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The Invisible War

By March 18, 2020March 19th, 2020One Comment

Yesterday, the Imperial College released its report on COVID-19. The report reveals massive, frightening predictions – underscoring the importance of the actions we are taking to prevent the anticpiated spread of this new virus.

I’ve been spending the last few days going back to my public health roots and digging deep into the novel coronavirus. And I felt compelled to share the points I found salient from the above mentioned report and otherwise. Compelled enough to write my first blog post in…years? Anyway…

COVID-19 is not the flu. It is most closely related to SARS. The mortality rate is lower than SARS but it spreads significantly faster. This is why there is such a strong worry that the public will not take it seriously enough. Other names for COVID-19 that you might see: novel coronavirus, coronavirus 2, SARS-CoV-2, HCoV-19.

If we treat it like the flu, or go about business as usual: 80% of Americans would get the disease and an estimated 4 million will die. In a span of 3 months.

We [the world] have failed at containment so we have two options: mitigation and suppression. Mitigation = isolating all symptomatic cases in the US, quarantining families of those cases, and social distancing for those over 70. Suppression = isolating symptomatic cases and quarantining their family members, social distancing for the whole population plus preventing all public gatherings which includes shutting down the majority of workplaces, bars and dine-in restaurants, closing schools and universities.

Mitigation is not enough. We will still overwhelm many hospital intensive care units and the death toll will be around 2 million with 45 million deaths worldwide. So what’s the good news?

Also, if we relax suppression improperly before a vaccine is administered to the population, the virus comes back in full force – and it’s almost like we never suppressed anything in the first place.

We should have a vaccine in 18 months, and until then – we cannot allow the virus to spread.

If we all work together and successfully socially distance and suppress the spread, per the Imperial College predictions, it is likely we can lift restrictions for a month – followed by 2 more months of suppression. This is likely to be our repeating pattern until there is a vaccine.

Since this is a novel virus, we are still learning new information about it everyday. Like I mentioned, it’s most-closely genetically related to SARS, the mortality rate is lower but it spreads significantly faster. Emerging evidence suggests that it is spreading via asymptomatic or pre-symptomatic folks.

A new study from the New England Journal of Medicine tested the stability of the virus, and it’s important to know how long it can last on surfaces: up to 3 days. Another reason for why we need to follow the suppression strategy (versus mitigation). [Of note, they tested plastic, stainless steel, cardboard and copper in a lab environment. Personally, I wish they had also tested fabrics, rock and dog hair, but I made the decision to not go into research many years ago.]

We still have yet to institute widespread testing (which differs from South Korea’s most successful approach to date, read about it here or here), so we do not even accurately know where in the US the virus is at this point in time. This is another reason to self-quarantine: we need to have time to catch up to how widespread the coronavirus is. And if we socially distance appropriately – we’ll be able to have a better grasp on the numbers in a couple weeks, and we should be able to deal with those numbers. There will be a lot more to deal with in the coming months – including how to bolster the people who will lose the most during this time, such as isolated elders or small businesses – but first, we must all accept the reality of where we are at.

So, why The Invisible War? There are palpable war-like qualities: the impact to every member of society, the death rates, and the fact we have to work together because of the shock on society. Unlike what we think of as a normal war, there will be no visible reward system, making it more difficult to stay on track and continue working together. If suppression works, it will feel like almost nothing is happening because infection rates will remain low. And it’s going to be really difficult to take this seriously. My plan is to keep checking the authorities we can trust for the most up-to-date information to keep myself aware of what’s happening outside of my small bubble. Here are the sites I use:

Johns Hopkins: each of the links go to a different (and equally valuable) Hopkins website related to coronavirus. I like to read their daily situational reports and the interactive world map of the outbreaks actually pretty cool.

CDC: where to go for testing information and updates. This site is updated on a near-daily basis.

NIH: stay up to date with the ongoing research.

Most of us don’t know it yet, but society will be dramatically different when the crisis is over. I believe, like Spenser, we can all work together to make it an improved one. To me, this feels like a restart, a second-chance – for each community, and our entire globalized world. Think about how much worse it could be. This novel virus could have had the mortality of SARS and the transmission of COVID-19. And guess what: we (the world, but I’m specifically pointing a finger at the United States) weren’t even ready for this one. We are lucky to have the opportunity to prevent the deaths of millions, and, I would contend, the added benefit of rebuilding society with compassion and equality at the forefront.

A couple ways we’re dealing with our new reality.

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