Immediate Action Makes All the Difference With Coronavirus
An infectious disease epidemiologist on why we need to act now
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In the West, we watched the Covid-19 outbreak develop in Wuhan as though it were happening on another planet. But this disease moves fast. Italy had just 21 cases on February 21, and now the entire country is on lockdown. Deaths in Italy increased by 60% in the last two days from 631 to 1,016, and overwhelmed Italian doctors are now faced with having to choose which patients to treat with breathing equipment and who should be left to die.
There’s no reason to think that the spread of Covid-19 will be any different in the U.S., the U.K., France, or Spain than it is in Wuhan or Lombardy. That’s why we and our governments in these and other nations must take action now.
As an infectious disease epidemiologist, I know that outbreaks follow a very predictable pattern. There is a short window in the early stages during which there is hope of containment but, once the disease takes hold, case numbers increase exponentially.
It’s not enough to test those returning from an “affected area.” We have to realize that the virus is already present and we ourselves are an “affected area.”
The case numbers in the United States and several countries in Europe are developing and doubling at the same rate as we’ve seen in Italy and Wuhan. There is every reason to expect very serious outbreaks in Spain, France, Germany, the U.S., and the U.K. in the coming weeks — and others to follow.
Wuhan was caught unawares, and Italy was unlucky to have the first big outbreak in Europe, although it is unclear why. The United States and European countries must learn from this very quickly. We need to stop assuming we are different and start introducing measures to protect our communities.
How? The countries not yet seriously affected must start testing seriously. It’s not enough to test those returning from an “affected area.” We have to realize that the virus is already present and we ourselves are an “affected area.” Another essential measure is social distancing, which could include things like stopping all large (and some small) gatherings, closing schools, working from home, limiting not only international but also domestic travel, even isolating specific cities or regions.
Governments would also be wise to learn from the example of South Korea, which has led the way in terms of widespread testing, contact tracing, and isolation/quarantining. Yes, wash your hands like your life or someone else’s depends on it — but that’s not enough.
The U.S. has 2.8 intensive care unit beds (ICU) per million citizens. A recent article from researchers at Harvard University models what would happen in the United States if a Wuhan-scale outbreak of Covid-19 occurred, and if the U.S. responded in a similar way, with strict social distancing, contact tracing, and quarantining measures introduced late in the outbreak. In short, the health care system would be overwhelmed, there would not be nearly enough ICU beds for everyone who needs them (Figure 1, bottom left). Imagine Times Square as a makeshift infirmary. I know we can’t imagine it — but we need to.
Yes, wash your hands like your life or someone else’s depends on it — but that’s not enough.
The article also looked at what happened in Guangzhou, the neighboring province of Wuhan. By the time SARS-CoV-2 made its way to Guangzhou, China had learned its lesson from Wuhan and had imposed strict social distancing measures as well as contact tracing and quarantine protocols across Chinese cities. At that time, Guangzhou had only seven confirmed cases. The work from Harvard University shows that if the United States can impose these types of measures early, it will be able to comfortably handle its epidemic (Figure 1, bottom right). Plainly stated, far fewer lives will be lost.
Similarly, we need to remember (or learn!) lessons from the infamous Spanish influenza pandemic of 1918–1920. In the United States, cities that imposed social distancing policies early on suffered the least in terms of fatalities. Philadelphia waited — even allowing a city-wide parade to take place 11 days after the first reported case — and paid for this mistake with a huge peak in deaths a month later. On the other hand, St. Louis acted swiftly, enacting measures two days after their first case. The city suffered less overall and never hit an alarming peak (Figure 2).
Some leaders say they want to wait and be driven by the science of what the outbreak indicates. Unfortunately, we don’t have the luxury of time. We don’t know precisely which social distancing measures are better or worse than others. But here is what we do know from the science: Doing nothing will likely be disastrous.
All countries and localities need to throw as much effort as they can at this thing. Individuals and governments need to show decisive leadership and break their paralysis by indecision. Speed is everything — and we are all in this together.
The coronavirus outbreak is rapidly evolving. To stay informed, check the U.S. Centers for Disease Control and Prevention as well as your local health department for updates. If you’re feeling emotionally overwhelmed, reach out to the Crisis Text Line.
