The Pandemic Paradox
As we end this tumultuous year, 2020, which has been defined by the coronavirus, deaths in the U.S. from COVID-19 are approaching 330,000 from over 19 million confirmed cases. These numbers understate reality because not all cases and deaths have been diagnosed.
Why did it turn out so, the infections accelerating this fall as the weather turned colder and the U.S. responded with que será, será and a shrug?
The pandemic is a paradox which the country has not been able to solve.
Many who are infected with COVID-19 have no symptoms, many have mild symptoms, most recover — yet the virus is the third leading cause of death in the U.S., the cumulative death toll the same as the population of Salt Lake City or Birmingham, according to Scientific American.
The highly contagious disease spreads largely by close contact among people and, in some cases, transmission across longer distances. Limiting gatherings with others avoids exposure, by definition. When that is not possible, wearing a mask to reduce the probability of either inhaling the virus or expelling reduces the risk of infection. Yet government and business policies implementing these steps, either as regulations or simply recommendations, have been decried by some as unconstitutional infringements on personal liberty.
The life of an infection is relatively short — weeks — yet the U.S. has not been able to contain it after 11 months. It has consistently spread across the country, infecting all regions, even those knowing for months it was coming. December — not yet history — has been the worst month for deaths since the first peak in April.
Why is this pandemic such a paradox, when the U.S. has the medical expertise, the infrastructure, and financial resources to counter it? Why is it so difficult to manage, when other countries have demonstrated strategies that work?
I’ve concluded we lack government leadership, a coordinated and unified response, and both community and individual resolve. These interconnected deficits, amplified by a vocal minority of naysayers, have created a controversy about wearing masks and a false either/or choice between reducing infections or sustaining the economy.
What Can We Do?
Eleven months in, can we do anything to mitigate this tragedy or must we await the country being vaccinated, accepting the collateral infections and deaths while hoping they don’t affect us personally?
I think the following steps would yield measurable improvement, reducing infections and deaths until enough of us are vaccinated for the country to reach herd immunity. These steps must be implemented consistently across the nation, a “united we stand, divided we fall” strategy.
1. Stay in place for 14–21 days to minimize new infections.
The idea is for everyone to stay in place to let the current infections play out without causing new infections.
The incubation period for COVID-19 infection is 5–6 days average and up to 14 days, according to the World Health Organization. The BMJ reports data from culture studies indicates people can become infectious 1–2 days before feeling symptoms and will remain infectious for up to seven days. CDC guidance is a person with a mild case of COVID-19 remains infectious for “no longer” than 10 days after symptoms appear, while a person with a more severe or critical illness will “likely” be infectious for no more than 20 days.
The life of the infection defines the time we need to stay in place. While some exceptions will be required — seeking medical care, getting groceries — wearing masks and reducing the number of people in stores will reduce the probability of infection.
Staying in place must be done nationally at the same time; otherwise, the virus will cross borders and spread from areas with high infection to those with low infection — just as we’ve seen it cross the country this year.
2. Quarantine international travelers entering the U.S.
As other countries and some U.S. states have done, incoming travelers must quarantine for an appropriate time to minimize the risk of bringing in the virus and spreading infection.
A 14-day quarantine has been the norm, based on the incubation period for infection, although this time could be reduced if the quarantine is combined with testing.
Our near-empty hotels can provide the rooms, meals, and testing centers for travelers.
3. Implement a multi-layer testing strategy.
The foundation of a multi-layer testing strategy is in-home antigen tests with near real-time results, with a protocol of one or two tests per week per person following the national stay-in-place period. This policy would apply nationwide, for anyone going to public places (e.g., offices, stores, churches).
If a test is positive, the person quarantines while confirming the infection with either additional in-home antigen or local PCR tests.
Although the antigen tests may not be as accurate as PCR tests, they can be widely accessible, and the near real-time results will enable anyone infected — especially if they are asymptomatic — to protect others from becoming infected (see RapidTests.org).
Ideally, the test results would be reported to public health officials to provide community data on the positivity rate. To balance individual privacy with public health, the data — even from a positive test — could be reported anonymously (by zip code, perhaps). Someone with a positive test could be asked to contact local health officials. Anyone becoming seriously ill will presumably show up at a hospital.
4. Provide additional economic relief.
Given the economic impact of staying in place, adding to the year-long effects, it’s reasonable for the federal government to provide additional economic relief: unemployment, rent and mortgage assistance, and business support. Considering this national disaster, the “cost” to the federal deficit is an investment in the economy, particularly with interest rates so low.
I believe if this strategy had been employed in the spring, when the coronavirus was first spreading in the U.S., the number of infections, deaths, and attendant economic devastation would be considerably less than what we’re living through. Had we been united around a nationwide response, the virus would not have been able to dance through our patchwork of local and state plans and political divisiveness.
While Operation Warp Speed’s development of vaccines is heartening and will, hopefully, enable us to return to a more normal life by the end of 2021, we have a long winter and spring to endure. A strategy built around these principles will alleviate the nation’s suffering near-term.
SARS-CoV-2 won’t be the last pandemic to threaten the globe. Developing such a strategy will help us prepare for the next time.
Caveat: I claim no medical expertise. Nonetheless, I think this framework is a sound approach and should be appropriately tweaked to reflect the latest medical knowledge of the virus.