The current piecemeal, a la carte, wait-and-see approach to COVID-19 I’m seeing in my community and in Maine in general appears to be inconsistent with what we should have learned from the data.
As a mountaineer, I can’t count the number of times I backed off a climb in the Rockies because of the threat of a thunderstorm. Depending on the orientation of the mountain, a thunderstorm can be on top of you with little warning, and so most mountaineers take precautionary measures to make sure they’re headed down before the afternoon thunderheads, even if they have not seen them yet. Mountaineers who ignore the possibility of an afternoon thunderstorm (something that is very well represented in the weather data) may find themselves in a panic as a cobalt sky is suddenly eclipsed by a dark anvil shaped cloud. Summit fever has put me there a couple times, and it’s terrifying as the wind picks up, the hair of your beard stands on end, and, in the most terrifying of cases, your rack of metal climbing gear begins to hum and then glow. COVID-19 is like a really bad thunderstorm, and it’s increasingly feeling to me like we didn’t start down the mountain in time.
While I’m a science writer by profession, the science surrounding COVID-19 is not in my wheelhouse or on my beat unless we’re talking about how it affects the Maine lobster fishery (and it is affecting the Maine lobster fishery!). Having said that, I am concerned about COVID-19 and, more important, our collective response to it. While I would not characterize my concern as fear–and I do not believe what I’m about to write is fear mongering–I’m very concerned we’re not acting based on the best available data, and if you know anything about me, you know I think the data matter.
Although COVID-19 may not be my beat as a journalist, data certainly are a big part of my daily work flow. Looking at the data, it appears clear to me that the best thing we could be doing right now for our families, communities (mine is Rockland, Maine) and nation as a whole is to be all-in when it comes to social distancing. The current piecemeal, a la carte, wait-and-see approach I’m seeing in my community and in Maine in general appears to be inconsistent with what we should have learned from the data.
What would an all-in approach to social distancing look like? In my opinion, the time to close schools, museums, theaters, gyms, and the like has long since past. It’s long past the time to cancel all sporting events, trade shows and any other large gatherings. Everyone who can work from home should be working from home. Any essential commercial activity that must continue should be carried out only with protective measures in place (e.g., there should be sufficient space for people to maintain at least two meters distance between themselves and others). Restaurants that can provide effective distance between diners ought to adopt limited hours to focus only on their essential function and then close early. Businesses that remain open should implement and publicize protocols for effectively sanitizing public spaces. This is not a comprehensive list, and I am not a public health expert, but these are the sort of steps that seem obvious to me based on the data.
I know these measures may sound extreme, but consider the alternative….and the point I really want to drive home here is that considering the alternative doesn’t need to be a theoretical exercise based on some model of a hypothetical situation. Instead, we can actually look directly at the data available from places that are a couple weeks or months ahead of us insofar as the spread of COVID-19 is concerned. Many of those places did things (and are doing things) we have not done, and we can learn from those actions and the results of those actions as they manifest themselves in the data.
While people have been seriously talking about coronavirus in Maine since at least early February, the public discussion about altering behavior didn’t really ratchet up until early March. On 5 March, the Maine Center for Disease Control and Prevention (Maine CDC) announced that “testing for the 2019 novel coronavirus (COVID-19) at the state’s Health and Environmental Testing Laboratory is expected to begin in the next several days.” Further, Maine CDC said they would inform the public if positive tests are confirmed, and they said that the number of positive test results would be posted to Maine CDC’s coronavirus webpage. This was forty-five days after the first known coronavirus case was announced in the United States.
On 10 March, Maine CDC began daily reporting, and we learned that less than 30 people had been tested for COVID-19 and none had tested positive. The population of Maine is in the neighborhood of 1,345,000.
By 11 March, 47 people had been tested and there were still no positive test results.
On the 12th of March, the first presumptive positive case of COVID-19 in Maine was announced by Maine CDC after a total of 85 people were tested. By the following day, 13 March, there were three presumptive positive cases of COVID-19 in Maine with a total of 108 people people tested statewide. NOTE: A presumptive positive result is when a patient tests positive at a state, reference, or commercial laboratory but results are pending confirmation at US CDC.
How does Maine compare to the Nation as a whole? As of today, the US CDC is reporting 1,629 cases nationwide (in 46 states and the District of Columbia). US CDC is reporting 41 deaths.**
Put another way, according to Maine CDC data, 0.0002229 percent of Maine’s population has tested positive for COVID-19 compared to 0.0004936 percent of the US population as a whole. Wow! Those are pretty small numbers. All things being equal, I think many of us would take those odds. Consider, for example, that we have around an 8 percent chance of being struck by lightning in the US and yet we really don’t alter our behavior that much to avoid a lighting strike, do we? So why should we alter our behavior for a 0.0002229 chance of becoming infected with a virus that probably won’t even kill most of us?
I have two answers: 1) Only about 0.008 percent of the population of Maine has been tested to date, and 2) Most of us actually do alter our lives to avoid being struck by lightning, but the actions we take are so intuitive and ingrained–such common sense–that we hardly even notice them–so much so that we think we aren’t even taking them.
On the first point, the exceptionally low testing rate has given us a false sense of security. The lack of positive tests in the State and in individual communities is always the first argument for why this school has not closed or this event is still happening. This low testing rate insures, however, that there were most certainly cases of COVID-19 in Maine before CDC reported the first positive test on the 12th of March. In addition, we need to consider that the best available data show that the number of secondary infections generated from one infected individual (the transmission or reproductive rate) is somewhere between two and three for the coronavirus. So every non-isolated infected person has potentially infected two or three other people who in turn may now have infected four or six more people.
“But wait,” you say, “we got the word out early and people have been great about staying home if they have symptoms.” While that’s debatable, keep in mind that, unlike influenza, the coronavirus can be transmitted before any symptoms appear. In fact, the data show the probability of a transmission event happening before the infected individual becomes symptomatic (much the less tests positive) is 26 percent. Finally, in addition to direct human-to-human transmission, the data show this virus “can persist on inanimate surfaces like metal, glass or plastic for up to 9 days.” At least one study has also shown that the virus can live in the air “up to three hours post aerosolization.”
In short, we are long past using the number of positive tests for COVID-19 as our guide for whether or not we should implement mitigation strategies like social distancing.
On the second point about the relative risk of being struck by lightning, one of the reasons we have almost cut the fatality rate of lighting strikes in half in the last decade is surely because we understand the data and we respond appropriately to it. In the same way that not standing in the middle of a field during a lightning storm is obvious based on lightning strike data and our understanding of how lighting works, social distancing is clearly the common sense move in the face of COVID-19. I fully understand that mitigation of COVID-19 through the type of social distancing I outlined above is certainly a big ask, but COVID-19 is not a lightning storm. Nor is it influenza, a common cold or a hoax. All the credible data with which I’m familiar show COVID-19 is here, and it’s going to get worse before it gets better.
Even if we implement the most austere social distancing possible, there is no evidence to suggest it would stop COVID-19 in its tracks. Actually the data show that it wouldn’t. What it can do is buy us time, and that’s what we need right now (this is what you’ve heard referred to as “flattening the curve”). Why do we need time? To be blunt, I’ll borrow population health and health policy expert Dr. Drew Harris’s words: “It’s the difference between finding an ICU bed & ventilator or being treated in the parking lot tent.”
For too long, we here in Maine listened to the news and looked at those maps showing Maine as one of the handful of states with no confirmed cases of COVID-19. We forgot perhaps that Portland is under two hours by car from Boston, which is home to an international airport that sees more then 50.5 million passengers per year. COVID-19 was scary but in the same way news of foreign wars is scary. We’re not, after all, Washington or California or even Massachusetts. By the time the first Maine case of COVID-19 was reported by Maine CDC, we were already in the grips of a declared global pandemic, and we didn’t even know it. We were already past the point of having the conversations we are having now–conversations like should we close k-12 schools. Conversations like should we close museums and theaters, especially as we have the oldest population in the nation with almost 20 percent being 65 or older.
We are at a point where every day we don’t act matters. When we look at how COVID-19 has behaved in other countries, we can see what to expect. When we look at other nations’ response times and outcomes, we can clearly see what has worked and what hasn’t. When we look at historical analogs like the Spanish Flu, we also can glean the same information.
So what works? I’ll leave you for now with a great chart from Tomas Pueyo’s article for Medium titled “Coronavirus: Why You Must Act Now.” This is one of the best articles I’ve read on the subject, and it is certainly the one that cemented my current belief in calling for all-in social distancing.
As Pueyo writes of the above chart, “This theoretical model shows different communities: one doesn’t take social distancing measures, one takes them on Day n of an outbreak, the other one on Day n+1. All the numbers are completely fictitious (I chose them to resemble what happened in Hubei, with ~6k daily new cases at the worst). They’re just there to illustrate how important a single day can be in something that grows exponentially. You can see that the one-day delay peaks later and higher, but then daily cases converge to zero.”
The time for debating what we are going to do is over. We know the thunderstorm is cresting the summit. We’re going to get rained on and we might even hear some distant thunder rumbling, but we can still decide to mitigate the risk. We can still decide to be prudent and begin a systematic descent immediately with no lingering thoughts of standing on the peak. This isn’t about panicking. It’s about being prudent.
We have the data, and the data matter.
**The New York Times has updated their numbers twice since I started drafting this piece. Almost 100 new cases were reported in the time it took me to write this piece:
As of Saturday afternoon, at least 2,345 people in 49 states, Washington, D.C., and Puerto Rico have tested positive for coronavirus in the United States, according to a New York Times database, and at least 50 patients with the virus have died.
As of Saturday afternoon, at least 2,443 people in 49 states, Washington, D.C., and Puerto Rico have tested positive for coronavirus in the United States, according to a New York Times database, and at least 50 patients with the virus have died.
Thank you to Richard Ross and Andrew Rhyne for your pre-press comments.