The COVID-19 pandemic is likely to be the scenario that marks the decade, and for good reason. It has been far more disruptive globally than our experiences with SARS in 2003 and H1N1 in 2009 both of which taught us valuable lessons. As a health official in Baltimore and Washington, D.C. both those outbreaks helped me learn a lot about leadership as a collective outcome, and the many multi-agency drills we did in preparation for future events have stuck with me. A pandemic is a serious situation, and the global impact of COVID-19 is irrefutable. We are seeing a lot of very mindful and effective problem-solving on the business-continuity, mental health, community resilience, and support networks to limit social isolation fronts. There are however a few other questions we have been fielding in our listening sessions with health systems, civic organizations, local government agencies, and community members. Here are a few of those.
1. Who are the "asymptomatic carriers"? – These are people who do not feel sick, and as a result may unknowingly facilitate the spread of disease because they may believe the directives being given about keeping distance do not apply to them. If tested, they would test positive for the virus, but because they have not shown any flu-like symptoms they may not self-select for testing or isolation.
There are probably many more people in this pool than we realize which is why the social distancing directives are so important. In the absence of mass-testing we will not identify this group quickly, so our best move is to stay the course with social distancing and get busy on making testing more available.
2. What about testing? – Once testing becomes widely available our collective priority should be to ensure that first-responders (including healthcare workers) are able to be tested first, followed by high-risk populations like our seniors, those with chronic respiratory conditions like asthma, and anyone with a compromised immune system (due to pregnancy, medication, or disease). This will help ensure that health systems have the staff available to provide care to those who need it.
Testing protocols will likely be put in place to facilitate this prioritization, but where those protocols are unclear some will ignore them and "jump the line". We have to keep in mind the need to take care of the priority groups first, especially while the availability of testing is limited.
3. What if I get tested and it is negative? - That's good news, but it does not mean you will not test positive in the future because the virus may not have been picked up when your throat was swabbed. This will be an issue of major concern with the all testing, but especially the home test kits which will likely be available. The false sense of security a “negative” test gives can make us feel comfortable being in crowds and near vulnerable individuals, inadvertently putting our loved ones at risk. This is important for all of us, and especially important for family-members who are care-givers to vulnerable populations.
4. How do we impact “the curve”? - When testing is available to everyone, the number of cases reported will increase which will look like (and probably be reported as) an "explosion" of the pandemic. Initially, the disease curve we hear about (cases over time) will look like it is moving in the wrong direction because the truth about testing in this scenario is that the more you test, the more cases you will find.
Think of it like being asked to count confetti on the floor in a windowless room with the lights out, and then being asked to count it again with the lights on. In the first scenario (lights out) you can’t count any, so you report “no cases”, but with the lights on (mass testing) the situation quickly becomes clearer and the case count is exponentially higher and much more accurate.
The benefit to this is that we will know more about cases in vulnerable populations, allowing us to protect people we already know are at highest-risk for bad outcomes from this infection. And we will get closer to knowing our baseline, but we should remember that test reporting is not instantaneous, meaning there will be a lag between testing, data gathering, and reporting. This is something I know agencies will aim to keep to a minimum. All the more reason to work on the best ways to keep our distance while progress is made.
5. Vaccine (when available) – Same priority as for testing, i,.e. first-responders and healthcare workers first, then vulnerable populations, then the rest of us. And until a vaccine is available, if social distancing directives are relaxed we are at risk for case counts increasing. The need for a vaccine to complement the immunity we can acquire from community exposure (herd-immunity) and distancing is clear, but a vaccine alone (whenever it arrives) will not fix this.
6. Take care of each other – Right now this means paying extra attention to how we are feeling as individuals, and our interactions with each other and everyday places. It means thinking about who we are around, and how we can be of service to them. The resources at our disposal in this country are considerable, but pre-pandemic access to those resources was a daily challenge for some communities, and that gap will become more apparent in the weeks and months to come. Mindfully planning for the long-term with sustainable, equity-based, cross-sector solutions is our best move. We have the capacity to do this, and to do it well.