Blog Article: Weighing Next Steps in the COVID-19 Pandemic

The world has been in crisis mode for the past few months, trying to mitigate the effects of the novel coronavirus (COVID-19) pandemic.  As of May 13th, 2020, COVID-19 has infected over 4 million people, and has caused over 294,000 deaths worldwide, according to Johns Hopkins UniversityThe estimated 1-3% mortality rate (Adams and Walls, 2020; Wu, et al., 2020), coupled with the highly contagious method of transmission via respiratory droplets, have led entire nations to close their borders and require citizens to stay home in hopes of controlling the spread of the virus.

While several medications and vaccines are being fast-tracked by the U.S. Food and Drug Administration (FDA), there is currently no cure for the virus. Therefore, the sole options to contain the virus have included measures such as social distancing, or physical distancing of at least six feet between people; and stay-at-home orders, many of which enforce closure of non-essential businesses including salons, gyms, and malls.  Additionally, international travel has been discouraged and even halted. All of these strategies facilitate the containment of the virus so that global healthcare facilities do not become overwhelmed.  Thankfully, this drastic mitigation strategy, coupled with efforts to ramp up medical supply and device production, has succeeded in “flattening the curve” of new infections and resulting mortality.

However, while this strategy has worked in the short-term, these significant measures have hurt everyday people and threatened international economies.  Cruise ships, which have proven to be incubators of COVID-19, have been halted temporarily, and airline travel has all but shut down.  As a result, the entire travel industry has no revenue, prompting airlines to ask for a bailout from the government.  Universities are operating online or have cancelled classes entirely.  Retailers and restaurants have been forced to shift to online-only and/or curbside delivery operations to stay profitable.

The precautionary measures against COVID-19 have resulted in an economic downturn that has cost over 22 million Americans their jobs — that’s nearly 20% of the United States population (Lambert, 2020).  Defying local stay-at-home orders, and risking their own health, many concerned citizens have taken to the streets, lobbying lawmakers to let them go back to work.  As a result, many U.S. states are weighing their options for reopening, in some places preempting the White House Coronavirus Task Force’s guidelines for a three-step reopening guided by decreases in COVID-19 cases over a two-week period.

We all now find ourselves weighing our next steps in the battle against COVID-19.  The truth is that the world must get back to a new normal — but the way forward remains unclear.  Questions that people around the world are considering in this international effort include:

  • What element of risk are we willing to accept in our daily lives? 

    The federal government has put “safety first” in their efforts to reopen amidst the COVID-19 epidemic.  There is a delicate balance here between our financial prosperity and our health as a nation.  People need to be able to go back to work for their own economic well-being and may be willing to espouse some level of heightened risk in their day-to-day life via the use of personal protective equipment (PPE) such as masks.  Some mix of working-from-home and working onsite will likely prove effective for mitigating risks at this early stage.  People who are most vulnerable, such as older people and persons with compromised immune systems, must remain protected.

The decision to slowly begin transitioning back to normal daily life must account for both the amount of risk inherent in reopening the United States as well as the risks that can be mitigated via some of the behaviors we have adopted in the past several months such as staying home, wearing protective gear, and so on.  The most susceptible should continue to be protected, and those who are less at risk may opt to get back to work.  People who are at risk of developing COVID-19 should not be expected to assume the same level of risk as lower-risk populations.

  • What tools and strategies do we now have that we did not have just a few months ago? 

    Sufficient testing — both to detect ongoing COVID-19 infections and antibodies to the disease — as well as contact tracing — will be an important part of the economic reopening effort to control the spread of the pandemic.  

Additionally, medical facilities have managed to leverage any and all eligible staff to assist in their hospitals and emergency departments. Medical students and retired nurses and physicians have dedicated their efforts to combat COVID and have proven to be significant assets to the teams.

Whatever our next steps will be, we must ensure that our decisions are guided by risk minimization and based on our growing knowledge of COVID-19 and how it spreads.  Monitoring patterns of decline in new cases of COVID-19 should guide decision-making for the reopening of local businesses.  Risk categories should be taken into account in this process.  If cities open too quickly, without proper safety measures, there is risk of a second wave of disease more fatal than the first, likely to necessitate a second wave of even more drastic action.

We must get used to a new way of life, guided by science and reason, which seeks to minimize the spread of COVID-19.  Around the nation and worldwide, communities can apply what we have learned about the virus in the past few months to continue the journey towards greater economic prosperity and social well-being.

Sources:

Adams J, Walls R. (2020).  “Supporting the Health Care Workforce During the COVID-19 Global Epidemic.”  JAMA, doi:10.1001/jama.2020.3972

Associated Press.  (2020). “Seattle model projects that first four U.S. states could reopen on May 4.” MarketWatch. https://www.marketwatch.com/story/seattle-model-projects-that-first-four-us-states-could-reopen-on-may-4-2020-04-17 

Centers for Disease Control.  (2020).  “Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings.” https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html 

Joffe, S.  (2020).  “Doctors working while sick is bad enough in ordinary times. During the Covid-19 outbreak it could be catastrophic.” STAT News.  https://www.statnews.com/2020/03/09/doctors-working-while-sick-covid19-catastrophe/ 

Johns Hopkins University. (2020).  “Coronavirus Resource Center.” https://coronavirus.jhu.edu/map.html 

Lambert, L. (2020).  “22 million have lost their jobs over the past month—real unemployment rate likely nearing 18%.” https://fortune.com/2020/04/16/us-unemployment-rate-numbers-claims-this-week-total/ 

Wu, J., et al. (2020).  “Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China.”  Nature Medicine, doi: 10.1038/s41591-020-0822-7