Public health experts and officials say the global battle against the spreading coronavirus has moved to a new phase as it becomes obvious that efforts to contain the virus to just a few locations have failed.
Now, as the number of cases mounts across the United States, health officials are beginning to prepare mitigation strategies, efforts aimed at delaying the virus’ spread rather than eliminating it altogether. The rapid spread has made a broad outbreak inevitable, experts say, adding that containment is simply unrealistic.
“When we’re in the containment phase, the idea is you can find every case and you can stop it,” said Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University Medical Center. “Mitigation is recognizing that there is community spread, which there clearly is. It’s recognizing that we might not have the resources to do individual contract tracing for every single case. It means you’re moving to taking more population-based actions and thinking about things at scale.”
Those mitigation steps include promoting more social distancing, limiting large gatherings at which the virus might spread, and potentially even closing schools or canceling sporting events.
Several school districts in virus-impacted areas in Washington, California and Kentucky have closed already. Washington Gov. Jay InsleeJay Robert InsleeWhat if politicians were required to tell the truth? New Washington secretary of state orders staffers to be vaccinated Conservative Washington state lawmaker dies after positive COVID-19 test MORE (D) said his team is considering mandatory measures to promote social distancing.
Universities have ordered classes be held online rather than in person, and even some churches have limited services or changed communion rituals to fight the virus. Major medical conferences were canceled, and officials in Austin, Texas, ordered the South By Southwest film festival canceled for the year.
The aim, experts said, is to limit the spread of the virus so that the public health system does not become overwhelmed.
Left unchecked, a typical outbreak spikes quickly, creating a huge number of cases that the health system cannot handle and threatening the lives of those who go untreated, before dying off as more people develop immunity.
If serious mitigation steps are taken, the virus may still infect the same number of people, but over a much longer period of time, allowing the health system to treat and release patients and open new beds for the newly infected.
“The goal is to slow down the spread and have it happen over a larger period of time so that hospitals aren’t overwhelmed and supply chains can keep up. It’s important for the public to understand what that goal is so that they’re not confused and say, 'Hey, this isn’t working,' ” said John Wiesman, the Washington state secretary of health.
As of Sunday, 34 states and the District of Columbia had reported coronavirus cases. The hardest hit areas are in Washington state, California and New York, each of which reported more than 100 cases, according to statistics compiled by data scientist Jeff Hammerbacher. The World Health Organization pegged the number of cases in the United States at 566, and 22 have died.
The worst-case scenario, experts said, looks something like what happened in Wuhan, China, the epicenter of the outbreak. More than 67,000 people have been diagnosed with the virus in China’s Hubei Province, and the early spike in cases before the government took quick action left people untreated and vulnerable.
“What we want to make sure is that we do everything possible to avoid any area becoming like Wuhan, where the health system becomes overwhelmed,” said Tom Frieden, who was director of the Centers for Disease Control and Prevention during the Obama administration.
If a health system becomes overwhelmed, the risk spreads far beyond those who contract the virus, to those who need a doctor’s care for more common ailments. Millions of Americans suffer from chronic conditions such as hypertension, heart disease and diabetes, all of which require management and medicine. If the health system is stuffed with coronavirus patients, those who suffer from other problems can be left out.
“The greatest impact is often from people with multiple chronic conditions whose care is going to be interrupted,” said Prabhjot Singh, a health systems expert at Mount Sinai Hospital in New York. “Systems are triaging. These folks are going to be pushed to the back of the line a bit.”
During an Ebola outbreak in West Africa six years ago, thousands of people died from malaria and cholera, treatable diseases that went untreated because they could not get to a hospital.
“It is undoubtedly the case that many more people died because of Ebola than from Ebola,” Frieden said.
Health officials are walking a fine line between sounding an alarm about the growing spread of a virus and creating a public panic. But many said the growing number of cases in the United States — which nearly doubled over the weekend — was becoming cause for serious concern. And after years of budget cuts, some said a new focus on public health is just what the country needs.
“You don’t want to cry wolf, but it really, really feels like things are going to get a lot worse. We have to be on top of it,” Katz said. “If I am totally wrong, which I really don’t think I am, the very worst thing we do is we promote our public health infrastructure.”