June 25, 2020
Earlier this week in conversation with Dr. Sigurdur Kristinsson from the University of Iceland, the leader of the IMF-supported iStopMM project, he told me, “There are no cases of COVID-19 in Iceland right now!”
This enormous achievement—a triumph—is a testament to what a combination of science and political resolve can achieve: eradication of active COVID-19 infections. This success was documented in a recent article in The New Yorker. Testing, tracing and quarantine allow you to shut this virus down.
But then Sigurdur asked, “What about you, Brian?” Then the tragedy emerged: the U.S. has no unified, nationwide plan, and COVID-19 infections are surging across the country, prompting New York, New Jersey and Connecticut to require travelers from states with rising case numbers to quarantine and provoking the European Union to consider banning entry by U.S travelers.
The magnitude of our country’s current healthcare tragedy is indicated by the fact that the U.S. has 4% of the global population, but more than 25% of the deaths from COVID-19. Failure to contain the pandemic in the U.S. reflects not just an incompetent public health response, but a callous disregard for human life.
So why are the real outcomes here so bad and in Iceland so much better?
Strategies that work
The strategy for triumph in the face of this pandemic is simple. In the absence of a vaccine or effective treatment for COVID-19, it is possible to beat COVID-19 down to zero as they did in Iceland by testing, tracing and quarantine, combined with sensible public health measures. End of story.
A common sense plan resonates with people and cooperation is almost automatic.
Excellent scientific input (in Iceland, from deCODE Genetics and CEO Kári Stefánsson, plus public health leaders) and a charismatic and trusted leader like Iceland’s Prime Minister Katrin Jakobsdóttir help.
The renewed surge
What is causing the renewed surge of COVID-19 infections and where are these infections coming from?
- Air-droplet spread: We now know that the dominant feature of COVID-19 is that it spreads readily by air droplets. When physical distancing is ignored, person-to-person spread is likely, and COVID-19 can spread at a rapid pace.
Circumstances favoring rapid spread are:
- NO masks
- Group gatherings
The risk is at the very highest indoors, especially when ventilation is poor and prolonged contact occurs. Anything more than 15 minutes within less than six feet is considered close contact.
Examples of group gatherings, as I have discussed many times, include large public gatherings; factories or working environments or commercial spaces with frequent close contacts (such as gyms, salons, bars, restaurants); extended households; and, perhaps, the greatest risk of all—nursing homes with a high percentage of vulnerable individuals.
Key points to remember:
- Asymptomatic individuals (such as the many young individuals currently infected) can shed virus for three weeks. Aerosol spread is the biggest problem.
- Spread of COVID-19 within households is a major source of spread to the most vulnerable.
Other scenarios and methods of transmission, such as from surfaces and in outdoor settings, of COVID-19 do occur, but these are not the dominant methods of spread and do not seem to sustain or enhance the pandemic.
- Enhanced spread in the U.S.
Indoor group gatherings without masks are fertile ground for virus spread and in the last few weeks we have seen ample evidence of increasing case numbers with this type of reckless behavior. Conversely, outdoor protests have not seemed to result in any major increase in new infections spikes. This is probably because outdoor spaces are much safer, and many protesters wore masks. An important exception occurred within the ranks of the Los Angeles Police Department, where a post-protest spike in COVID-19 infections may have been due to some of its members not wearing masks.
Why is this emergence of an increased COVID-19 so dangerous? To answer this question, it is important to understand more details about the virus itself:
- Is the virus still coming from the Wuhan, China outbreak?
No, not directly. The recent cases reflect community spread of COVID-19 from Europe (Italy, Austria and Germany). This strain of virus became dominant in the Tri-State area. Studies of the different virus strains have shown that the European strain rapidly dominated and became the source of most new infections.
- Could there be new infections coming from China?
This is possible but does not appear to be happening right now. Coronavirus infections are widely spread in the population in South West China. The origin of COVID-19 is found in horseshoe bats. These bats are unique in that coronaviruses can grow and mutate in them without causing harm to the bats themselves. These coronaviruses spread to both people living the SW China, Vietnam and Laos, and to animals that are served in restaurants as an exotic delicacy. This disturbing trend has been dramatically increasing what is called “spillover” from damaged, diverse natural habitats into local populations.
This is the cause of the COVID-19 pandemic, other coronavirus episodes, and serious epidemics like Ebola, which comes from the fruit bats in Africa.
Fortunately, there is no indication of new coronavirus infections coming from China. However, strict prevention measures need to be put in place.
- What happens when there are many new COVID-19 cases in the community?
The infection rate goes up. This week, for example, many workers at a factory in Germany became infected. As a result, the “R value,” which indicates the tendency for the infection to spread to more people, rose from 0.6 to 2.88. This means that COVID-19 takes on a life of its own and keeps spreading. A recent mutational analysis showed that new virus strains that emerge are more infectious and potentially more dangerous. Aggressive measures, such as full or partial lockdowns, are essential to shut down such episodes and, fortunately, are ongoing in Germany.
The bottom line
Just as new, more dangerous coronavirus infections have been emerging from bats, more dangerous COVID -19 strains are emerging as part of huge community spread in people across the U.S. This serious development is making the pandemic ever more difficult to contain. It is literally a matter of life and death to shut down new super-spreader events in the community. New strains pose new dangers.
What can be done to triumph?
- Stop the spread of COVID-19.
- Test, trace and quarantine.
- Wear masks.
- Halt large gatherings.
- Physically distance.
- Socially network virtually.
- Stay safe at home. Venture out in a step-wise, cautious fashion (as described in the June 22 episode of the Johns Hopkins public health podcast).
- Work to stay resilient.
- We can get through this together.