Public health experts warn of major disruptions from coronavirus

The coronavirus is sparking major disruptions around the world, closing schools, canceling events and causing havoc to the global economy.

Public health experts warn that Americans should also prepare for major disruptions as the number of cases tops 100,000.

Already, governments at home and around the world are taking drastic actions to limit the virus’s spread.

In China, the government has ordered travel restrictions and quarantines that have affected hundreds of millions of people. In South Korea, public gatherings have been banned.

Iran and Italy, sites of two major outbreaks, have closed schools. Regional officials in Italy have canceled Catholic Mass and soccer matches. Saudi Arabia has banned pilgrimages to Muslim holy sites. 

“When Italy cancels Mass, you know that this is real, right? And that’s what they’ve done,” said Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University.

In the United States, a school district in the Seattle area has shuttered for two weeks, and the University of Washington said Friday it would cancel in-person classes. A cruise ship carrying 3,500 passengers and crew remained anchored off the coast of San Francisco after a passenger from a previous voyage became the first American to die of the virus. The National Basketball Association has urged players to avoid high-fives or accepting pens from fans to sign autographs.

Some public health experts said the virus is putting a new focus on state and local health departments, the front-line responders who must both confront the virus and also make significant decisions about what elements of everyday life get shut down.

“Public health entities have not been in the situation to make large-scale population-level decisions for about 100 years. The last time a health department was asked, ‘Should we quarantine your entire city or not,’ was 1918,” Katz said, referring to the Spanish flu outbreak that killed tens of millions around the globe.

Now, those departments have to consider taking drastic actions. In interviews with state health directors and secretaries last week, several said they were keeping their options open — including revisiting contingencies for shutting schools, canceling sporting events and concerts, and making preparations for the surrounding fallout.

“Many students receive their breakfast and lunch nutrition at school, free and reduced lunches. If we close schools, one of those impacts is student nutrition, and that’s a hard one to mitigate, but those are some of the factors we have to consider,” said John Wiesman, the Washington state secretary of health. 

Katz said she was concerned that Americans have not yet fully grasped just how drastic the disruption might be, in part because the federal government has not offered strong guidance about the path ahead.

“The challenge here is the administration has taken a posture of keep calm and carry on, particularly if it influences the economy, and I am deeply concerned that we are not doing everything we need to do,” Katz said. “For weeks, we’ve been talking about don’t panic but prepare. And I think a lot of people in the U.S. have taken prepare as meaning go out and buy a lot of toilet paper.”

There are signs that the American public is willing to take drastic steps in order to protect themselves and their families. Polling conducted for the Centers for Disease Control and Prevention (CDC) in 2006 showed a huge majority of Americans would be willing to stay home for seven to 10 days if a member of their household was ill with a pandemic flu.

In that poll, conducted by the Harvard School of Public Health, more than three quarters of Americans said they would follow recommendations offered by public health officials that included significantly curtailing elements of their daily lives, like going to a mall, using transportation or even going to church.

“We know from influenza data that people are really willing to make life changes. They just need to know what to do,” said Prabhjot Singh, a health systems expert at the Mount Sinai Health System. “We’ve got a public that’s really willing to step up if it knows what it ought to do, and that means that state and local messaging down to the community level is probably the most important infrastructure we need to make sure is working right now, along with testing.”

Convincing an entire community to change its daily habits is difficult, public health experts say, but it can be done. During an Ebola outbreak in West Africa, health experts curtailed that virus’s spread by convincing residents to stop washing and burying their dead relatives, a major source of transmission that required communities to abandon centuries of tradition.

“People aren’t stupid. When they see people dying, they will change their behavior. What we want to do is communicate that before people start dying,” said Tom Frieden, the former CDC director who oversaw the American response to the Ebola outbreak and who now runs Resolve to Save Lives, a global public health nonprofit.

But health experts said delivering timely and actionable messages to prevent the spread of something like a coronavirus or a pandemic flu requires a consistent top-down message that has so far been lacking from the Trump administration. 

Senior CDC officials and members of Trump’s Cabinet have demonstrated some of the behavior change likely to make a difference. Arriving in the Seattle area on Thursday, Vice President Pence shared an elbow bump with Gov. Jay Inslee (D), rather than shaking hands. 

But Trump himself has raised questions about the cause for concern. On Wednesday, he offered a “hunch” that the virus was not as deadly as World Health Organization officials had suggested. In an interview on Fox News, he said “thousands or hundreds of thousands of people … get better just by, you know, sitting around and even going to work.” At a town hall meeting in Scranton, Pa., on Thursday, Trump shook hands with attendees.

State officials are taking firmer action. Inslee, whose state is suffering from the highest number of cases in the United States, signed an order extending workers compensation coverage to first responders who face quarantine after being exposed to the virus. California Gov. Gavin Newsom (D) has warned companies against price gouging on supplies like hand sanitizer.

“You have to make sure you are protecting individuals as much as you can. Making sure they’re protected against job loss and economic hardship and making sure that we’re thinking about vulnerable populations. What does it mean for the elderly, and what does it mean for prisons?” Katz said.

Maryland Gov. Larry Hogan (R) and Tennessee Gov. Bill Lee (R) have sought to calm residents Wednesday and Thursday as they announced the first confirmed cases in their states.

Public health experts pointed to China’s success in locking down its population, a harsh measure that has nonetheless contributed to a declining number of cases at the epicenter of the current outbreak. But China has an authoritarian government that controls its society with an iron grip. The United States does not.

The challenge in the United States is magnified, in part, because of constant tensions in the political system and a broad lack of trust in government institutions. That puts a premium on local governments, which are generally seen in a more positive light than a federal government riven by partisanship.

“If you don’t trust your institutions, then we have to be able to trust our neighbors and in a time of crisis what everybody’s assigned to do,” Singh said. “It’s your responsibility to know what to do, because we don’t live in an authoritarian society.”

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