Issue Nine: Ready or Not, Here We Come
5.9.20 | We're reopening parts of the country without proper safeguards in place
Hello,
It’s a strange week. The worst of the first wave of the pandemic has clearly passed in New York, enough so that parts of the state should be ready to reopen by May 15th. Across the rest of the country, many states are barreling ahead with reopening even if they don’t meet the loose gating measures set by the White House. In more than half of states where restrictions are loosening the pandemic wave is still building, as measured in both raw case counts and percentage of Covid tests coming back positive. Modeling suggests new cases and deaths will continue to rise over the summer. Meanwhile the administration quashed a set of detailed guidelines for safe reopening devised by the CDC, over worries the guidelines would slow the economic restart (you can read part of the guide here).
Health experts agree that the key to reopening safely is a combination of widespread testing for the virus, tracing the contacts of people who test positive, and isolating the infected to break future chains of infection. Some describe this as the “box-it-in method.” Few areas in the country right now have the capacity to easily do any one of those things, let alone all three.
Most Americans think it’s too soon to reopen businesses and end physical distancing. And simply reopening without taking concrete steps to curb the pandemic won’t stem the economic damage — people won’t engage in economic activity if they think doing so carries a strong chance of making them and their loved ones dangerously ill.
In other words the loosening restrictions will leave many people trying to navigate the post-lockdown environment on their own. What’s safe to do and what isn’t? What kind of testing is available and what do the results really mean?
This issue tries to help with those questions.
// In this issue:
Link roundup
A brief interlude on partisanship and disinformation
Testing, contact tracing, and isolation
[Dr. Deborah Birx gesturing to a figure from the IHME model during a White House Briefing in March. Erin Schaff for The New York Times. Of note here: the model from March seems to have come extremely close to projecting the correct number of deaths for April 15, but instead of declining through May, daily deaths have actually begun to increase.]
// Link Roundup
Can you go shopping? Hug a friend? Get a Tattoo? Yes, no, and—surprisingly— maybe, according to this wide-ranging and informative guide to making your way through the slowly thawing social world.
— “A Guide to Staying Safe as States Reopen.” Joe Pinsker, The Atlantic.Infection is a function of viral dose and time: This long post by a biologist goes into the mechanics of disease spread. It’s well worth your time as you consider what kinds of spaces you want to visit in the next few weeks and months.
— “The Risks - Know Them - Avoid Them.” Dr. Erin Bromage.Monitoring and tracking your symptoms if you think you might have contracted Covid-19 will help you and a doctor get you through it. This piece describes what to look out for day by day.
— “Why Days 5 to 10 Are So Important When You Have Coronavirus.” Tara Parker-Pope, The New York Times.Shortness of breath is a common symptom, but Covid-19 tends to starve people of oxygen slowly enough that it becomes dangerous before it’s noticeable — a condition known as “silent hypoxia.”
— “They Don’t Struggle To Breathe—But Covid-19 Is Starving Them Of Oxygen.” Maya Wei-Haas, National Geographic.King of the beach: Warm summer weather won’t on its own stop the spread of SARS-CoV-2. A new study shows social distancing has a much greater impact than heat, sunlight, and humidity.
— “Why Summer Likely Won’t Save Us From The Coronavirus.” German Lopez, Vox.
— “Impact of Climate and Public Health Interventions on the Covid-19 Pandemic: A prospective cohort study.” Peter Jüni et al, Canadian Medical Association Journal.One of the scientists who discovered the Ebola virus in 1976 recently caught Covid-19, and reflects on the experience in this extraordinary interview, in which he notes: “you have a 30% chance of dying if you end up in a British hospital with Covid-19. That’s about the same overall mortality rate as for Ebola in 2014 in West Africa. That makes you lose your scientific level-headedness at times, and you surrender to emotional reflections. They got me, I sometimes thought. I have devoted my life to fighting viruses and finally, they get their revenge. For a week I balanced between heaven and Earth, on the edge of what could have been the end.”
— “‘Finally, a virus got me.’ Scientist Who Fought Ebola and HIV Reflects on Facing Death From Covid-19.” Dirk Draulans, Science.The lethal characteristics of the virus: A long and detailed explainer on the family history and arsenal of the novel coronavirus.
— “Profile of A Killer: The complex biology powering the coronavirus pandemic.” David Cyranoski, Nature.An illustrated guide to eight avenues toward a Coronavirus vaccine.
— “The Race for Coronavirus Vaccines: A Graphical Guide.” Ewen Callaway, Nature.Hurricane season starts next month, and emergency managers already exhausted from responding to the pandemic are preparing for the possibility of a dual disaster.
— “Emergency Managers Work Nonstop To Prepare Communities For Hurricanes During Pandemic.” Carly Berlin, Southerly.Disasters are always characteristic of the times and places in which they erupt, and so they reveal truths people tend to take for granted as the invisible background of social life: “What Covid has revealed is that the truly essential work of society is care: care for the sick, care for the young and the old, the care work of food production, the mutual care that allows any of us to function in the world.”
— “Covid-19, the Halifax Explosion, and Crises of Care.” Jacob Remes, LAWCHA blog.The House held a hearing on the pandemic this week, with enlightening testimony from former CDC director Dr. Tom Frieden and epidemiologist Dr. Caitlin Rivers of the Johns Hopkins Center for Health Security.
Frieden points out that in New York City, the pandemic’s death toll from the first wave has been equivalent to the worst of the 1918 flu pandemic, and gives a good road map for the fight against the disease. Among other things he stresses that the choice between economic stability and public health is a false one — people won’t return to economic activity unless they feel that the virus is under control.
Rivers testifies that while diagnostic testing in the U.S. is improving, the rate of testing needs to double or triple or more before we have enough information about disease prevalence. Something else that caught my eye — she notes that the federal government lacks a standing capacity to do sophisticated epidemiological modeling of new diseases, and that we should establish a federal bureau for epidemiological forecasting similar to the National Weather Service.
// Partisanship and Disinformation
The partisan gap around how seriously to take the pandemic has been fairly narrow, though it’s growing. This isn’t an inevitable development. Political scientists know that everyday people’s opinions and perceptions are shaped by cues from influential messengers who share their political affiliation, including elected officials and media figures. Lately some influential figures in Republican politics have been pushing the message that the threat of the virus has been exaggerated, that medical experts aren’t to be trusted, and that the federal health bureaucracy is primarily interested in undermining the president.
There’s an unbelievably dangerous messaging strategy afoot to frame physical distancing and mask wearing as a “base mobilization” issue. One Republican strategist described it this way: “For a lot of voters, it’s going to become, which side of the barricade are you on? Are you on the mask-wearing side or are you on the MAGA hat-wearing side?”
The extent to which “a lot of voters” come to think this will depend largely on the efforts of partisan strategists, television pundits, and elected officials to encourage that framing. And to the extent that messaging strategy succeeds, it will deepen the damage caused by the pandemic by corroding social trust (among partisans of all stripes) and weakening public health efforts.
This kind of messaging can be persuasive not because people are dupes — they’re not — but because systemic problems like a global pandemic are difficult to see and experience from our standpoints as individuals, they’re loaded with uncertainty, and we all look to others for context and clarity.
In these situations of risk and ambiguity there’s inevitable misinformation, but also active disinformation spread by malicious actors and amplified by otherwise well-intentioned users over social media.
For a deeper exploration of this, I recommend this joint interview with disinformation scholar Joan Donovan and risk communications scholar Jeanette Sutton on the Slow Disaster podcast.
// Testing, Tracing, and Isolation
The only way out of the pandemic, without a vaccine, is testing, tracing, and isolation to break infection transmission chains. Countries that have had the greatest success fighting the pandemic have aggressively pursued this strategy. South Korea, for example, rapidly ramped up testing capacity to determine the spread of the disease, interviewed thousands of people who had either tested positive for Covid or who had come into contact with someone who had, and isolated both the sick and their high-risk contacts.
Contact tracing itself is a labor-intensive task that requires trust and buy-in from the public. Isolation isn’t straightforward either — sending infected people to their homes to self-isolate means exposing everyone in their household, who themselves are likely to then catch the virus. It’s more effective to set up temporary isolation dorms or barracks, or requisition hotels, to isolate the potentially quite large number of people who have been identified through contact tracing but who do not require hospital treatment.
But before we get to tracing and isolation we have to master testing, something with which the country is still struggling mightily.
There are two main types of tests. The first is a Polymerase Chain Reaction (PCR) test, which detects the genetic material of the virus itself — it’s the best way of determining whether or not a person is currently infected. Antibody (or serological) testing, meanwhile, tests for the presence of the antibodies your immune system generates to fight off the virus once you have been exposed or infected. These antibodies can hang around in your blood for some time after they’ve destroyed all of the virus in your system, in order to keep you from becoming re-infected.
Now that antibody testing in particular is becoming more widespread, and in some cases is easier to get than PCR testing, a lot of people are wondering whether they should get one, and how they should interpret the results.
This primer from ProPublica suggests that antibody tests might not be all that helpful especially for individuals, though they can inform community-level health efforts:
There are reliability issues with current antibody tests for Covid-19. We also don’t know exactly what concentration of antibodies provides people true immunity from reinfection, or how long they last. The test also can’t tell you when you were exposed or infected — whether that bad cold you had in February was actually Covid, or whether you got exposed and had an asymptomatic infection in March. So while serological testing is absolutely crucial for determining at a population level how the disease is spreading, the individual experience of getting an antibody test can be pretty underwhelming.
Meanwhile there’s no nationally coordinated effort to ramp testing up to the 3-10 million a week most experts think we’ll need to get a full picture of the pandemic’s spread in U.S. communities. There isn’t even a reliable federal effort to publicly track testing nationwide, which is why scientists, journalists, and policymakers are relying on “The COVID Tracking Project,” housed out of The Atlantic.
// Concluding thoughts
The lack of federal coordination continues to hobble the pandemic response. Leaving individual states to experiment on their own leaves the country at risk — New York’s outbreak seeded infections across the country earlier this year. The new hotspots that flare up in the next few weeks are just as likely to seed new waves of infection in states that are just getting their local outbreaks under control.
It’s possible, of course, that things will make a dramatic turn for the better, and by next weekend the country will start to come down off the case plateau. But with the number of new cases increasing in more than half the states in the country, that seems unlikely.