Containment to mitigation
The situation with coronavirus has changed dramatically over the last few weeks. We are in the midst of a worldwide pandemic, and the U.S. will see an even more dramatic escalation in the weeks to come.
A moderate outbreak could result in 200,000 patients needing intensive care, according to the U.S. Department of Health and Human Services. The U.S. only has 100,000 intensive care beds, and most are already occupied.
Hospitals are already implementing pandemic preparedness plans. They are increasing capacity, canceling routine procedures, ramping up telemedicine and counseling people who can to stay home.
But hospitals alone cannot solve this crisis. It’s up to all of us to decrease the demand for hospital care by reducing the rate of disease transmission. In epidemiology, this is called flattening the curve.
We cannot stop transmission altogether, but we can slow it down. That way, we can reduce the number of acutely ill patients and reduce the likelihood that patients who need care have to go without.
What does this mean? So far, the U.S. has focused on containment: quarantining travelers and investigating contacts of the ill. As more and more cases are detected, public health agencies won’t be able to keep up, nor would it make sense to try. The focus has to shift from containment to mitigation.
These efforts have already started. The CDC announced new guidance for those most vulnerable to coronavirus (people over 60 with underlying medical conditions) to avoid crowded places and not go on long-haul flights and cruises. The NCAA announced Wednesday that all March Madness games will be played without fans. Major conferences affecting hundreds of thousands of people are being canceled.
These are all timely, appropriate and responsible decisions. It’s time for all sectors to implement social distancing measures that are in their control. Many companies have already started telework and canceled nonessential travel. Some jobs don’t lend themselves to work from home, but all those that can should do so.
Public meetings should switch to virtual town halls. Universities that haven’t already should change to online instruction, and schools need to weigh the downsides of closure with the risk of children being vectors for transmission to their families and beyond.
All of these decisions come with tradeoffs. They will hurt the economy in the short term. But bold actions will save lives. During the 1918 influenza pandemic, Philadelphia held a parade of 200,000 people, while St. Louis shut down schools, theaters and sporting events. The death rate in Philadelphia was double that of St. Louis’, a result directly attributable to St. Louis city officials’ aggressive—if initially unpopular—actions.
Individuals can each do our part. Even if the young and healthy may not get very ill, they can still spread coronavirus. Everyone can stay home when sick, cover coughs and sneezes and stop shaking hands. Washing hands frequently makes a huge difference. Together, we can reduce the risk to ourselves and all those around us.