To Reopen American We Need Public Health 101

I want to congratulate the American people. Mass quarantine and social distancing slowed the spread of Covid-19 and turned the tide in the New York tsunami of cases. As I mentioned in my last post, [LinkedIn or Medium] getting the measure of contagiousness, the Reproduction Rate (R0), below 1, is critical. The evidence is that we have reduced the Covid-19 R0 from around 4 to around 1 by our efforts.

If we could push that number below 1, combined with sound public health measures, we could begin to truly contain the virus as New Zealand and other countries have accomplished.

We have slowed the ravaging of our country by this invisible killer. Unfortunately, we have also paid a heavy price of over 81,000 American lives lost. This was unimaginable just 3 months ago. And importantly, we did not necessarily use the time we bought, wisely. We should have put in place the public health 101 Non-Pharmaceutical Intervention (NPI) strategies that we know work. These NPI best practices are regular and widespread testing, isolation of those testing positive and meticulous contact tracing. And time is of the essence. To win you have to stop the virus in its tracks before it starts exponential growth. Other countries have successfully applied these best practices and contained the virus and thereby saved countless lives.

The other price we have paid is economic. Left with no other choice but mass quarantine and shutting down non-essential businesses, we pressed the pause button on a $10 trillion dollar economy. The best strategy for a deadly communicable disease with no effective treatment is prevention through NPIs. Like it or not, this is an investment that needs to be made and there are thoughtful models on how to accomplish this aim for a fraction of the cost of the shutdown of the economy. We could then re-open the economy safely with a level of confidence and assurance that we could quickly locate “hot spots” and contain them. Without an effective national public health strategy, we are still blind to the path and reach of this otherwise invisible and deadly virus. We can only see the tracks with testing and contact tracing or with hospital admissions and deaths. The former is the better option.

Nevertheless, without true visibility, we are now beginning a real-world experiment with the highest of all stakes. Even though many states have not met the White House criteria for “Opening Up America Again”, many are going forward with relaxing restrictions. By definition, communicable diseases depend on human closeness. This is why closed, tight settings (e.g. prisons, nursing homes) and large gatherings (e.g. nightclubs, concerts, large meetings) are like a Petri dish for the virus. Hopefully, social distancing will reduce the spread of Covid-19 and R0 to a crawl while allowing careful re-opening of the economy. We will have an answer in 3–6 weeks, when hospital admissions and deaths will begin to reflect the spread 3–6 weeks prior. 

The challenge with this virus is that it is one of the most devious pathogens we have ever faced. It is much more contagious and at least 10 times more deadly than the flu. It spreads so rapidly and silently because people can spread it before or without any symptoms (pre-symptomatic or asymptomatic transmission). With the flu, you will generally become sick 1–3 days after becoming infected. The time from becoming infected to becoming sick with Covid-19 can be as long as 14 days. During this time you can unknowingly spread the infection to many others. It can live for days on surfaces and potentially be aerosolized beyond the standard six feet of social distance. A single cough or sneeze of an infected person can dramatically spread the virus in the air. Covid-19 can cause strokes, attack the heart, and potentially cause a mysterious illness in children. It is a brand new pathogen, so there is so much that we do not know about it. We will learn through our real-world Russian roulette experiment with the virus. It is already the number one cause of death in the United States in 2020 in only 5 months.

There is hope on the horizon. We have never witnessed the degree of focus around the world on creating a vaccine. Remdesvir, antibody serum and monoclonal antibodies show early promise as treatments. We have never seen the degree of collaboration of scientists around the world sharing data and information about this virus. Technology giants Apple, Google, and Amazon are rolling out health information technology at a rapid pace, including working to build a global contract tracing infrastructure designed to help public health agencies to contain the spread of COVID-19. With or without these innovations, we need to ensure that NPIs are applied to the greatest extent possible to reduce the risk of an experiment failing.