This is part of our Coronavirus update series in which Harvard specialists in epidemiology, infectious diseases, economics, politics, and other disciplines offer insight into what the latest developments may bring in the COVID-19 outbreak.
Harvard public health experts said the nation’s COVID-19 epidemic is “spiraling out of control” and that, with cases increasing rapidly in the worst-affected states and a two-week delay between infection and hospitalization, the situation seems to be getting worse quickly.
“I have this horrible feeling of deja vu, like it’s March again, “said William Hanage, associate professor of epidemiology at the Harvard TH Chan School of Public Health.
Hanage, who spoke to reporters during a conference call Thursday morning, said the hospitals are near capacity in Arizona and Houston and are likely to feel stressed elsewhere soon. And, in contrast to the nation’s initial spike in COVID-19 cases that were concentrated in some states, the current increase is much more widespread and therefore has greater potential for takeoff.
“The increases we are seeing right now have the ability to cause much more disease in the future,” said Hanage.
Barry Bloom, public health research professor Joan L. and Julius H. Jacobson, who also answered journalists’ questions on Thursday, said other countries have shown that the epidemic can be contained by acting quickly when cases appear. Even Italy, once on the brink of collapse of the health system, has regained control of its epidemic, Bloom said. Italy reported only 113 new cases and 18 deaths on Tuesday.
“When political leaders wait until it gets really bad, that’s where we are now,” said Bloom. “If you just look at what you see today, you are three weeks behind the curve. … She’s trying to imagine what it will be like in three weeks, instead of what she sees today, that should be a determining policy. “
Hanage said he understands the reluctance of political leaders to reimpose the blockades, but with few tools to combat the coronavirus and more moderate steps such as masking and handwashing are more effective when the numbers are also more moderate, a shutdown can be What is needed.
Let me be clear: I don’t like stops. But if they are the only thing preventing a worse catastrophe, you have to use them, “Hanage said.
A positive point in the current epidemic is that the age of those who contract COVID-19 seems to be decreasing. Hanage said he did not see it as a sign of the epidemic’s evolution, but rather as a marker that the tests were more widespread and detected more cases than during the March-April peak. Although younger people have better survival rates, that good news is tempered by the fact that we have been largely ineffective in keeping the virus away from those most susceptible to serious illness – the elderly and people with pre-existing conditions. However, that may mean that there is an opportunity to suppress the epidemic before it takes over the most vulnerable populations.
“If there is an action window, it is now,” Hanage said.
Hanage made a similar note about lower death rates at the current peak, saying that deaths lag behind cases, so we must wait a few weeks before concluding that something different is happening.
Bloom said the difference between the US and the nations where the pandemic appears to be controlled is that those countries had uniform national policies and did not lift the blockades until the case numbers were very low. Hopefully some of them have experienced new outbreaks, such as the recent series of cases in Beijing. Once the local epidemic is controlled, reducing the blockade will inevitably lead to new cases. So the strategy is to use tests to quickly identify cases and use contact tracing and isolation to contain outbreaks before they become widespread. In a state like California, with 7,000 new cases reported Tuesday, tracing the contacts of each positive test becomes a monumental task.
Rather than opening the doors wide, the two said that the reopening should be more like refining the closure, allowing some things to resume with safeguards in place that can be tightened should cases arise. Leaders must consider risk versus value to society when deciding what to reopen and when. For example, bars, casinos and churches, where people are crowded and have been shown to be critical points of infection in some cases, may need to remain closed to keep the overall infection rate in the community low enough for us to be able to Reopening places safely with broad societal benefit, Bloom and Hanage said.
“We should want to be able to open schools, and schools should possibly have a higher priority than other parts of the economy,” Hanage said. “What those [other parts of the economy to reopen] they are, they must be debated. … What we should be thinking about when reopening is not to reopen everything safely, but what things we want to reopen and be able to do it without improving community transmission. “
However, even well-honed strategies will fail if citizens fail to comply, Bloom said. In New York City, contact tracking programs have run into people who don’t answer phones or refuse to isolate themselves after hearing they’ve been exposed to an infection.
“If people ignore the epidemic, it will be very difficult to control,” said Bloom, “and leadership should inspire people to be more cautious.”