Illustrasjon av virus

Nøkternhet i coronatider

Mye er skrevet om coronaviruset, spredningen av viruset og prognoser både over utviklingen i befolkningen og utviklingen hos den enkelte som blir smittet. Mye av det som er skrevet er av tvilsom karakter.

Å leve i coronatider

Følg helsemyndighetenes generelle smittevernsråd. Vær kritisk til rådene som gis overfor mennesker med utviklingshemming. Husk at de som utarbeider rådene har liten innsikt i funksjonshemmedepolitikken generelt og situasjonen til utviklingshemmede spesielt.

Hvert år kommer influensa, med noe lenger mellomrom kommer virusepidemier som vi aldri har hatt før og som vi derfor verken har imunitet eller vaksine mot. De fleste av slike epidemier av nye virus, skaper avisoverskrifter, frykt, økonomisk nedgang i de fleste bransjer, utenom legemiddelindustrien. Likefullt, kommer vi over epidemiene og glemmer dem, helt til det etter noen år kommer en ny og ukjent virusepidemi.

Coronaviruset synes å være særdeles smittsomt. Men alt tyder på at de fleste ikke vil få spesielt store plager selv om de blir smittet. Det spesielle er at i en rekke land har det rammet svær hardt blant de gruppene som i utganspunktet har en svekket allmenntilstand,dvs. eldre, personer med hjerte- karsykdommer, diabetis, høyt blodtrykk, kroniske luftveissykdommer og kreft.

I solidaritet med dem som er i risikogruppen, bør vi gjøre det vi kan for å begrense smitten. Men vi skal heller ikke glemme grunnleggende etiske retningslinjer eller menneskerettighetene. Hensikten helliger ikke middelet i Coronatider. Det er all grunn til å være svært bekymret for tjenestene til mennesker med utviklingshemming! Likestilling er ikke forbeholdt solskinnsdager, men gjelder like mye i både i storm og virustider

Litt om influensa

Alle kjenner til influensa. Coronapandamien er ikke det samme, men det er mye likt. I tillegg kan det være greit å sammenligne coronapandamien med influensa. Det gir et nødvendig perspektiv. Uten noen som helst referanse, er det umulig å si noe som helst om faren vi står overfor.

Influensa kommer i en eller annen variant hvert år. Folkehelseinstituttet oppgir at 5-10 prosent av alle voksne får influensa i løpet av et år. 10-20 prosent av barn får influensa, mens 20 prosent av helsepersonell får influensa.

I gjennomsnitt forventes det at rundt 100 000 personer går til legen på grunn av influensalignende sykdom bare i løpet av vintermånedene i Norge.

Risikogruppene er:
  • Barn og voksne med:
    • diabetes type 1 og 2
    • kronisk lungesykdom
    • hjerte- og karsykdom
    • lever- eller nyresvikt
    • kronisk nevrologisk sykdom eller skade
    • nedsatt immunforsvar
    • svært alvorlig fedme (KMI over 40)
    • annen alvorlig og/eller kronisk sykdom hvor influensa utgjør en alvorlig risiko
  • Alle fra fylte 65 år, uavhengig av helsetilstand
  • Beboere i omsorgsboliger og sykehjem
  • Gravide fra 12. svangerskapsuke
Det er verd å merke seg at risikoen for dem som inngår i risikogruppen også er svært lav. I Norge er risikogruppen på 1,6 millioner for alvorlig influensasykdom. De fleste i risikogruppen vil ikke en gang bli smittet.
 
Sykehusinnleggelse og dødsfall
I gjennomnsitt regner en med 5000 sykehusinnleggelser, dvs. at en av 20 smittede kommer på sykehus. De fleste er innlagt i kort tid. Rundt 500, dvs. 0,5 prosent, blir såpass hardt rammet at de må gis intensivbehandling. Rundt 900, dvs. 0,9 prosent dør av komplikasjonene med influensa i gjennomsnitt per år.
 

Litt om coronasmittede

En forskjell mellom coronapandamien og influensa, er at vi har mer eller mindre gode vaksiner mot influensa. Mange vaksinerer seg. Vaksine mot coronasvirus finnes ikke. En annen forskjell er at den årlige influensaen på virusnivå er små variasjoner over to ulike virustyper. Mange kan dermed ha en viss imunitet mot influensa. En regner med at ingen har lignende imunitet overfor coronaviruset.

Basert på 72,314 registrerte smittede av coronaviruset i Kina, fant en at 

  • 80 prosent hadde et mildt sykdomsforløp. De fleste merket at de var syke, men de absolutt fleste hadde et mildt sykdomsforløp
  • 13,8 prosent hadde et mer alvorlig sykdomsforløp, fikk lungebetennelse og ble kortpustet
  • 6,1 prosent fikk kritiske pusteproblemer, blodforgiftning og organsvikt
  • Rundt 2 prosent døde som følge av sykdommen
Svært få barn og unge var registrert smittet, kun 2,4 prosent av de registrerte smittede var 19 år eller yngre. 0,2 prosent av de unge hadde et kritisk sykdomsforløp.
Dødsraten i Kina, var altså rundt en prosent høyere enn for normenn med vanlig influensa.
Dødsratene var høyest for personer over 80 år med 21.9% av de smittede. Blant personer med hjerte- karsykdommer, diabetis, høyt blodtrykk, kroniske luftveissykdommer og kreft, var det forhøyet dødelighet (fra 13,2 prosent til 7,6 prosent). For voksne under 60 år, uten andre alvorlige sykdommer, var dødsraten 1,4 prosent.
Tallene fra Kina forteller også at dødsprosenten var høyest i starten av epidemien og ble mye lavere etter hvert. Blant dem som testet positive for coronaviruset fra 1. til 10. januar, var dødsraten 17,3 prosent. Blant dem som ble testet positive etter 1. februar, var dødsprosenten 0,7 prosent, altså lavere enn ved en vanlig norsk influensa. WHO viser til at helsevesenet ble bedre istand til å møte smittede etter hvert.
Tallene fra Kina viser også stor regional variasjon. Både alvorlige tilfeller og dødsraten var høyest i storbyen Wuhan.

 

utvikling av mortalitet

Sykdomsfare, atferd og helsevesen

Døden er like naturlig som fødselen. Når folk dør av sykdom, så kommer det som regel av at en i utgangspunktet er svekket, så kommer en sykdom som blir en for stor belastning for kroppen. Slikt skjer daglig på norske sykehjem og er ikke noe spesielt verken med influensa eller med coronaviruset.

Tallene fra Kina må ikke leses som fysiske konstanter. I Italia er det dødsprosenten per 13.02 7,2 prosent. I Tyskland er dødsprosenten per 13.02 0,2 prosent, mens den i Norge per 13.02 er 0,1 prosent. Mange av de viktigste forholdene til variasjonen i dødsprosent kjenner en til:

  • Tiden smittede har vært smittet. Det tar tid å bli såpass syk at en får alvorlige komplikasjoner og kanskje dør. I Italia har dødsprosenten vokst med snaut en prosent per dag i det siste.
  • Dødsratene og prosenten som får alvorlige komplikasjoner, er trolig for høy i alle registreringer. Det er knapt noen som tester seg for en virussykdom som de ikke har hørt om. Alle som havner på sykehuset med alvorlige komplikasjoner, blir testet. Når virussykdommen er blitt et samfunnsproblem, så er det nok større sjanse for å bli testet selv om en ikke har symptomer eller vesentlige plager. Slike effekter bidrar til å redusere prosenten av død og alvorlige komplikasjoner.
  • Helsevesenets kvalitet og kapasitet er svært avgjørende for hvordan det går med de sykeste. Uten helsevesen, ville forventet levealder i Norge blitt redusert med noen tiår. I Nord-Italia har effekten av coronaepedemien vært at helsevesenets kapasitet er blitt alvorlig redusert samtidig med at pågangen av dødssyke har vært himmelhøy.
  • Antall registrerte smittede avhenger av antallet personer som blir testet. Til å begynne med i Kina, så var det ingen som testet seg mot et coronavirus. Ingen visste at det eksisterte. Når en ble klar over viruset, så ble kun de med såpass store komplikasjoner at de søkte helsehjelp som ble fanget opp. Med tiden så ble en flinkere til å teste alle som potensielt kunne vært smittet. Fallet i dødeligheten over tid, gjenspeiler at en over tid har blitt flinkere til å teste for coronaviruset og også testet flere som ikke ble alvorlig syke.
  • Folks atferd varierer. Coronaviruset smitter i stor grad gjennom bitte små vanndråper som smittede puster ut. Vanndråpene beveger seg over korte avstander. Hvis det er slik at en møter mange mennesker på kort avstand, så er sannsynligheten mye større for å bli smittet enn hvis en treffer få. Bor en alene i ødemarken, så vil en ikke kunne bli smittet. I kinesiske storbyer er det svært tett med folk og de fleste benytter kollektivtransport og står tett på buss, tog og trikk. Leilighetene er små og folk bor tett.
  • Når Kina, Taiwan, Sør-Korea og andre asiatiske land dels synes å ha fått epidemien til å avta i spredning, dels synes å ha forhindret epidemien, så kommer det blant annet av styresett og innbyggernes respekt for myndighetene. Selvbestemmelsen har nok svakerer kår Kina enn i Norge. I Taiwan og Sør-Korea er nok innbyggerne flinkere til å følge myndighetenes råd enn her i Norge. Det er nok få av dem som hatt karantene i Taiwan og Kina som har gått på butikken, spilt golf eller vært på treningssenter.

Den italienske tragedien

Historiene fra Nord-Italia har vært mange og rystende. Det rapporteres krigslignende tilstander hvor helsevesenet ikke har kapasitet til å behandle alle med livstruende komplikasjoner. Legene må prioritere mellom hvem som må dø og hvem som skal få sjansen til å leve.

Etter hva jeg har lest om situasjonen, så hadde ikke Italia forberedt seg på epidemien og heller ikke fanget opp at smitten var kommet til landet. Starten på pandamien var katastrofal. Folk som blir alvorlig syke oppsøker naturlig nok helsevesenet. Den gruppen som i størst grad blir smittet i en slik uforberedt situasjon er helsearbeiderne. Når leger og sykepleiere ikke er klar over at de er smittet, så fortsetter de å jobbe. Leger og sykepleiere jobber først og fremst med syke og svekkede personer. Slik bidro det italienske helsevesenet til å smitte svært mange i risikogruppen. Men konsekvensene ble verre. Mange av helsearbeiderne ble syke og kapasiteten i helsevesenet blir redusert. Helsevesenet ble såpass svekket at for mange alvorlig syke, så eksisterete det ikke.

Epidemien i Italia startet på den verst mulige måten, så ble det verre etter hvert.

Smittespredning

Hvis vi har en mengde høner i en hønsegård og slipper ute ei høne som er smittet av et alvorlig fuglevirus, så vil antallet smittede over tid utvikle seg slik som i figuren under.

Logistisk vekst

Den samme funksjonen vil en få uansett om det er smitte blant høns, hauker, mennesker eller sauer, hvis de er i samme hønsegård eller i samme området. Den samme funksjonen gjelder også for ryktespredning, rottespredning, utbredelsen av nye moter og utbredelsen av nye mobiltelefoner. Kurven viser at antallet som er smittet eksploderer til å begynne med. Når omtrent halvparten av de som kan bli smittet er smittet, så blir avtar veksten i antall smittede. Når kurven flater ut, så kommer det av at alle som kan bli smittet, er blitt smittet.

Kurven forteller kanskje om situasjonen i San Marino eller andre lilleputtstater. For Norge blir kurven over for enkel, kort og godt for vi kan ikke forstås som ett, men mange overlappende sosiale- og geografiske områder. Jeg treffer flest som bor på Nord-Jæren og i Oslo. Blir jeg smittsom og ikke endrer omgangsmønsteret mitt, så vil jeg smitte flest på Nord-Jæren og i Oslo. Jeg treffer flere i funksjonshemmedebevegelsen enn folk flest. Folk i Trondheim treffer først og fremst andre i Trondheim og vil først og fremst smitte Trøndere. Fotballspillere omgås fotballspillere og prester omgås prester. Utviklingen av coronapandamien i Norge vil være en slags sum av slike kurver som vist over, men virkningsmekanismen vil være den samme som virkningsmekanismen i den enkle kurven over.

Data fra Kina antyder at økningen fra den første smittede har vært omtrent som i følgende tabell:

https://scontent-arn2-1.xx.fbcdn.net/v/t1.0-9/89722188_10216779453778721_4862013819293007872_o.jpg?_nc_cat=102&_nc_sid=32a93c&_nc_ohc=dxrd5Nrm7cMAX_IZ0DZ&_nc_ht=scontent-arn2-1.xx&oh=7cd44baae01b8a5803466a6b79bdebfc&oe=5E939642

Den første personen smittet kanskje så mange som 2,8 andre (i gjennomsnitt). Slik fortsatte det i hvert ledd. Allerede i det 18. leddet fra den første med smitte, så var omtrent 40 millioner blitt smittet.

Data over registrerte smittede i Norge, forteller at smittede nordmenn har vært svært flinke til å smitte andre. Fortsetter vi på samme måten, så er det høyst realistisk med en million smittede før sommerferien. En slik utvikling er imidlertid svært lite trolig (Folkehelseinstituttet har sine estimater, men de har jeg sluttet å tro på. Instituttet har gjentatte ganger bevist at de ikke helt evner slik estimering).

Ser en på Kina fra omtrent 1. februar, så har det gradvis blitt færre nye smittede. I går ble det i hele Kina registrert 11 nye coronasmittede i landet med 1,386 milliarder innbyggere. Kinas befolkning er 260 ganger større enn Norges befolkning. I Norge ble det registrert 196 nye coronasmittede i går.

Det som skjedde i Kina, var at folk begynte å bli forsiktige med å omgås andre. Myndighetene iverksatte restriksjoner, innførte karante, stengte bedrifter, kollektivtransport, kultur- og fritistilbud og offentlig service. I sum førte dette til at hver ny smittet, smittet minde enn en annen. Da reduseres epidemien. På sikt vil den dø ut. Noe lignende skjer nok i Norge også. I forrige uke var det nok få som tenkte på å avlyse fylkesårsmøtene i NFU. Denne uken ble anbefaling møtt uten protester.

Kina er på god vei til å utrydde coronapandamien innenfor landets grenser. Det samme kan skje i Norge. I Italia synes situasjonen foreløpig å bli verre dag for dag. Men den vil helt sikkert snu i Italia også. Vi får i medmenneskelighetens navn håpe at myndighetene får kontroll med pandamien før den siste italiener dør av coronaviruset.

Om å flytte beboere i bofellesskap hjem til foreldrene

Bofellesskap er en smittefelle, men det er langt i fra sikkert at det er lurt å flytte beboerne fra bofellesskapet. Det var ei mor som varslet at hun ville hente datteren hjem. Hun regnet med at datteren ville protestere.

Det vil sikkert kunne være koselig for moren å ha datteren hjemme i helgen. Men et slikt tiltak reduserer ikke smitterisikoen, da må det langt kraftigere lut til. Moren må holde datteren hjemme til høsten eller til neste vår, når smittefaren er over. I tillegg må moren holde datteren borte fra jobben og fritidsaktivitetene like lenge. Risikoen for å bli smittet ville heller ikke blit fjernet. Hadde moren plassert datteren i isolat hjemme hos seg i ett års tid, så ville datteren hatt omtrent samme risiko for å bli smittet som moren.

Hvis datteren i utgangspunktet er frisk og fin, så forteller statistikken at datteren høyst sannsynlig ikke ville fått de store helseutfordringene selv om hun ble smittet. Da er det ingen grunn til å gjøre smittevernstiltakene verre enn sykdommen.

Skal vi følge morens logikk, så bør vi selge bilen for å unngå trafikkulykker. Vi bør selge huset slik at vi ikke risikerer å brenne inne. Vi bør slutte å spise, slik at vi unngår å bli matforgiftet. Vi bør slutte å leve, slik at vi fjerner risikoen for å dø.

Tiltakene som iverksettes må stå i forhold til risikoen for smitte. Er en svekket fra før, så kan coronaviruset være det lille som skiller døden fra livet. I en slik situasjon, kan det være berettiget å sette inn svært sterke tiltak.

Coronaviruset kan mutere og bli mye farligere

 

Alle virus kan mutere. Når farlige virus oppstår, så er det en ny mutasjon. Men det er så mye alvorlig som kan skje, både på virusfronten og de fleste andre fronter. Hvis jorden treffes av en stor asteroide, så kan både menneskeheten og coronaviruset bli utslettet. Hvis en eventuell mutasjon ligger langt frem i tid, så kan klimakatastrofen bli et større problem. Det er så inn i hampen mye forferdlig som kan skje. Når vi ikke kan si noe om sannsynligheten for det forferdlige som kan skje, så er det vanskelig å forholde seg til alle de potensielt fryktelige hendelsene som har truet menneskeheten siden Adam og Evas dager.

Utviklingen av coronapandamien bestemmes av:

  1. Hvordan hver og en av oss oppfører oss. Først og fremst hvor mange vi omgås og hvor tett vi omgås. Reiser og kollektivtrafikk bidrar ofte til rimelig tett kontakt i lukkede rom.
  2. Helsevesenets kapasitet og kvalitet.

Hvordan hver og en av oss oppfører oss. Først og fremst hvor mange vi omgås og hvor tett vi omgås. Reiser og kollektivtrafikk bidrar ofte til rimelig tett kontakt i lukkede rom. Helsevesenets kapasitet og kvalitet. I Norge har vi et bra helsevesen. Ikke noe tyder på at helsevesenet skal rammes av coronaviruset slik som i Italia. Er vi flinke til å oppføre oss og myndighetene driver en fornuftig smittevernpolitikk, så kan konsekvensene av coronapandamien bli mindre enn en vanlig influensa, slik som i Kina i senere tid.

Selv om en har hjemmekontor og avisene er fulle av skrekkhistorier, så kan en leve godt og lenge. Det er liten grunn til å delta i coronahysteriet. Ikke noe tyder på at vi står overfor en katastrofe. Men jeg er glad for at folk blir litt hysteriske og overvurderer trusselen. Det fører til at folk tar forhåndsregler og at viruset får mindre spredning.

Jens Petter Gitlesen

14 mars 2020

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