapy in critically ill COVID-19 patients. They will continue to test these treatments in patients with milder cases, where the drug may still have some benefit. (Hannah Kuchler /Financial Times)

It may be time to reset expectations about when we will get Covid-19 vaccine
Experts increasingly realize that we cannot see a safe, effective, licensed and widely available vaccine next spring. That’s not a bad thing – with one that can affect billions of lives, you must be cautious. (Helen Branswell /STAT)

Moderna says it is preparing to launch the Covid vaccine globally because it needs $ 1.1 billion in deposits
Even as the timeline is pushed up, pharmaceutical companies are still working on production of their vaccines, expecting to be approved. That’s not a bad thing either – if the drug is safe and effective, getting ready could help reduce demand and get more people vaccinated faster. (Berkeley Lovelace Jr./CNBC)

The temperature sensor will help keep the COVID-19 vaccine active
A look inside technology will help to safely dispense any eventually approved vaccine. (Nicole Wetsman /The Verge)


What we are voting for: Public health
There is an election in the US next week. The outcome matters for any cause, from fundamental regulation to democracy – and amid a worsening epidemic, the future of public health in the United States will be decided at the ballot box. Nicole Wetsman has an editorial now The Verge about what’s at stake to public health in this election.

Read more:

America is about to choose how bad pandemic will be
(Ed Yong / Atlantic)

More than numbers

With more than 45,683,708 people worldwide who have had a positive test result, we hope your recovery will be a smooth one.

To the family and friends of 1,190,516 dead people worldwide – 229,710 in America – your loved ones will not be forgotten.

Keep safe, everyone

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