Today the United States exceeded 4 million reported Covid-19 cases, according to the Johns Hopkins coronavirus tracker. One million of these were reported in the last two weeks and outbreaks continue to result in record case numbers in several states. Over 1,000 Americans died yesterday from the disease and the only way seems to be down, leaving many people asking “What can be done now?” to try and stem the pandemic.
We asked several U.S-based and international experts about this:
What is the first thing the U.S. and badly-affected states such as Florida, Arizona and Texas must do in order to try and slow down this spread?
“Slowing the spread is not a mystery,” said Rebecca Katz, Professor and Director of the Center for Global Health Science and Security at Georgetown University. “We know it is a combination of individuals taking appropriate precautions (masks, physical distance, hand hygiene, avoiding crowded locations) and having sufficient capacity to test, trace and isolate,” she added.
“It’s not an easy decision, but many of these states need to move to more aggressive efforts to limit person-to-person contact,” said Steven A. Pergam, MD, MPH Associate Professor, Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center. “The virus thrives on humans being close together and to date what has been most effective at controlling spread is policies targeting gatherings in public places. More restrictive “shelter at home” orders are likely the most effective, but major local efforts to limit even small gatherings is the key. This, coupled with masking of those who cannot physically distance, limits opportunities for the virus to spread and can help slow community transmission,” he added.
“They need a full on enforced lock down ASAP to get things under control,” said David Fisman, Professor of Epidemiology at University of Toronto in Canada and a practicing internist.”The difficulty is that lock down won’t stop transmissions that have already happened so would expect ongoing increases in hospitalizations for 2-3 weeks even after lock down as that’s the amount of time it takes for those transmissions to become cases, and those cases to get sick enough for hospitalization and intensive care,” he added.
“That’s tough and a tie between state-wide masking mandates and efforts to ensure adequate testing is available,” said Saskia Popescu, an infectious disease epidemiologist and Professor at the University of Arizona College of Public Health. “This includes drive through options, free testing sites, and ultimately the capacity to rapidly perform the tests and relay the results. A delay in testing means that people are forced to isolate longer assuming they have the virus, but it also delays reporting and contact tracing. This needs to be followed by ensuring hospitals and public health departments have the resources they need to avoid being over-stressed and healthcare workers have the critical resources needed to treat patients safely. Lastly, we need more public communication campaigns about risk awareness and the importuning of masking/social distancing,” she added.
“Based on international experience, for example in Hong Kong, the following measures would likely make most difference (short of a full stay-at-home order): Close bars, restaurants and gyms. Switch to working from home as much as possible. Stop indoor gatherings between different households,” said Adam Kucharski, Associate Professor at the London School of Hygiene & Tropical Medicine in the U.K.
Many states are experiencing significant outbreaks – do you think that these are likely to spread to all/most U.S. states or can individual states potentially curb the spread?
“People move across state borders. If we have outbreaks in one part of the country, we must be prepared for transmission to other parts of the country. This is why continued vigilance is critical,” said Katz.
“It seems likely that travel between states is going to lead to recurrent clusters in states that have controlled transmission. For example, what is going on in Florida may eventually affect New York or other cities throughout the country. This is particularly true if outbreaks cannot be controlled. I just imagine how many people from all over the U.S. will visit Disney World over the next few weeks,” said Pergam.
“In states with disease under control can do cautious opening with adherence to the Japanese C’s (avoid close, closed, crowded) and mask mandates. This has worked elsewhere and there’s no reason it shouldn’t in the U.S. Need to test widely as this is a sneaky disease, and you don’t want to be recognizing spread only with super-spreader events,” said Fisman.
“It’s very likely at this point and the politicization of the pandemic hasn’t helped. Other states and prepare their health and public health systems, but also ensure they can scale up testing and response mechanisms,” said Popescu.
“Contact tracing alone is unlikely to be enough to stop large outbreaks, but scaled up testing – particularly in high risk groups like healthcare works, care home staff, key workers in shops – could help identify infections and prevent chains of transmission, working in tandem with wider social distancing measures,” said Kucharski.
Some people have suggested that mitigation strategies proposed several months ago such as contact tracing and accessible testing are no longer adequate to contain outbreaks in badly affected states. What are your thoughts on this?
“You need to have the combination of strategies. People need to do their part. You also don’t give up on testing, tracing and isolation. But when you have widespread community transmission, you may also need to put more restrictive policies in place,” said Katz.
“Testing and contact tracing remain critical pillars of prevention, but in some of these large urban centers, the public health infrastructure are overwhelmed and won’t keep up with the sheer number of cases. This is exacerbated by major cutbacks in county and state public health programs. However, cities like New York city show it can be done even in the midst of a large pandemic – it takes investment,” said Pergam.
“ Mitigation in these situations really shifts to structures and policies which assure more physical distancing in the community – keeping people at home. Universal masking can help decrease exposure risk, and targeted prevention specifically targeting high-risk setting like nursing homes and prisons, can save lives. Finally, all good public health policy involves communication and community education about prevention,” Pergam added.
“Those efforts definitely become strained the bigger the outbreak and the fewer their resources, which means we need to be able to flex and scale up their capacities. That shouldn’t be seen as an indicator for giving up though,” said Popescu.
“Contact tracing is meaningless when you have a massive number of cases…it’ll simply overstretch and wear down and already overextended public health workforce,” said Fisman. “It may be a helpful intervention when cases are knocked down to low levels and you’re preventing resurgences,” he added.
What in your view was the most significant point in the U.S. pandemic trajectory where a different decision or course of action could have prevented or mitigated the large case numbers currently seen?
“Early preparation on every level – from organizing stockpiles of personal protective equipment to community preparedness – there were numerous missed opportunities. We also de-funded our pandemic preparedness program. Perhaps most important, was that testing was delayed for so long, and even when it was initially available testing was highly restricted. If we had known about early transmission in WA and NY, we could have acted faster when there were fewer cases. The earlier you stop spread the more impact you have on later events. We didn’t learn from what we saw happening in Italy and we didn’t act – I think many people thought “that can’t ever happen here,” said Pergam.
“Once you got through March and April outbreaks in the northeast, most places should have learned their lesson,” said Fisman. “Again, you can look around the world for best practices (3 C’s, masks) and see how this is done. The push to reopen economies and the minimization of COVID, and disinformation around COVID, has led to this very predictable, disastrous response,” he added.
“Honestly, I don’t even know how to answer that because there have been so many. Large and small. Continued communication from the White House that the pandemic isn’t an issue and we’re testing too much. Avoiding using the war time production act, not working to ramp up testing so we were flying blind for months, just all of it. Pulling out of the WHO. The moment this became a political topic that guided public health and not the other way around…I guess the first red flag for me was when the White House made public health agencies (CDC/NIH) go through them to speak to the public (and vice versa)…that was not the case during Ebola,” said Popescu.
“The current situation is incredibly frustrating to the public health community. We did not have to get to this point. But since we are, people need to understand why it is critical to do their part, and we need to fully resource public health departments to they can do their job,” said Katz.
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I am a postdoctoral research scientist focusing on childhood cancers and new, targeted cancer therapies. As a survivor of childhood leukemia myself, I am a determined
I am a postdoctoral research scientist focusing on childhood cancers and new, targeted cancer therapies. As a survivor of childhood leukemia myself, I am a determined advocate for research into better, less-toxic cancer treatments and how to reduce the long-term side effects of current drugs. I am an award-winning science communicator and have written for The Times, The Guardian and various cancer-focused outlets. I am also a 2017 TED Fellow, having done my TED talk on cancer survivorship and I regularly do public talks on topics ranging from ‘Why haven’t we cured cancer yet?’ to ‘Cannabis and cancer; hype or hope?’. I am passionate about using social media to communicate science and frequently share pictures and stories from my own laboratory work in real-time on my Twitter account @vickyyyf, alongside commentary about important research breakthroughs. You can find out more about me and how to get in contact via my website drvickyforster.com. All of my articles reflect my personal views and not those of my employer.