When will this end?

In the upcoming months, there will be intense pressure to relax social distancing, get back to work, and let your children run outside. And never return. For at least a week. Tension over when to open sectors of the economy will explode into a ThunderDome Death Match between politicians, economists, and medical experts.

Expect government officials and pundits to make a lot of noise about reopening sectors of the economy this month. Even though we have not yet reached the beginning of the end of the COVID pandemic. Even though in less connected cities and towns, we haven’t even reached the end of the beginning.

It might be helpful to think of social distancing as the country being on a ventilator. Meaning a life-saving intervention that is currently the only thing keeping us from a complete national medical catastrophe. There may be signs that the country (patient) is on the upswing. And that the most life-threatening period has passed. But would you ever want a loved one taken off a ventilator before a medical expert gave the okay? Even if your favorite politician thought she looked pretty good? The same should go for social distancing. Just as most doctors have a good idea of what would happen to a patient if taken off a ventilator too early, the scientists who study infectious disease patterns for a living can provide a pretty good picture of what will happen if we prematurely let up on social distancing.

Because, just to be clear, COVID will not just naturally disappear as the weather warms. Some of you may recall that the spring wave of the 2009 H1N1 influenza pandemic peaked in June in the United States. That does not mean that COVID will also peak in June. H1N1 has different transmission dynamics and was introduced later into the US, so there is no reason to expect COVID to follow the same curve. But it’s a potent reminder that novel pandemic viruses do not behave like seasonal viruses and are perfectly capable of causing severe outbreaks during warm weather.

This doesn’t mean we shouldn’t put economic considerations into the equation. If the ventilator for your loved one cost $1 trillion a day, you might decide to take the risk even if your doctor advised against it. The point is just that the economic considerations should be scrupulously and ethically weighed against well-calculated risks on both sides. It shouldn’t come down to a politician noticing a little improvement in a patient’s vital signs and deciding enough is enough.

The upshot is that, politics aside, everyone should be mentally prepared for intense social distancing to continue at least through the spring. But, the good news is that as we learn more about the virus, we can be more strategic about how we go about social distancing and hopefully improve our quality of life. The more we understand how the virus transmits, the more we can cut needless paranoia and allow ourselves new little freedoms.

For example, this is purely a hunch, but I think it’s possible that we’re going to find that talking is going to be important in the spread of the virus. We tend to focus on coughing and sneezing, but one of the things that makes COVID so dangerous is that it is transmitted early in the infection cycle. The 2003 SARS virus mostly spread to other people after a person had already been sick for a while. Same thing for Ebola. COVID is very different in that it spreads readily right at the onset of early symptoms, and to some degree even before symptoms. This makes it much harder to control. And suggests that while sneezing and coughing certainly helps transmission, talking may also contribute to transmission at those early stages of infection. In which case, better understanding of this could inform exactly how we go about social distancing. It could be that extended periods of talking with someone, even at a properly social-distanced 6 feet away, could be far riskier than opening a box of delivered groceries. (By the way, 6 feet is a good baseline number to shoot for in grocery stores, but is not entirely protective — the Washington State choir outbreak suggested that people singing loudly might shoot virus a lot farther than 6 feet and infect each other).

But the point is we still have a long way to go in understanding the virus and what activities put you at most risk for infection. So there is cause to be optimistic that even if social distancing continues into the summer, that greater knowledge of how the virus transmits could at least tell us how to do social distancing right and with less stress and uncertainty.

When we start to think about reopening parts of the country, it will be useful to look closely at how things play out first in Asia. A few months ago, I was able to be pretty confident in my early predictions about the arrival and intensity of COVID not because have great foresight, but because Asia (and later Italy) provided a vivid roadmap in real-time of how the virus was behaving, and it was obvious that America had no special sauce that would lead us to follow a different trajectory. If anything, America was less prepared. Since Singapore and other Asian countries that initially managed COVID far better than the US have already started to reopen society, we can get another sneak preview of how things are playing out. So far, their struggles with resurgences of COVID outbreaks as economies reopen sends a pretty clear message of how fraught reopening society is even in places where the virus has been brought under control and where intensive testing is available. This seems to be because, as long as there is trade and movement with other areas with high COVID activity, there are too many opportunities to import new cases. This will be particularly difficult in a country as large and heterogenous as the United States. It will be particularly interesting to see whether countries like New Zealand and Iceland can successfully reopen sectors of the economy in the upcoming months, as these would be the best candidates given their gold-medal responses to controlling COVID through high testing and early, intensive controls as well as innate geographical advantage as islands.

What seems to be most frustrating to people right now is the uncertainty about the future. The darn models keep changing. But the models aren’t changing. Human behavior is changing. The original models with really bad projections were based on what would happen if we didn’t do social distancing. New models have lower projections because they include current levels of social distancing. That doesn’t mean the original models were wrong. The models project much lower numbers because this is a virus with exponential growth potential, so changes in human contact patterns have really pronounced effects on the trajectory.

So why can’t models be smart and incrementally increase social distancing parameters as the number of cases and death increase, since this is how humans would naturally respond to a building threat? Because a smart model requires uniformly smart humans. And anyone who has been following the news knows just how much variability there has been in the responsiveness of leaders at different levels of US government, from the White House down to mayors of small towns. So instead models have to be updated manually according to real-world human behavior. If social distancing relaxes, the models will get updated again and show things getting worse.

The models also have a lot of uncertainty because they are only as good as the data fed into them. And, at least in the United States, the underlying data is unfortunately not so good. For a country that is a global leader in biomedical research, there will be a long reckoning at some point in the future about why our testing flopped.

This is what happens when testing flops:

  1. We are always chasing the epidemic from behind. Localities still seem to still be under the impression that they don’t need to do anything until a positive case pops up. But at our slow pace of testing, by the time even a single positive case is detected, the virus is already transmitting like wildfire in a community.
  2. We don’t know fundamental characteristics about COVID transmission, and these are needed to inform any decisions to relax social distancing. Things like how many people are asymptomatic or mild cases, and how important are they in overall transmission. Things like how much transmission occurs within households versus in the community. For all you parents out there, things like how important are children in transmission, and what would happen if we reopened schools?
  3. Not testing mild or asymptomatic cases means we don’t know how many people actually have had the virus. Those numbers you see of lab-confirmed cases are just a fraction of the real number. And therefore we don’t know what proportion of the American population will be immune in the upcoming months. In theory, the greater the number of people who are immune, the lower the rate of transmission in the community (Re) and the sooner we begin to relax social distancing. It becomes very difficult to model the effect of reopening sectors of the economy without a baseline estimate of existing immunity in the population and well as individual-level knowledge of

There are certainly blockbuster events that could accelerate the reopening of society. If a new or existing therapeutic is proven to be effective (with the emphasis on proven). If a vaccine becomes available at some point in 2021. A high-quality antibody test would be very useful in determining who has been infected and is now immune (I mention high-quality because serological tests often have too many false-positives or false-negatives to actually inform policy).

I do want to emphasize that the COVID pandemic will officially end at some point, likely in 2021. That does not mean that the virus will be eradicated from the human population. It just means that through natural infection or vaccination, there will be enough herd immunity* that the virus is controlled. It remains to be seen whether the coronavirus behaves like an influenza virus, recurring in seasonal epidemics that affect the global population and vary in intensity year-to-year. Or whether it is more like a measles virus, causing intense outbreaks in localized pockets where vaccination levels are low. The answer will depend on the effectiveness of the vaccine and the evolutionary rate of the virus, specifically in the spike protein on the exterior of the virus that will be targeted by human antibodies. [You would think we would have a little more baseline knowledge of how coronaviruses evolve year-to-year in humans, since there are at least four strains that circulate widely and cause common colds in humans (e.g., HKU-1, OC43). But since they don’t tend to kill people, there’s not much funding for research.]

So the upshot is that social distancing is not the new normal. The COVID pandemic will eventually end and we will eventually see the return of baseball and senior bingo nights. And, if we have the political will, it is possible that, after decades of underfunding pandemic research and preparedness, we will be better prepared next time.

*Note that we do not know how long natural immunity to the virus lasts. It is likely that people who are infected with COVID and recover will have strong immunity to it for at least several months, probably longer. In terms of opening society back up and improving quality of life, having a proportion of the country that is known to be immune would be extremely helpful logistically. But if we don’t test enough, there will be many people who are immune but don’t know it.

COVID book club

In case the COVID epidemic has piqued your interest in the wild world of viruses, there are some wonderful books that manage to pack scientific detail about viruses, emerging pathogens, and the threat of global pandemics into vivid narratives aimed for a lay audience. Here are 5 non-fiction books I recommend. Excellent for bored teenagers.

  1. Spillover, David Quammen (2012)

2. The Great Influenza, John Barry (2005)

3. The Viral Storm: the dawn of a new pandemic age, Nathan Wolfe (2012)

4. The Coming Plague: Newly Emerging Diseases in a World Out of Balance, Laurie Garrett (1995)

5. The Planet of Viruses, Carl Zimmer (2015)

Return of the COVID blog

I apologize for the three-week hiatus in the COVID blog. A few Saturdays ago a horse and I had a little disagreement about whether I or not I should be on its back. The horse won. The Suburban Hospital ER was empty except for a few COVID cases, and scans showed that I had experienced a concussion but nothing life-threatening. It was a strange twist of fate that after preparing my entire career for something like COVID, I was suddenly in a brain fog and incapable of viewing screens or even following the COVID situation by radio. For all of you moaning about social distancing, try doing it for a week plus without the distraction of work, Netflix, or cat memes.

So after a three-week semi-dream state I’ve woken up to a brave new world. Some things have stayed the same, including the curious age structure that is mostly sparing children from severe disease. And of course the absence of toilet paper on any store shelves. But in my three-week haze America raced to the top of the global COVID case count. Part of this is increased testing, which we finally seem to have gotten up and running after a botched start. However, I will continually emphasize that the true epidemic is far worse than the case counts and death tallies suggest. We are still massively undercounting cases due to lack of testing. And even the reported death toll is just a fraction of the true number of deaths (which will be statistically calculated, within a certain degree of uncertainty, only after the pandemic is over).

Somehow my concussion perfectly overlapped with the critical early growth period of COVID cases in the United States.

Americans also seem to have all overnight become experts in viral epidemiology. Who imagined a day when droplet transmission and reproductive number would be trending on Twitter? There are some consequences to the proliferation of armchair epidemiologists. The internet has become a cesspool of misinformation. At this moment Americans desperately need reliable information. To know how to stay safe. And to know that they’re tanking their economy for a good reason.

One of the problems is that it can be difficult to evaluate the quality of information, especially on social media. A source of confusion is figuring out who is really an expert. A professor from an eminent US university with a fancy title (e.g., laureate) seems like they should know what they’re talking about. So should a top infectious disease doctor. I can perfectly understand that when COVID is taking over people’s lives there is an irresistible urge for anyone with a loose connection to the biomedical field to weigh in on aspects of COVID. Even in areas far beyond their specific area of expertise. You just make some reasonable assumptions, plug in the little numbers (death rates, attack rates, our favorite reproductive rates), and voila! Anyone can make a pretty graph.

I wish it were so easy to make a good COVID model. I wish we had really good underlying data drawn from intensive testing so we could nail down even simple parameters like rates of mild and asymptomatic infection. Across all age groups so we could know whether children were important in transmission. I wish we had a finely-tuned model that could be more prescriptive about the kinds and intensity of social distancing is needed and for how long. Right now, in the absence of good data, we’re using social distancing as a bludgeon rather than a scalpel. It’s like an elimination diet where you just stop eating everything — gluten, eggs, nuts, dairy — because you don’t know the specific culprit yet.

At this time, we have enough information to know that the situation will be dire if we don’t do anything. That’s not up for debate. But we don’t have a more detailed model that could fine-tune our approach to social distancing. At least not at this late stage in the epidemic (more targeted contact tracing was an option early when the virus was just entering the US but at this stage could not be done without a massively higher intensity of testing). The current unavailability of a good model that can answer our most pressing questions is not because US epidemiologists aren’t any good. There is a relatively small and tight-knit community of experts in the field of mathematical modeling of emerging pathogens. The community has grown over the last decade, as H5N1, Ebola, Zika, and other emerging infectious diseases have increased funding and scientific interest. However, neither H5N1, Ebola, nor Zika every truly invaded America, leading us to become complacent, and major funding networks across the US government for infectious disease modeling have lapsed.

So the list of people who have any business building models to predict the trajectory of COVID-19 would fit no more than a single page. What makes building a COVID model so difficult is how many uncertainties there are, not just about the virus but also human behavior. It doesn’t matter if you’re a professor of epidemiology at an esteemed university or one of the top infectious disease doctors, it takes years of specific study of modeling pathogen dynamics needed to accurately account for these kinds of uncertainties.

Just, to be clear, I am not a modeler. I am an evolutionary biologist who happens to work closely with mathematical modelers. I have great respect for how difficult it is to make a good COVID model. There are enormous gaps in data and information needed to parameterize it. And the parameters are constantly changing as humans modify their behavior. And being a good modeler is a thankless job. Either everyone ignores your model and you fail to help anyone at all. Or politicians take necessary actions and avert a full-scale epidemic, effectively making all your original projections wrong. Which is of course a good thing. But it leaves people with the impression that modelers chronically over-hype.

My area of expertise is how viruses evolve. I’m the person who knocks down the rumors that there are genetically different strains of COVID circulating that cause different severity of disease. Or that the virus will mutate over time to become less lethal and more like a typical cold virus. (It’s quite the reverse. Over the next year or so humans are the ones who will be changing, developing natural or vaccine-induced immunity that makes re-infection less severe. Over the next decade, rather than mutating to become less severe, coronaviruses, like influenza viruses, may continue to evolve to evade human immune responses and cause recurring seasonal epidemics.)

Okay, I’m still limited in my daily allowed screen time. But I want to clear about one final thing that seems to be tripping people up: masks. I am absolutely heartened that so many Americans are willing to don masks to help #flattenthecurve. While it’s been part of Asian culture for a long time to wear a mask when you’re sick, in the West masks are only for doctors, nurses, and Halloween. So, should we imitate the Asians? First off, there is currently a severe shortage of medical-grade masks for doctors and nurses, so if you have a commercially made mask you should donate it instead of wearing it. Even if you’re a risk group. Because the mask cannot protect you, it can only reduce the likelihood of you infecting someone else. Second, if you’re considering making a homemade mask, there’s been a line of thinking that this should be encouraged because keeping your mouth from spewing droplets and infecting other people, and at worst it couldn’t do any harm. But I do think people should be aware of potential harm. An important part of the fight against COVID is training people not to touch their faces. So just be aware that masks that are itchy, uncomfortable, or ill-fitting could actually draw the hand the face, especially for people who aren’t used to wearing them. Or subconsciously give people a false sense of security that emboldened them to do activities they otherwise wouldn’t do without a mask. So it’s not a scientific question, but a human behavior question. But if you’re in a position where you simply can’t follow social distancing at all times (e.g., an essential worker who needs to ride the subway), a mask may be appropriate for a limited time period of commuting. But just keep in mind that the mask is not protecting you.

Hmm, I wanted to finish on a more positive note. I’m going to stretch my screen time a little further to mention something people should do that I don’t think has received as much attention as it deserves. Certainly not compared to masks….. Pre-symptomatic transmission can occur in the days before a person’s first signs of infection (fever, cough, shortness of breath). So if you get a positive test result for COVID, right away you need to inform any people that you had close contact with in the days prior, even before the onset of symptoms, so those people can self-isolate. You should also consider informing people who regularly share surfaces with you know, for example residents in your apartment building. The key is to inform people right away – not days or weeks later.

Taking this another step further, I would even encourage people to let contacts know before you get a test result, as soon as you have been declared a suspected COVID case by your doctor based on symptoms. Many people are still not getting tested, either because they have a mild case or because tests in their area are still unavailable. I understand the desire not to make people unnecessarily anxious, but personally I would rather know if a contact of mine was a suspected COVID case, so I could decide for myself how to act on the information. You could decide to entirely self-isolate if you live with people in risk groups. Or simply postpone going to the grocery store for a period of time.

Most of us are social distancing and hopefully won’t have many contacts. But there are essential workers, whether working in hospitals, grocery stores, or the government, who are still reporting to work, which is why transmission is still occurring. Recognizing the risk for pre-symptomatic transmission and rapidly sharing information about early symptoms and test results with contacts could be a simple, relatively non-draconian way we empower each other to make informed decisions to momentarily intensify our social distancing and potentially break onward transmission of secondary cases.

Summary

  • American is experiencing a catastrophic disease event unlike anything we’ve experienced since 1918. The virus is deadly and transmissible.
  • Other countries in Asia have demonstrated that an early, aggressive campaign of intensive testing, targeted isolation and contact tracing, and social distancing can dramatically reduce COVID transmission. But America missed that early intervention window and we are now the global epicenter. Ahead is a long period of economic hardship coupled with sickness and death.
  • The good news? This is not the new normal. Eventually people will gain immunity, either through natural infection or vaccination. This time next year I am cheerfully optimistic we will be enjoying spring baseball again.

Question for next time: what are the most likely scenarios for the rest of the year?

Good COVID Ideas

Across the world, people are coming up with great ideas for how to deal with the COVID emergency. I’ll keep a running list in case others want to copy.

Senior hotline for COVID information, isolation (CA)

Drive-through testing clinics (NY)

Free COVID testing (including emergency room visit), regardless of health insurance (Fed)

Paid sick leave (Fed)

Immune Corps! Enlisting people who have recovered from COVID and are immune to serve on the front lines of the response for people who are sick or in need (I made this up)

Develop hospital surge capacity plans

Helpful COVID Resources

Map of global COVID cases/deaths, Johns Hopkins University

Good summary of several aspects of COVID outbreak

Incubation Period

Symptoms

CDC info for preparing your home

Deeper into the Science

Modeling tool to simulate how interventions could alter the course of a COVID epidemic, Richard Neher

Molecular epidemiology, Trevor Bedford

If you think you’re infected

Week 11 (March 9-15)

Do I have COVID?

The most tell-tale signs of a COVID infection are:

-Fever

-Dry cough

-Shortness of breath

More details on symptoms here.

A snuffy/runny nose is a sign that you probably have just a regular respiratory infection.

What do I do now?

If you are severely ill, go to the hospital. If you think you can rest at home, call your doctor. Your doctor will probably tell you just to stay home, hydrate, and self-isolate for 14 days. There are no treatments available at this time. This is a virus, not bacteria, so antibiotics are not helpful.

Should I try to get tested?

There are many advantages to knowing if you’re positive or negative for COVID. You can inform people you had prior contact with, since there does seem to be transmission in conjunction with the very first mild symptoms.

When you recover from COVID, you will have immunity for at least the near term. When all hell breaks loose, it would be highly useful to have a cadre of people who know they are immune who could be on the front lines to serve vital roles in the community. For example:

(a) Delivering groceries and essentials to older people at home

(b) Interacting with patients arriving for COVID testing at drive-through clinics

That said, there is a severe shortage of testing capacity for COVID. Most people are being told to not even try.

How Afraid Should I Be?

Week 11 (March 9-15)

There’s a simple reason people can’t decide whether they should be scared out of their wits or shrugging off COVID. It’s because human brains are not good at thinking at abstract population levels. Even doctors’ brains. But you cannot understand the current COVID situation if you don’t have a simple understanding of contact networks and population-level risk. So I’m going to give it a try:

Why you will be scared. COVID is frightening at a population level. At some point, in the upcoming year, someone you know personally is going to die of COVID.

This is because:

In a likely scenario, around 40% of the population will be infected. So if you know 1,000 people, 400 will get the virus.

Maybe half will show symptoms (200 people). Of those, 0.5-1% are estimated to die (1-2 people).

Social networks are complex and variable. You might not have 1,000 close friends, but if you have a couple hundred friends on Facebook, and know many of their friends and family members, plus people you went to school with, people your kids go to school with, and their parents….well, pretty soon your contact network starts to grow exponentially and a thousand is probably a pretty low-ball number.

Why you should not be panicked. The natural instinct is to panic when you hear about people you know getting severely ill and dying. But no matter what happens around you, you must remember that the circle of people you know is probably larger than you realize, and your personal risk is still very low if you are a young, healthy adult or child. Even if you get infected, you have a very slim chance of severe illness.

In the near term, what this means is that your decision to limit your social contacts over the next weeks and months is not so much for your personal health, or that of your children, but for your community and your circle of contacts, especially those at high risk.

That’s why it makes strong mathematical sense to upend your life in many ways, to protect your larger community, but not to panic, recognizing that your personal health is probably not at great risk.

Also, expect that there will absolutely be news reports about children and young people getting severely ill and dying. If large enough numbers of them get infected, there will inevitably be a small number that have poor outcomes. But these news reports do not change the fact that you are low risk.

Don’t Panic

Week 11 (March 9-15)

What a difference a night makes. Tom Hanks has COVID. The NBA and MLB canceled games. It’s going to suddenly become a whole lot easier for mayors to close schools and cancel senior bingo games. Most Americans now recognize that COVID is going to have a major impact on their daily lives. At this time, our goal is that no American city ever looks like Wuhan. Accomplishing that will require collective action and changes to how we socialize and work over a period of weeks or months. Certain economies will be hit very hard. But here are a couple thoughts to help you sleep at night:

  1. Our children are safe. For unknown reasons, children, teenagers, and young adults are not getting severely ill from COVID. During past influenza pandemics, deaths were concentrated in children and young adults. Young people with underlying conditions are still at risk. But it should help us all sleep better to know that most children do not appear to be at risk for severe disease.
  2. Tony Fauci. The director of the NIH infectious disease branch is possibly the most revered government official in the country. Serving since 1984, he has guided 5 US presidents on infectious disease threats — HIV/AIDS, SARS, Ebola. We are currently in a leadership vacuum. But having a high-level figure with impeccable scientific credibility who is deeply respected by both Republicans and Democrats in congress should help us sleep at night.
  3. Tom Hanks probably won’t die. We don’t know the precise fatality rate because our knowledge of mild cases is so low. But we do know that death rates get higher as you get older. At age 63, Hanks is in a higher risk group. The risk of death in the 60-69 age group is 3-4 fold higher than the 50-59 age group. But it’s still probably only a bit higher than 1 out of 100. Tom Hanks was already an American hero. But it’s possible that his decision to report his infection will save Americans lives by getting everyone to finally take this seriously.

Canceling big events

Week 11 (March 9-15)

Summary: COVID is more widespread than the numbers suggest. Waiting until you already have cases in your community before canceling large events will make your epidemic more intense and difficult to control. When you start flooding hospitals with sick people is when people really start dying.

(a) 𝐖𝐞 𝐡𝐚𝐯𝐞 𝐧𝐨 𝐜𝐥𝐮𝐞 𝐡𝐨𝐰 𝐦𝐚𝐧𝐲 𝐀𝐦𝐞𝐫𝐢𝐜𝐚𝐧𝐬 𝐚𝐫𝐞 𝐢𝐧𝐟𝐞𝐜𝐭𝐞𝐝 𝐰𝐢𝐭𝐡 𝐂𝐎𝐕𝐈𝐃. We are still woefully behind in testing for COVID. As of March 9, the UK has tested 18,000 people more than the US (26k vs 8k). That’s 15x more at a population level (per million citizens). Of 18 countries, the only ones the US ranks ahead of in testing are Vietnam and Turkey. We are driving blind. Individuals can’t make decisions about holding or attending events. Local leaders can’t make decisions about canceling schools. At these testing rates, by the time the virus is detected in a community, it’s probably already widespread and will be very difficult to stop.

(b) 𝐅𝐥𝐚𝐭𝐭𝐞𝐧 𝐭𝐡𝐞 𝐜𝐮𝐫𝐯𝐞. We’re not going to be able to stop COVID from transmitting. And if you start to run the numbers (say, 40% attack rate, and 10-20% hospitalized) and take inventory of the number of hospital beds, respirators, PPE in your state or community, you pretty quickly realize that we don’t have anywhere near the capacity for a full-blown COVID epidemic. Especially if healthcare workers are getting sick themselves.

Either act too early, or too late. Aggressive social distancing measures, even before there are confirmed cases, can slow the progression of the epidemic before it takes off. Americans are not particularly socialist by nature, but this is a case where individual sacrifices can collectively dampen the spike of an epidemic and save lives. Again, healthy people don’t need to seal themselves in their house. But be prepared for the cancelation of large events — concerts, sports events, political rallies, etc. I’ve been so impressed by the social consciousness of friends and family and the willingness to alter behavior, cancel plans, and think of the less fortunate. When local leaders and businesses start making very difficult decisions to cancel events, think about the 52 million Americans over age 65 and 133 million Americans with a chronic condition, and maybe resist the temptation to criticize. By the end of this, most of us will know someone who died of COVID, and in retrospect the sacrifices will seem small.

Apparently the internet likes cats.
Credit: Anne Marie Darling @amdar1ing

Protect Granny

Week 10 (March 2-8)

It’s been a week since my post about COVID-19. Here’s the latest.

𝑹𝒊𝒔𝒌 𝒈𝒓𝒐𝒖𝒑𝒔
If you’re in a risk group (e.g., elderly*, underlying conditions), the time to think about social distancing has come. The virus is now transmitting in US communities. It may not be in your community yet. But we don’t know. You don’t have to seal yourself in your home, but you may want to avoid large gatherings. Try to be reasonable. Book club: probably okay. Going to a conference with 10,000 people and shaking everyone’s hand: probably less okay.

The overall trend is what is important here.
The exact numbers may not be correct due to underreporting of mild cases.

𝑵𝒐𝒏-𝒓𝒊𝒔𝒌 𝒈𝒓𝒐𝒖𝒑𝒔, 𝒘𝒊𝒕𝒉 𝒓𝒊𝒔𝒌 𝒈𝒓𝒐𝒖𝒑 𝒄𝒐𝒏𝒕𝒂𝒄𝒕
If you’re not in a risk group, you have less risk of severe disease. But if you get infected and have mild or no illness, you could still transmit the virus to someone in a risk group. So if you have high contact with people in a risk group, you may want to consider a degree of social distancing yourself. Again, being reasonable. Taking the dog to the park: okay. Taking a cruise: less okay.

I wish I could provide an app where you put in your age/health history and you could submit various activities (grocery shopping, Caps game, flight to Florida, attend granddaughter’s nursery school class) and the app would tell you the level of risk. Honestly, the data is just not there yet. We still don’t know, for example, how important children are in community transmission. You just have to try to use common sense and protect the vulnerable.

𝑭𝒖𝒕𝒖𝒓𝒆 𝒑𝒓𝒐𝒔𝒑𝒆𝒄𝒕𝒔

If the United States was China, I’d be confident that we could avert a major epidemic. China has effectively beaten back the virus without any vaccine or any special treatments. If you put society on lockdown, and practice extreme social distancing, you can break transmission and cases will drop, saving thousands, potentially millions, of lives. Italians have learned this lesson the hard way and have now initiated extreme lockdown of 16 million people. You know Italy is taking a virus seriously when they cancel the football games.

But we are not the Chinese. Or the Italians. We are the land of Don’t Tread on Me bumper stickers. And we are in an election year where politics come into play. Brace for a new meaning for March Madness.

*I intentionally use a vague term like ‘elderly’ because a fit 70-year old may be less risk than a frail 60-year old.