On April 4th, 2020, there is a reported 1,192,028 cases of Covid-19 around the world accounting for 64,316 deaths. The United States leads the world with 301,902 cases and ranks third in fatalities at 8,175. How did we get here and what do we know?
On December 31, 2019, just 95 days ago, Chinese health authorities first identified an infectious novel coronavirus cluster. They filed an official report on January 7th, 2020. Seven days later on January 14th, human to human transmission of the virus was established. Three days later on January 17th, airports in New York, San Francisco and Los Angeles began screening for the virus. On January 20th, five days after returning from Wuhan, China to his home in the state of Washington, a 35-year-old American male citizen was identified with the virus. On January 29th, President Trump established the White House Coronavirus Task Force to coordinate efforts to monitor, prevent and mitigate the spread of Covid-19. Just two days later on January 31st, Trump called for a Public Health Emergency imposing travel restrictions preventing foreign nationals from entering the U.S. if they were in China the previous two weeks. Three days later on February 3rd, Dr. Tedros Adhanom Ghebreysus Head of the World Health Organization (WHO) stated there was no reason for a travel ban. As of March 20th, the U.S. was barring entry from twenty-eight European countries as well as China, Iran, Malaysia and South Korea. At the same time, the Surgeon General Jerome Adams suggested social distancing to mitigate the spread of a pandemic which is where we are at this time.
The bottom line is the U.S. got a late start but is gaining ground on testing due to waiving many of the regulations. There are several reasons as to why we were behind in testing and enough blame to go around including politics as well as poor decision making from both the CDC and the WHO.
Testing is integral to finding the solution to this pandemic. Going forward, decisions need to be data-driven. If there are not enough tests, there’s not enough data. The number of confirmed cases allows you to make informed decisions. The decision to exercise social distancing is based on the data inferring that many people carrying the virus are asymptomatic. For this reason, we must live our lives as if everyone has it to prevent its transmission. If you are waiting to see how many positive cases come to your area, it’s too late. I guarantee you there are infected people near you they just don’t know it because they are asymptomatic, there are not enough tests and we’re learning there is a percentage of invalid tests adding false negatives into the data stream.
Here’s a couple of examples of asymptomatic groups that tested positive. One defined study took place on a Diamond Princess Cruise ship. All 3,711 passengers were tested with 712 testing positive, 46% of the positives were asymptomatic. The first Covid-19 death in Italy was in the small town of Vo located in the northern region of The Veneto. They tested all 3000 people in the town learning that 3% of those that tested positive were asymptomatic. They were able to identify and quarantine that group to prevent the spread of the virus to the rest of their population.
Infectious disease experts keep talking about flattening the curve. This is a term used to project the number of people that will be infected over a period of time. Covid-19 is an extremely contagious virus that spreads exponentially. Infection curves that go up very quickly also come down very quickly because the virus has infected everyone it can possibly infect. The problem with a quickly spiking curve is that it puts a strain in the health care system that cannot handle that many sick people at the same time resulting in a high fatality rate. The idea of flattening the curve is to slow the infection rate down to a level that the system can handle. At this juncture there is no vaccine or drug to kill the virus therefore we must starve it.
The gold standard example to quickly starve the virus and flatten the curve is South Korea. South Korea saw their first cases around the third week of February and by the first week of March, their numbers were dropping. They accomplished this by aggressive testing, quarantine and social distancing.
At the time of this blog, we have not reached the apex but hopefully, the stay at home order in 42 of our states will have a positive effect on flattening the curve. Here in the United States, Covid-19 positive tests are increasing at an average of 6,861 cases per day accounting for 185 fatalities daily. These are the numbers in front of us but we know there’s more. There are administered tests that we are still waiting for the results, we know there are asymptomatic cases that are positive but haven’t been tested and we know there a number of false negatives. So, the models predict, with appropriate measures we’re still looking at 100,000 American fatalities. Without taking appropriate measures the death toll could reach 2.2 million.
Appropriate measures mean: staying at home, social distancing, self-quarantine and frequent hand washing.