In a telebriefing yesterday, officials from the Centers for Disease Control and Prevention (CDC) advised that the United States should prepare for the possibility of the new coronavirus spreading within local communities. What steps are there to take?
As the coronavirus disease, or COVID-19, continues to spread around the globe, the CDC have issued a statement saying that U.S. federal agencies are actively preparing for the potential spread of the new coronavirus — SARS-CoV-2 — at local level.
In yesterday’s telebriefing session, Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, also advised that the U.S. population should take stock of the preventive actions available in the case of a pandemic.
“The global novel coronavirus situation is rapidly evolving and expanding,” said Dr. Messonnier, referring to recent developments in Italy and elsewhere.
Currently, there are 53 confirmed cases of COVID-19 in the U.S., according to the CDC’s own data. Of these, 12 relate to travel in China, two stem from person-to-person contact with an infected individual, and 39 are among repatriated U.S. citizens.
So far, there has been no transmission of the virus within communities at local level, and the CDC state that although “COVID-19 is a serious public health threat,” at this time, it is “not recognized to be spreading in U.S. communities.”
Yet, the fact that the viral infections have been spreading in European countries, and that the number of new cases reported outside China has now exceeded that of new cases emerging within China, has led U.S. authorities to express growing concern.
“Community spread is often a trigger to begin implementing new strategies tailored to local circumstances that blunt the impact of disease and can slow the spread of [the] virus,” stated Dr. Messonnier in yesterday’s telebriefing.
“The fact that this virus has caused illness — including illness resulting in death — and sustained person-to-person spread is concerning. These factors meet two of the criteria of a pandemic,” she went, emphasizing that:
“As community spread is detected in more and more countries, the world moves closer towards meeting the third [criterion]: worldwide spread of the new virus.”
Dr. Messonnier noted that, so far, the strategies adopted by U.S. agencies to prevent an outbreak within the country have been fruitful.
“The U.S. [have] been implementing an aggressive containment strategy that requires detecting, tracking, and isolating all cases, as much as possible, and preventing more introduction of disease, notably at points of entry [in the country],” she said.
“We’ve restricted travel into the [U.S.], while also issuing extensive travel advisories for countries currently experiencing community spread,” Dr. Messonnier explained.
“We’ve also enacted the first quarantine of this scale in the U.S. and are supporting the State Department [of Health & Human Services] in repatriating citizens from high risk areas. We are doing this with the goal of slowing the introduction of this new virus into the U.S., and buying us more time to prepare.”
Dr. Messonnier stressed that even with the current success in keeping community spread at bay, the U.S. must put in place a strategy addressing potential negative scenarios.
“To date, our containment strategies have been largely successful,” she said. “As a result, we have very few cases in the [U.S.], and no spread in the community, but if more and more countries experience community spread, successful containment at our borders will become harder and harder.”
“Ultimately, we expect we will see community spread in this country,” she warned. “It’s not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen, and how many people in this country will have severe illness.”
Dr. Messonnier pointed out that public health organizations in the U.S. already have a basic framework for a pandemic containment strategy.
She directed the public to the CDC’s Community Mitigation Guidelines to Prevent Pandemic Influenza document from 2017, which, she pointed out, contains the key actions that individuals and communities can take in the event that a viral infection should spread widely.
The CDC are currently adapting these existing guidelines specifically to COVID-19.
The CDC’s director of the National Center for Immunization and Respiratory Diseases noted that all interventions necessary would be nonpharmaceutical, given there are currently no available vaccines against COVID-19.
These should occur at individual, community, and environmental levels. For individuals, she said, “everyday preventive measures” — ones they should apply to prevent any viral infection, including the flu — should be the first port of call.
“Stay home if you’re sick, cover your cough, wash your hands,” said Dr. Messonnier.
More pandemic specific measures might include “voluntary home quarantine” for people who have come into contact with someone with COVID-19.
Nonpharmaceutical interventions at community level would vary, as appropriate. Communities would have to decide what interventions to implement based on how severe disease spread is, Dr. Messonnier noted.
She also offered examples of what such interventions might look like.
“For schools, options include dividing students into smaller groups or, in a severe pandemic, closing schools and using internet-based teleschooling to continue education,” she said.
“For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options,” she went on. “On a larger scale, communities in cities may need to modify, postpone, or cancel mass gatherings.”
“For healthcare settings, this might include triaging patients differently, looking at how to increase telehealth services, and delaying elective surgery.”
From an environmental point of view, the CDC official noted that “everyone [should] consistently clean frequently touched surfaces and objects at home, at school, at work, and at large gatherings.”
Despite the urgency of this advice, Dr. Messonnier reassured the public that U.S. officials are well-prepared for any eventuality.
CDC and other federal agencies have been “practicing” for a potential pandemic, she noted.
She also addressed some public concerns about a recent incident involving faulty diagnostic kits. Experts are now modifying the kits, and new ones will soon be available.
“There are currently 12 states or localities around the U.S. that can test samples,” she added, and the CDC was also processing samples.
“There is no current backlog or delay for testing at CDC,” she clarified, adding that officials are taking steps to make tests commercially available.
In the Q&A session at the end of the telebriefing, Dr. Messonnier noted that, while the CDC’s shift in strategies may appear disproportionate to the problem, their stance is to be safe rather than sorry.
“I continue to hope that, in the end, we’ll look back and see that we were overprepared, but that is a better place to be in than being underprepared,” she stated.
While the CDC warned that a possible pandemic — and the ensuing response to it — could cause “severe disruption” to people’s lives through missed work and school commitments, or by affecting finances, other public health organizations are concerned about the profound social rifts that a moral panic could cause globally.
The World Health Organization (WHO) have recently stated that “[i]n the case of COVID-19, there are an increasing number of reports of public stigmatization against people from areas affected by the epidemic.”
“Unfortunately, this means that people are being labeled, stereotyped, separated, and/or experience loss of status and discrimination because of a potential negative affiliation with the disease,” the WHO note, emphasizing that social stigma could worsen disease spread.
That is because stigmatization can “drive people to hide the illness to avoid discrimination, [p]revent [t]hem from seeking health care immediately, [and] [d]iscourage them from adopting healthy behaviors,” the WHO explain.
“We are not just fighting to contain a virus and save lives. We are also in a fight to contain the social and economic damage a global pandemic could do,” the organization say in their latest COVID-19 update.