Guest Commentary: COVID-19 – What Has Brought Us Here, Where Do We Go Next?

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by Robb Davis

Yesterday David wrote of the difficult place in which we now find ourselves vis-a-vis the virus. It is a challenging moment and past time to think about what brought us here and what we need to do right now to get out of the worst of it and move forward.

I offer the following as a way to get us to the place where we can use the tools of disease surveillance to manage the virus until longer-term solutions—therapeutics and vaccines—can be put into practice. Implementation of traditional surveillance tools will enable schools and universities to move to in-person instruction, allow many businesses to offer services, and give people confidence in being in these spaces.

All of these things—schools and universities in-person and businesses offering services—will NOT be done according to the standards of pre-COVID life.

They will not.

However, with appropriate disease surveillance, we can start to achieve lifestyles that are, psychologically and socially, healthier than the current situation.

But, to arrive at a place where the traditional tools of disease surveillance for infectious diseases—testing, tracing, isolating, and quarantining—can work is going to require several things and, most importantly 1) clarity about how we have gotten here and what we need to avoid going forward, and 2) the key behaviors we all need to adopt now AND going forward until therapeutics and/or vaccines are broadly available.

The second point is VERY important: our behaviors need to transcend any understanding that there are ones that are appropriate for when we are “open” and others that are appropriate when we are “closed”. Indeed, it is clear to me that the concepts of “open” or “closed” (or shutdown) have become a hindrance to having a rational conversation about the behaviors necessary to get us through the crisis until treatments or a vaccine are widely available.

We need a clear set of behaviors that hold no matter the level of openness; that hold whether schools are in-person or not; and that hold whether businesses are providing goods and services or not. Why? Because these are the behaviors we need to “live with COVID-19” as the infectious entity it is.

So, what has brought us here? I would suggest six things, some of which we do not control and most of which we do.

1. SARS CoV-2 (the virus that causes COVID-19) is a novel coronavirus. We know a lot about other respiratory viruses, and coronaviruses have been around for a long time. But THIS virus is new. It is more infectious and more deadly than other coronaviruses and we know little about its long-term impacts on those who are infected but survive. We are still learning about how it is transmitted (though our knowledge has grown quickly). Many of the other points below flow from this virus’ “novelness” and our lack of experience in dealing with such an efficiently spread disease like it.

2. There is a great deal of misunderstanding about how science works. This is something we could control if we wanted to. Science does not advance with statements of absolute certainty—especially when it comes to novel infectious agents. Science advances with evidence built, hypotheses proffered, and corrections made over time. Many of us are watching the “art of science” practiced in public for the first time and while science speaks in “evidence for” and “probable outcomes”, newspapers (and politicians—see below) speak in headlines and an appearance of certainty and confidence that scientists find horrifying.

3. We lack humility. I say this in two ways: we lack humility about the need to learn more before we speak in any certain terms about this virus; and we lack humility about how we use information to score points in arguments. We need to step back and acknowledge that there is much we do not know and share our learnings in careful terms, ready always to self-correct, acknowledge errors, and move on to make better decisions based on the weight of evidence.

4. We have politicized EVERY element of this virus and our response. From its origin, to treatments, to testing, to preventive measures such as the wearing of masks, it is hard to talk about any part of this that has not been mobilized to denigrate rivals or advance narrow political ends. This demonstrates both a lack of humility AND a willful misunderstanding of science (or it is pure cynicism). From the president, who suggests scientists are lying to us, to local officials who call for “reopening” so we don’t “fall behind” the next county over, our leaders have too often used the virus to their ends, not ours. This has given the impression to normal folks that EVERY recommended behavior is contested and that there is no evidence, no truth, no clear path.

5. We have created unnecessary binary thinking. This is the main tool of the politicization noted above. We have created false dichotomies: health versus economy, or death of a few versus mild illness for everyone else, and the list goes on. These binaries have hijacked our discourse, created confusion, and have kept us from advancing a more nuanced understandings of how we might move forward.

6. We have been extremely impatient. Did I mention that this is a NOVEL coronavirus? Did we forget that it is has been infectious to humans for under 8 months? Despite this, we want answers, we want resumption of a normal life, we want normalcy to return. NOW! Well, none of that is going to happen quickly. None of it. And so, we must prepare for a long struggle and rediscover the value of patience and waiting (traits that many people in the world consider virtues).

This is how we got here and the negative synergies in the foregoing list describe why we feel helpless and angry, and unable to find a way through. But there is a way. It is not an easy one, but it is one that takes all of the foregoing and turns it around in three clear steps.
It is what I think of as the “Steps to Living with COVID-19”

First, we need to follow some very basic guidelines that have already been established AND expect them to be updated. Remember how science advances: it learns, it updates, it corrects. If every changed or updated recommendation is met with derision and hostility, if every correction is viewed as evidence of malintent, we cannot move forward. We need to see changes to recommendations as evidence that we are learning to overcome this disease and embrace them.

Second, and this is one of those recommendations, we need to wear masks indoors at all times when others are present, except at home. Period.

We also need to wear masks outside when in crowds or in any other context in which six feet cannot be maintained between us and others.

Third, we need to avoid what the Japanese have termed the three C’s. We need to avoid CLOSED spaces with poor ventilation. And since we typically do not know about the ventilation in closed spaces, we should be careful in all closed (tight, low ceiling, narrow, confined, etc.) spaces if possible.

We need to avoid CROWDED places with many people nearby. This means indoors and outdoors but especially indoors and especially for periods longer than an hour. Outdoor crowded spaces? See masks above. Indoor crowded spaces? Avoid them with or without a mask.

We need to avoid CLOSE CONTACT—that is, close-range encounters with people. We must use masks but even with them, we should avoid prolonged conversations close to people (<6 feet).

We should specifically avoid situations where all three of the “Cs” are present because those are the situations of superspread events.

Many other details could be hashed out in any of these but if you take them as a hierarchy—masks first and then the three C’s—they will guide much of your behavior.

If we do these things, we will drive transmission down to a point that we will be able to catch the few cases that occur DESPITE these behaviors. That’s right, none of these individually or taken together reduce risk to zero. We are facing a highly efficient virus that can spread despite our best efforts.

But, if we do these things, we can manage the cases that slip through, with lowered mortality, with schools and universities having in-person instruction, and with local businesses offering goods and services to clients. All of these will be modified but our lives will begin to feel somewhat normal and we can begin to regain the full social, cultural, and economic health we desire.


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Disclaimer: the views expressed by guest writers are strictly those of the author and may not reflect the views of the Vanguard, its editor, or its editorial board.

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6 thoughts on “Guest Commentary: COVID-19 – What Has Brought Us Here, Where Do We Go Next?”

  1. Alan Miller

    These are great guidelines.   And they would do exactly as you say, were it not for stupid people.

    Now we need a plan that works, given the high percentage of stupid people.

  2. Jeff Boone

    The evidence is now overwhelming that we blew it and are continuing to blow it.

    The data from Sweden (light-touch balanced approach) and Belguim (one of the most heavy-handed draconian shutdown approaches) clearly proves that destroying the economy over fears of IFR increases has been a very costly mistake.  Belguim has the highest death rate in Europe (820 deaths per million residents).  Sweden is at 442 deaths per million residents.   Sweden’s mortality rate is also comparable to or better than several other European countries with heavy-handed lockdowns including France, Italy, Spain, and the United Kingdom.

    What EVERY nation has in common is that the death rate is primarily from seniors and senior centers.

    All this talk about the virus becoming political… let’s grow some self-awareness on that.

    The original demand was to flatten the curve so hospitals were not overwhelmed.  Check

    Then we are counting the CRF to justify closing down the economy.  Check

    Today the CFR has crashed to be below what the CDC counts as an epidemic.  For people below age 66, the CFR is way below H1N1.

    We all KNEW that opening the economy and starting more rigorous testing would result in increased IFR.  Repeat WE ALL KNEW IT.  We also expected more hospitalization.  Don’t lie… we did.

    Yet the goalposts have been moved.  Now the rage of political and media-hyped fear is the IFR.  The fake news blows up stories of hospital room shortages, even though no hospitals report a concern.  Those at high utilization for COVID are under-utilized for everything else because of the virus fear, and thus are reporting they have capacity to treat.  The Administration put hospital ships in New York that were never used.

    And the next goalpost move is that we don’t know the long term health impacts from people catching the virus.  We get to wring our hands anew with irrational media-drive fear of some zombie apocalypse.  I’m sorry, but it almost seems like we have scared up people having Munchausen syndrome by proxy.  There are MANY, MANY, MANY more stories of people getting the bug and not even knowing they have it than there are stories of long-term health impacts for those that recover.

    The goalpost just keep moving and moving and moving.

    I was screamed at that I only care about the almighty dollar and not lives.  Now the risk of death has fallen and continues to fall to below epidemic levels… so what do I care about now?

    Meanwhile millions of people are losing their savings, their businesses, their homes, their ability to provide for their families.  There is little media coverage of that.  I wonder why?

    Yes, the COVID debate is political.  But it is has been made political by those stuck continuing to move the goalposts with the next new argument to support their almost religious conviction to economic destruction in the name of a virus.

    We all better wake up soon.  I hope we begin to open our eyes and consider ALL Of the criteria that contributes to ALL aspects of human health… and stop digging in for an ideological ego battle.  True we know so little about a new novel virus.  But we absolutely should now what prolonged draconian economic destruction will do… especially to the most vulnerable.

    As a related aside, I reading that simple and inexpensive steroid inhalers are keeping many out of the ICU and getting them to recovery much quicker.  It might help explain the crashing CFR rate.  But there isn’t much money in that treatment.  And it would also seem an inconvenient story for the shutdown motivated.

  3. Robb Davis

    We all KNEW that opening the economy and starting more rigorous testing would result in increased IFR.  Repeat WE ALL KNEW IT.  We also expected more hospitalization.  Don’t lie… we did.

    I have no idea what you are even trying to say here.  Do you even know what an IFR is?  It is a function of the virulence of the virus and has nothing to do with opening up.

    I won’t discuss this with you because you don’t even know what the terms  mean.

    You are Exhibit 1 of what has brought us here.

    1. Bill Marshall

      A family member was informed that he may have been exposed to Covid ~ 10 days ago… he has some risk factors, and was a tad anxious, so I took him to the testing event in West Sac… he wore goggles and mask… some in front of him in line, wore masks (all ‘wore’ them), but did not have them cover nose and mouth… many(~50%) were definitely obese [one or two borderline ‘morbidly’ so… the security guard (from the sponsoring entity), looked askance at me because even tho’ I was 20-30 feet away, I had opened my mask… while he was ‘judging’ me (he did not confront me except ‘glaring’) he pulled down his mask, and smoked a cigarette… watching me throughout…

      So, although I believe we should all be prudent, I agree that more education is needed to be prudent on Covid, and OTHER factors that can threaten our health, lives. and those around us.

      Hoping you see this as an affirmation of what you are saying/promoting… but folk need to realize, as well, that obesity/diabetes, smoking, and other factors (other than age.. not much we can do about that, in a socially acceptable manner), actually will cause more morbidity and deaths than Covid… but, the focus needs to be Covid, right now, but there is a ‘constellation’ of public health threats… the ones other than Covid ALSO  need to be addressed… I believe you fully understand that…

      But, in the here and now, the focus needs to be on Covid… but we should not forget to address the whole ‘constellation’… as many have said, diabetes (particularly Type II) and smoking, consumption of other substances are contributing factors to susceptability (sp?) to Covid… and many other diseases…

      Would be interesting to see graphs of morbidity/mortality for other factors, on the same graph… but that’s not going to be a happening thing… there can be only one ‘crisis de jour’, with little/no correlation to risk factors other than age…

      So Robb, please keep speaking truth… am just trying to amplify…

  4. Dave Hart

    Thank you for boiling it down so well.  Curiously, your suggestions on the three Cs haven’t changed based on what I’ve read since early March.  It has always appeared to be a numbers game, a probability problem.  A variant on the old adage “dilution is the solution to pollution”.  Even people in well ventilated rooms upwind of the Covid positive person contracted the disease.  This whole thing is so much like defensive driving.  Keep your speed down, signal, make eye contact and assume everyone else on the road is a homicidal maniac behind the wheel.

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