Editor’s note: This commentary is by Dr. Harry Chen, who was an emergency physician at Rutland Regional Medical Center for 26 years and Vermont’s health commissioner 2011 to 2017.
I am writing this piece from Uganda, where I landed just before American cases of COVID-19 began their dramatic rise. Being here has provided me a worldwide perspective on COVID-19. Given the rapid spread of the virus across the United States over the past few days, it is time to shift our strategy from containment to mitigation. This means moving from keeping it under control and even outside our borders to a focus on slowing it down to lessen the effects of the pandemic, not overwhelming the health care system and ultimately limiting the lives lost. This pandemic, a new disease that has spread worldwide, will be worse than the H1N1 pandemic of 2009 and may eclipse the Spanish Flu pandemic of 1918.
Uganda and the rest of Sub Saharan Africa are still focused on containment. This past week, Uganda began requiring visitors from the U.S. and many other affected countries to quarantine for 14 days upon arrival. Today’s world is indeed small. We (my colleagues and I here in Uganda) can all keep our fingers crossed, but it’s too late for the U.S. And while there are still many unknowns, modelling has produced estimates of the likely effects of COVID-19 in the U.S. Conservatively, half of the U.S. population may be infected, with up to one million deaths – this is up to 20 times the number of deaths in a bad flu year. Fortunately, for most Americans, especially healthy and young folks, COVID-19 will be no worse than the common cold or a mild case of the flu.
While these are really scary numbers, this is not the time to panic. We need everyone working together in our mitigation efforts. Simply put, the goal is to stretch out the outbreak so as not to overwhelm the health care system and allow time for vaccine development and better understanding of potential drug treatments. Doing this effectively will save lives.
Follow the CDC (https://www.cdc.gov/coronavirus/2019-nCoV/index.html) and your local health department (https://www.cdc.gov/coronavirus/2019-nCoV/index.html) for important strategies for mitigation. They will differ among states based on local disease activity and culture. They will change rapidly, so pay attention. Basic strategies that apply for all of us include regular handwashing, environmental cleaning, social distancing, avoiding large crowds and unnecessary travel. We will need creative efforts on the part of individuals, businesses, health care and government to accomplish our goals.
And when COVID-19 hits in earnest and you are one of the 80% with mild symptoms, stay home and protect your community. Call your doctor and don’t go to emergency departments unless absolutely necessary; they will be overwhelmed with patients and there is no better place to get COVID-19 if you don’t already have it. If you have elderly neighbors or relatives, make sure that they have what they need to take care of themselves in isolation. COVID-19 death rates rise dramatically with age and associated chronic disease.
Health care systems are rapidly preparing for widespread community transmission and in particular on COVID-19 that affects those at risk for severe illness. Surge capacity will be needed to address the anticipated volume. We’ll need innovative strategies to augment care that don’t require an in-person visit to lessen community spread. If you have a chance, thank your neighbors who are health care workers for their efforts in advance and please don’t hoard those N-95 masks they will need to stay safe.
Clearly articulated and efficiently implemented testing strategies need to be in place that don’t make things worse. And while we have failed in our initial testing efforts, they will get better and will provide important information but be aware, at some point they may be counterproductive. If everybody has it, and you’re sick but don’t need hospitalization, you already know the answer and the test will not make a difference. It will be better to stay home, get well and protect your neighbors.
To be clear, we have a lot of planning and work to do. I am anxious to roll up my sleeves and help when I return in a couple of weeks. We need all levels of government to share the unvarnished facts with us and provide the information we need to make the right decisions. We have to be accepting of the uncertainties, pay attention and do what is needed for us individually and collectively. I am reassured by my experience with disasters like 2011’s Tropical Storm Irene that Vermonters will answer the call.