There is good news and bad news in this week’s announcement that the Chinese government intends to lift travel restrictions on Wuhan by April 8th.
The good news: this would end more than two months of strict quarantine measures on the city where the novel coronavirus first emerged. Wuhan reported on March 18th that, for the first time since the outbreak began, it had no new confirmed cases of Covid-19.
The bad news is how far away we are in the U.S. from this happy milestone. Wuhan went into lockdown on January 23rd. But it took until February 18th for the outbreak there to peak. By the time Wuhan reported its last official new local transmission, the only stay-at-home orders in the U.S. were in counties around San Francisco. Crudely, based on this timeline, we might guess social distancing measures in the U.S. would have to be in place through at least May.
But it is hard to compare the two cases. Wuhan was China’s only Covid-19 hotspot. The epidemic in the U.S. has multiple epicenters, with more developing. The stay-at-home orders that have gone into effect in the U.S. are less stringent than were the restrictions in the city of Wuhan and the wider province of Hubei. The U.S. still broadly lacks the testing capacity to find and fight the virus effectively.
There is something else to consider about timing. As a disease in individuals, Covid-19 seems to develop slowly and then all at once. According to the CDC, symptoms usually don’t appear until four days after exposure, and remain mild for about a week after that. It’s usually in the second week after symptoms develop that the disease suddenly turns serious enough to require hospitalization. This turn in the second week has become a signature of the disease, as the New York Times’ science reporter Donald G. McNeil Jr. described it in a recent episode of The Daily: “It’s known as the second-week crash.”
The second-week crash has implications at the population level: waves of people who are relatively healthy in the first week of their infections can spread the virus to others well before healthcare systems start to register the exponential increase in cases headed their way.
In New York City, the Covid patients in the wave currently overwhelming hospitals were likely exposed some time in early March, extending chains of transmission that began weeks before that.
New Orleans is struggling against a surge of infections, showing some of the highest rates of spread in the country. The fuse for that explosion may have been lit by the week-long Mardi Gras celebrations that ended February 25th.
Nearly three quarters of Americans are now under Covid-related movement restrictions. Many of those restrictions haven’t even reached the end of their first week.
// In this issue
Quick Link Roundup
People to Follow
Lessons from Hubei
// Quick Link Roundup
Data on the Pandemic: With the lack of testing, counting deaths may be the best way of tracking the scale and pace of the pandemic. The New York Times’ Coronavirus Deaths Daily Tracker is a good place to start. As of right now it shows the death toll at 1,989, with a doubling time of three days. If the curve doesn’t bend, then by April 4 when the next issue of this newsletter is in your inbox the toll will be nearly 12,000.
A long-read on the long-term course of the pandemic by Ed Yong, one of my favorite science writers, who’s been thinking about pandemics for years.
— “How the Pandemic Will End.” Ed Yong, The Atlantic.
A clarifying piece about modeling: There’s been a lot of confusion and outright disinformation in the last few days about the epidemiological modeling around the pandemic. This piece adds some clarifying perspective.
— “Coronavirus Modelers Factor in New Public Health Risk: Accusations Their Work is a Hoax.” William Wan and Aaron Blake, The Washington Post.
Air pollution in the U.S. is down as the economy comes to a halt, which is good news …
— “Satellite Images Show Less Pollution Over the US as Coronavirus Shuts Down Public Places.” Madeline Holcombe, CNN.
… But the EPA has suspended enforcement of pollution regulations. The economic recovery, when it begins here and elsewhere, may be dirty enough to offset whatever environmental side-benefits the pandemic has produced.
— “Citing Coronavirus, EPA Suspends Enforcement of Environmental Laws.” Susanne Rust, Louis Sahagun, Rosanna Xia, Los Angeles Times.
A stunning photo essay on New York’s restaurant scene under the shelter-in-place order. You really should see these photos on as large a screen as you can to get the full effect.
— “NYC’s First Week of Dining Under Shutdown, In Photos.” Gary He, Eater New York.
You’re really unlikely to get Covid-19 from your groceries, takeout, or packages. The biggest danger is from inhaling droplets exhaled by someone who is within six feet of you.
— “Don’t Panic About Shopping, Getting Delivery or Accepting Packages.” Joseph G. Allen, The Washington Post.
You can still donate blood during the pandemic.
— “It's Safe to Donate Blood During the Coronavirus Pandemic. Hospitals Wish You Would.” Mikaela Lefrak, NPR.
The partisan gap on the crisis is holding and dangerous. It’s influencing health behavior in a measurable way and will be a major fault-line in weeks ahead. Via Tom Pepinsky, Cornell University.
A helpful interview with Michelle N. Gong, MD, from March 23rd, who is on the front lines of the fight against the pandemic in New York City at Montefiore Medical Center in the Bronx. The JAMA Network’s Covid-19 video series is generally a great resource.
A well sourced animated explainer on SARS-CoV-2 from the folks at Kurzgesagt, who have been producing scientifically-grounded explainers for a long time now.
// People to Follow
A small sample of the people I follow on Twitter whose posts I’ve found most helpful.
Craig Spencer. He contracted Ebola while fighting the outbreak in Guinea in 2014, became New York City’s only EVD patient when he returned home, and wrote a remarkable article about the experience in the New England Journal of Medicine. He’s returned to Emergency Room service in New York to treat Covid-19 patients.
Marc Lipsitch. A Harvard epidemiologist who raised early alarms about the pandemic.
Helen Branswell. Senior science reporter at STAT News, who has had deep experience covering disease outbreaks and has been on the Covid-19 beat since the very start.
// Lessons from Hubei
While physical distancing measures seem to have slowed the rate of infections and deaths in several Western countries recently, these measures haven’t matched the dimensions of the program that squelched the outbreak in Wuhan. Rapidly curtailing social interactions is only half the battle — intensified disease surveillance and temporary isolation of people who are sick is also crucial, since transmission within families has been a major driver of the pandemic.
What really turned the tide in Wuhan was a shift after Feb. 2 to a more aggressive and systematic quarantine regime whereby suspected or mild cases -- and even healthy close contacts of confirmed cases -- were sent to makeshift hospitals and temporary quarantine centers.
The tactics required turning hundreds of hotels, schools and other places into quarantine centers, as well as building two new hospitals and creating 14 temporary ones in public buildings. It also underscored the importance of coronavirus testing capacity, which local authorities say was expanded from 200 tests a day in late January to 7,000 daily by mid-February.
The steps went beyond what's envisioned in many hard-hit Western cities. As a result, many doctors and experts say the recent lockdowns in the U.S. and Europe may slow the rise in new infections -- if properly enforced -- but still won't be enough to stop it or prevent many hospitals from being overwhelmed, as they were initially in Wuhan.
“A lot of the lessons have been lost,” said Devi Sridhar, professor of global public health at the University of Edinburgh. “A lockdown helps buy time: The only way it will work is if you actually backtrack and start figuring out who has the virus.”
The U.S., Britain and some European countries will ultimately, like Wuhan, have to establish multiple makeshift hospitals and quarantine centers to isolate more cases if they are to bring the virus under control, she said.
“Absent of divine intervention, I don't think there's any other way out of it,” she said. “We're heading in that direction: We're just doing it too slow.”
With luck, physical distancing and increased testing will bend the curve and allow the U.S. to move to stratified isolation. But with the virus spreading so widely in the U.S., it may be some time before we’re able to broadly go on offense against the pandemic. In the meantime, it would be a mistake to take China’s success at curbing the disease as an easily followed path.
As often happens in China, they never got around to telling us what the rules were. We could see the roadblocks, and heard rumors of people being locked into, or out of, places, but were left guessing about what we were and weren’t allowed to do.
For the time being, we could still walk by the river. We noticed that the flower shops were closed, but they left funeral arrangements outside on an honesty box system. Other families were evidently more cautious: Sitting on our 16th-floor balcony one sunny afternoon, the air was suddenly cut by a young boy’s voice repeatedly howling: “I need to go out and play! I need to go out and play! I need to go out and play! I need to go out and play!”
This short documentary provides another perspective.
// Concluding thoughts
This week’s newsletter came a little later and less polished than I would have liked, as the realities of carrying on my normal workload under the pandemic have set in. I hope it’s still been helpful, and I’ll see you next Saturday.