I bought this award-winning board game about three years ago not guessing how relevant it would become. Now that many of us are sheltering in place from COVID19, what could be better than a science-based game where the goal is to cooperate in order to defeat life-threatening viruses!
The game is designed to mimic the behavior of contagious diseases which if left unchecked kill thousands of people (sound familiar?). There are several mechanisms to spread germs from one locale to another. Individual cities can become quickly overwhelmed (“outbreaks” in the game’s terminology). Outbreaks add to a “burden of disease” tracker on the side of the board. If you reach the final skull-and-crossbones–it’s game over!
source:@thatbgshow
The game unfolds quickly by drawing “infection” cards with names of cities onto which you place infection markers (small colored cubes). Several events can occur that will accelerate these infections to the point they become outbreaks (as outlined above).
Pushing back on this process is the actual game play. Each player has a special role (medic, researcher, etc.) with special abilities. Unlike most games the point is to maximize the benefit for everyone. This leads to discussion and cooperative problem-solving.
Pandemic is appropriate for older children, works best with four players, and takes less than an hour to complete.
I’ve annotated this NY Times graphic, rounding the estimates for COVID19 (aka the 2019 novel coronavirus) to 2% mortality and 2 people infected for every one who has the disease. What this suggests is the infection rate will be similar to a bad cold season, but unlike the common cold, a significant number of people will die of the disease.
This is not good news, but it is also not catastrophic.
By comparison the 1918 “Spanish” Flu had a similar infection rate but killed 1 in 10! The 1918 Flu infected approximately one third of ALL the people on earth… and that was before air travel!
Based on these numbers alone, up to 110 million people in the US could be infected. 80% of these cases should be mild, 20% will need some form of special care in hospitals or at home, and 2% (2.2 million) could die.
One area where the 1918 Flu differs from COVID19 is the latter does not seem to kill children, which is a small bright spot. However, children may be a source of infection for vulnerable adults!
Note that the currently reported mortality rate is over 3% but here in the US we have done almost NO testing, so the total number of infected individuals is unknown, but likely to be much higher. This means the reported mortality rate is probably inflated due to lack of good data. I’ll stick with 2% as a conservative figure for now.
It is also important to remember one of the lessons of the 1918 epidemic, things may look better when warmer weather returns but this should not be reassuring. In the spring of 1918 it looked like the disease was weakening, but it returned with a vengeance in the fall and winter!
Social Isolation and Hand Washing
For the general public, not living with or caring for a sick person, wearing masks really doesn’t help. Social isolation (eg, staying home) and effective hand washing remain the best things you can do to prevent getting most viral respiratory diseases (the common cold, influenza, and the new coronavirus). Just being in the same room with a sick person is not that risky, but touching surfaces and objects in that room and then touching your face is a good way to catch one of these viruses. Note that hand washing studies suggest we generally neglect our fingertips (including the nails) and wrists.
The best information available comes from CDC and WHO (which I consider the best source since it is not caught up in US political shenanigans). For up-to-date worldwide information download the most recent WHO Situation Report.
My Wife’s Grandfather worked as a chemist for The Tilden Company in Upstate New York during the early 1900s. As a result we came into possession of his “Recipe Book” for the plethora of nostrums and remedies he helped create. Some of the ingredients are still sold today under various brand names. Some are humorous, others are forgotten, while still others are downright dangerous. The following installments are my exploration of this unique window into the medical past. [Note: We donated the actual book to the historical section of the National Library of Medicine.]
The Tilden Company (circa 1930) source: NLHS
The book is mostly a unordered compilation of the labels that appeared on the various products they sold. There are a limited number of handwritten notes as well. Here is the full first page.
The words “Poison”, “Opium” and “Strychnine” sort of jump off the page. Let’s look a bit closer a the bottom/center item.
Good for What Ails You
Note the alcohol component of 12-17%. This would presumably “fortify” the patient. Alcohol was a common primary ingredient or base for many daily tonics. I wonder why?
Let’s start with Maltopepsine. This appears to be a Tilden brand concoction of digestive enzymes and acids. A search yielded nothing current about it, but plenty of very old medical journals mention it. Here is a full page ad from the 1895 Journal of Materia Medica.
source:google books
The rationalization for it being a “very perfect substitute” for missing (?) body fluids and relying on “the indubitable testimony” of a few “reliable” physicians is quaint but hardly evidence-based as they claim.
Moving on to the other ingredients, supplemental Iron (in alcohol of course!) may still be used as a tonic in some quarters. No big surprise there but it does have GI effects, mostly constipation.
Quinine (of gin & tonic fame) is next. During my early career it was given to patients with leg cramps. Apparently it helped because there was a hue and cry when it was taken off the market in the 2000s because it’s also known to cause bleeding and arrhythmias. It is still used to prevent and even treat malaria.
Finally there’s Strychnine!! Extracted from the plant Strychnos nux-vomica it is a central nervous stimulant, anti-emetic, and at higher doses a deadly poison. According to the ad the elixir was used by pregnant women and infants. Yikes!
Most of these patent medicines had multiple active ingredients (the “shotgun approach“) and were used to treat broad groups of symptoms and/or diseases. From the physician’s standpoint this made diagnosis and therapeutic decisions rather simple.
“Cerebral Sedative”
Now let’s consider the two labels marked “Poison” near the top. I’ll note here that these are the only oral medication labels in the collection thus marked.
Of course we start off with Alcohol 20%. Add a little Opium resin and you have a Tincture (one or more substances dissolved in alcohol). This is better known as Laudanum of novel and movie fame. The “40 M” may refer to molar concentration (?), but I can’t pin this down.
Chloral Hydrate is a potent sedative that was in common use until the past few decades. It may be the original date rape drug referred to as “slipping someone a Mickey” (a frequent plot element in old movies). It was commonly used to treat psychiatric patients and children. It is no longer available in the US.
Potassium Bromide is a sedative and anticonvulsant that is no longer used in human medicine. Gelsemium is a native plant containing alkaloids related to strychnine.
Units of Measure
The labels make reference to units of measure that are mostly gone, and in some cases obscure:
M – molar concentration??
m – ?? short for minim?
grs (grain) – 1/7000th of a pound (this is where we get the odd size of a standard aspirin tablet (5 grains = 325mg)
minim – 1/480th of a fluid ounce
dram – short for drachm, 60 grains or one eighth of an ounce, or 60 minims or one eighth of a fluid ounce
Haimased
Next we’ll consider the simpler concoction “Haimased” that was prescribed for high blood pressure. It has just two ingredients: Alcohol (no surprise there!) and SodiumThiocyanate.
Here is a description (ad?) from an Ohio medical publication:
Lower blood pressure effectively…safely, with this time-tested Sodium Thiocyanate formula. The proved clinical record of Haimased for 27 years and more than 1,500,000 prescriptions shows this to be the therapy of choice over the newer, potentially more toxic Hexamethonium-veratrum-rauwolfia preparations.
Bulletin of the Mahoning County Medical Society (1962)
Sodium Thiocyanate was first used to treat hypertension around 1900. It was apparently effective and safe enough for the time. It is however unpredictable and potentially toxic and was taken off the market except as a treatment for cyanide poisoning.
