Today’s guest post is courtesy of Rachel H. DeMeester, MPH, a public health expert and Latter-day Saint living in the Seattle area.
Living in Washington state and being a public health professional, Covid-19 is on my mind almost constantly, but really, there are few places it hasn’t touched. Public health’s greatest challenge is giving recommendations that don’t induce panic but also aren’t ignored. That clearly has failed so far as people hoard toilet paper (irrational) and masks (ineffective since healthcare workers need them) and in many cases ignore pleas to spread out. Do we know everything we need to know about the virus? No. Do we know enough to act? Absolutely. No matter how independent we feel we are, we all have some level of social contact and therefore a personal stake and responsibility in Covid-19. Those who believe in God receive an extra reminder that we are all God’s children and are expected to care for each other as such. We should be concerned—not panicked—enough to act.
If I had thirty seconds to describe the Covid-19 situation, I would say:
- The main goal is to slow down its spread to avoid overwhelming our medical system beyond capacity and to reduce its impact on people. This requires doing things differently than we are used to.
- There are no steps yet that will perfectly balance economic impact, loss of life, healthcare capacity, and individual freedom at the same time. We should try anyway.
- Recommendations may change rapidly. Critical thinking is important, but most of us aren’t sitting at home studying the virus or modeling how the disease spreads. It would be wise to listen to those who do.
What’s different about this pandemic? It’s not the first one the world has ever encountered.
Maybe the disease isn’t so different, but the world’s incredible interconnectedness exacerbates a pandemic. As in prior pandemics, we have no existing immunity to slow the virus down; that will change slowly as people recover and a vaccine is developed. Features of the virus itself combined with a highly mobile society make the speed of transmission concerning.
- The novel coronavirus can be transmitted before people have noticeable symptoms.
- After you get it, you might not show symptoms for up to five days (the “incubation period”). Think about how many people you normally interact with in a work week!
- The virus can live on surfaces for a few hours or up to nine days. To compare, common cold and flu viruses typically remain infectious for less than 24 hours—and we still suggest hand washing and disinfecting.
- The virus may or may not be seasonal. While it’s too soon to say, we do know it can still spread in hot, humid environments, so delaying action in the hopes that warmer weather will save us would be under-reacting.
Fast transmission affects more people and could strain the healthcare system past capacity, decreasing recovery rates. Even if we personally aren’t at high risk, do we care about the risk to our friends and neighbors?
Why panic when HIV/flu/car accidents have killed way more people? Why don’t we do something about that?
I relate to the skeptics, but first, there are interventions to try to address those issues. (Level of funding is a different story.) Second, we aren’t sure yet how bad Covid-19 is going to be, but almost certainly worse than the seasonal flu that we’re used to. Third, any previous lack of action is a bad justification for continuing lack of action.
What’s the big deal? The recovery rate looks pretty good to me.
The recovery rate is fairly high, but it may not stay that way. Currently, recovery is high overall but not for certain populations (elderly or certain conditions), and more interestingly, not everywhere. Recovery will decline if healthcare systems become overwhelmed by continued exponential spread of Covid-19.
- Healthcare capacity affects outcomes. My favorite analogy compares this to what would happen if a family got sick; if everyone gets sick at the same time, especially the parents, it’s much harder to deal with than if one person at a time gets sick. That is why “flattening the curve”—or slowing down transmission—is important. The US has 95,000 ICU beds (the kind needed for severe Covid-19), many of which are occupied already. About 20% of Covid-19 cases are sick enough to require hospital care. We need masks, hand sanitizer, and healthy staff to provide care. Washington state has already had to receive federal shipments of masks to keep up with demand. The WA department of health is also issuing emergency licenses to healthcare providers from other states to help us out.
- Fatality rates vary widely between countries. Italy’s current fatality rate is 8.3% and seems to be rising. Germany’s is 0.2%. Ours is 1.4%. (Check out this map by the World Health Organization.) There are many possible explanations, including population age, population density, testing availability, level of coordinated response, and social customs, but one thing is certain: we are not guaranteed a low fatality rate without effort.
That effort for individuals is mostly “social distancing.” We also desperately need to do more testing and “contact tracing,” as in South Korea where they are actively finding people who have been exposed, testing them, and containing the disease. In the US, we’re still only testing people that self-report and meet a list of criteria.
If you’re still on the fence about social distancing, watch this fascinating simulation. The level and duration of social distancing may not be the same in every community or country, but in the US all fifty states have confirmed cases, so be prepared.
Since everything is canceled, let’s get together for a playdate/homeschool co-op/etc.
When my kids’ preschool was canceled last week, I left chatting with a friend about getting together to make sure we didn’t lose our sanity. I have changed my opinion as cases continue to rise. In order for the virus to really slow down, pushing the limits of recommended group size doesn’t make sense. I don’t want to be alone for weeks, but my spouse works with the elderly; if we can prevent the virus from coming through our house, we can keep them served and safe. If rates start dropping here, I’ll reassess. Dr. Darria Long Gillespie (American College of Emergency Physicians spokesperson) suggests asking oneself: “How many people will be there? How close will you be to all of those people? How well ventilated is the space or how much people can move around?”
So if everyone stays home for two weeks will this go away?
Theoretically, sure. But since one host can infect multiple people, it would have to be 100% to stop the virus. That’s pretty unlikely. Even if everyone stayed home, the 14-day incubation period is an estimate; there’s a possibility that 14 days might not be long enough. The best bet IS to take some space, paying attention to your area’s risk of transmission.
If this goes on too long, won’t the economic effects cause worse health effects than the disease?
I don’t know how long we have before the societal cost of social distancing outweighs the benefit. Food insecurity, medical bankruptcy, domestic violence, and mental illness are already widespread and likely to get worse. For individuals living in compromised situations, actual harm due to social distancing may already outweigh potential harm; we need more information. Food and money are easily shared without contact, but I urge us to consider anyone in our network who may need a “buddy home” at which to spend time. I think this small increased risk of transmission is worth keeping people safe in their homes. (See domestic violence and suicide resources at the end of this page.)
How long will this last? A recent model from the Imperial College London predicts several months followed by a second peak later in the year unless containment measures continue until a vaccine is available in 12-18 months (summary and full report). That’s scary. But they also modeled an “on/off” method of social distancing and school closures. In it, Covid-19 cases would be closely monitored and social distancing/school closures implemented only when ICU cases pass a certain (manageable) threshold. This would result in the more disruptive measures being “on” about 2/3rds of the time, with some respite in between. That might be a nightmare to coordinate at even a state level, but it could help mitigate the impact to other health and financial outcomes.
(Graph from Page 12)
Stay compassionate.
A final note about equity during this pandemic. Most of my professional life has been spent targeting vulnerable populations and working to reduce disparities in the health care system. There are going to be differences in people’s ability to distance. Someone with a well-paying desk job is going to have a different experience than someone who must physically show up to work either by function or by risk of not being able to pay their rent. When someone orders groceries, someone delivers them. When grandma gets sick, someone cares for her and cleans the hospital. In all of this, let us be gracious and not use someone else’s extenuating circumstances to justify any unwillingness on our part to act responsibly. Instead, let’s support each other from a distance however we can. Buy gift cards. Send a text. Lists of ideas are all over the internet to remind us that social distancing doesn’t mean shutting down all communication and regard for those around us.
Obviously, I wish the Covid-19 pandemic weren’t happening. But since it is, I hope we succeed in slowing its spread and emerge with greater curiosity for the role we play in each other’s wellbeing. We could learn so much.
National Domestic Violence Hotline allows you to speak confidentially with trained advocates online or by the phone, which they recommend for those who think their online activity is being monitored by their abuser (800-799-7233). They can help survivors develop a plan to achieve safety for themselves and their children.
Suicide Lifeline: If you or someone you know may be struggling with suicidal thoughts you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time of day or night or chat online.