COVID-19 cases, hospitalizations and deaths are climbing to record levels across the nation.
Ohio and California have implemented curfews, with targeted stay-at-home orders. Illinois, Michigan and Massachusetts have placed restrictions on businesses like restaurants and bars. The majority of states have implemented face covering mandates, and many are encouraging people to simply stay at home, all designed to prevent the spread of the virus.
Stay-at-home orders sound good in theory, but are unsustainable. They were tolerated back in March and April by necessity. We now know enough about COVID-19 to inform better strategies for mitigating the spread of the virus.
Most people are experiencing face covering and physical distancing fatigue. Stay-at-home orders would only further exacerbate COVID-19 anxiety and the pervasive frustration felt by many.
Current Centers for Disease Control and Prevention (CDC) guidelines focus on informing people what is necessary to suppress the spread of the virus, with the goal of preventing the health care system in areas from being overwhelmed and collapsing. This is the message that must be widely communicated, that restrictions are less about individual health and more about community wellbeing.
The data tells its own story. The nation is adding well over one million new cases per week, and over 60,000 deaths per month, with the inflection point shrouded in fog. The full benefits of the Pfizer and Moderna vaccines will not significantly impact these numbers in the short term. With such heinous data, why are top-down, stay-at-home orders problematic?
There are no mechanisms to enforce stay-at-home orders. Every person can find an exception to fit his or her purpose for not complying. This makes such orders voluntary. Even without a stay-at-home order, many people, particularly those at-risk, have been and will continue to limit their exposure by minimizing activities with others outside their bubble. This is one reason why the case fatality rate in the United States has dropped over the past eight months, with this rate now 10 percent for those over 65 years of age. Better management of COVID-19 patients has also contributed to better outcomes.
Stay-at-home orders could ask people to forgo traditional Christmas, Hanukkah and Kwanzaa celebrations. Are there ways to partake in holiday gatherings without an overwhelming amount of added risk?
Practicing CDC recommended precautions will not eliminate all infection risk. With multiple bubbles, electronic tools are the best approach to gather during the holidays. Bubbles that contain seniors and others at-risk should use such approaches. Holidays are less about food and beverages, and more about the personal interactions necessary to maintain mental health and community wellbeing. COVID-19 has strained many people’s social support systems. Asking for yet more sacrifices that isolate people, when risk can be managed, is challenging.
The 800-pound gorilla driving the current surge of cases nationwide are asymptomatic infections. They are people who are infected, display no symptoms, yet are capable of transmitting the virus to others. Too many people believe that if they have no symptoms, they are fine. From a personal health perspective, this is true. From a population health perspective, this is flawed and dangerous. There are many asymptomatic infections in the population spreading the virus. Most of these cases are never confirmed, which is why only testing those with symptoms drives positivity rates so high. Asymptomatic infections are the ones who need to stay at home and not spread the virus to those who may not be so fortunate, become symptomatic, with some requiring hospitalization.
The options to stop asymptomatic spread are limited. One strategy involves surveillance testing with rapid responses and communication. Several universities have instituted surveillance testing, including Cornell and Duke. Efforts to move in this direction must begin today, and are consistent with President-Elect Biden’s COVID-19 response plan. The country may need to administer 20 to 40 million tests every day to provide adequate surveillance testing benefits.
Given the challenges to implement surveillance testing, an aggressive communication program on how to combat asymptomatic spread of the virus is a more sustainable alternative to stay-at-home orders. Messaging on the population risk of COVID-19 with people who feel fine and never show any symptoms is imperative to guide people to wear face coverings in public, maintain physical distancing and hand hygiene. Lackadaisical and inaccurate messages from the White House have contributed to this misinformation. A “full court press” campaign to communicate this message is in order. With the sitting president now a lame duck, it is time for the CDC to take the reins and do the right thing.
The next six weeks will be a challenge for everyone. Each of us can contribute to the greater good. Face coverings in public, physical distancing and hand hygiene are the only tools available to combat the spread of the virus and preserve many of the area’s health care infrastructure. These are personal choices. Communicating why we must all choose wisely is a holiday message worth sharing.
Sheldon H. Jacobson, PhD, is a founder professor of Computer Science at the University of Illinois at Urbana-Champaign. He applies his expertise in risk-based assessment to evaluate and inform public policy and public health.