Tough choices around coronavirus
The ongoing coronavirus outbreak has disrupted life on a global scale. Many of us need to make tough choices to adapt to its impact on our life and routines. There are several high quality resources to understand what is happening, some referenced in this post. However, it is still hard to make our choices just based on this data. The following are some things I found as I attempted to fill this gap for myself. Let’s get started.
Policy versus personal choices
Each issue involves the choice made by policy makers and the choice made by individuals. For example, consider the issue of kids and their schools in the context of the coronavirus outbreak. The policy choice is whether to shut down schools or do remote education or continue to operate schools as normal. The personal choice for parents is whether to send their children to school. The responses to the two related choices need not necessarily align. For instance, a district may decide that the best policy might be to keep schools open in an area, but they allow parents to choose whether or not to send their children in. In that area, one parent may have a child with asthma, and may determine that the best choice is to keep the child home. Another parent in the area is a single parent doctor, who needs to send their kids to school to go to their job. The key thing to realize is that there is no one size fits all solution. The right thing to do is what works best for each case.
- The corona virus attacks humans and makes them sick.
- Since this is a new virus in humans, most people do not have immunity when first exposed to it.
- Currently, the virus is known to have mild impact on most people, except high risk individuals — particularly people of older age, and also people with chronic conditions including immune system disorders, diabetes and respiratory illness such as asthma. Caution is also advised for pregnant women, though the exact impact is not known. This study shows the effect of age, coexisting disorders, etc. on a group of patients in China.
- Every few times the virus goes from one person to another, it mutates — changes its genetic structure — slightly. The more it mutates, the more likely it is to transform into something that may change its behavior patterns. For instance, a newer strain might attack some classes of people more severely. This mutation is important to consider. Some people are of the opinion that it is a good idea to develop immunity early on by being exposed earlier — but it is possible that a new strain emerges later that can attack the same person. Also, by more people letting the virus infect them (either due to disregard of suggested precautions, or intentionally trying to get infected), we are spreading the virus more rapidly and increasing the chance of mutation and possibly stronger variants of the virus.
- Another reason to minimize spread is that the more it spreads, the more at risk individuals are going to develop serious disease and more of them will, unfortunately, die. By taking steps to minimize the rate of spread, we prevent deaths and severe illness in our community.
- Yet another reason to minimize spread: The research community around the world is working on studying the virus, trying to develop vaccines, treatments, etc. One estimate states that a treatment may come in months, but a vaccine is likely further out. There is a race between researchers trying to find a vaccine or treatment strain of the virus has a vaccine or treatment, and the virus mutating itself to generate strains that have no treatment. Minimizing the spread buys humans time to win the race. A much weaker factor is that there is some chance that warmer temperatures might render the virus inactive. If this turns out to be the case, minimizing spread till the temperatures turn warmer could buy us additional time.
How to minimize spread
For all the reasons listed above, we want to minimize the spread and the rate of spread.
The current CDC take is that the spread happens primarily through person-to-person contact, and primarily when the infected person is symptomatic. We can do a few main things based on the CDC guidelines for prevention and treatment is to:
- avoid close contact with people who are sick
- stay home when we are sick
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
- People showing symptoms of Covid-19, or those giving extended care to them in a hospital or at home should use face masks to avoid spreading the disease to others. (The CDC also recommends that other non symptomatic people should not use masks to prevent risk of Covid-19. This is important because the benefit of doing that far outweighs the damage done due to the current global shortage of masks, gloves, gowns, etc. for health workers.)
These next few are also important. For example, in case someone sneezes on a surface, we touch it and touch our mouth, we might get infected:
- Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty. (This is critical for infected people to minimize spreading, but also important to prevent getting infected if you are not — or spreading it if you are infected and don’t know that you are infected).
- avoid touching our nose, eyes and mouth
- Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
Some of these preventive choices to minimize spread and chances of infection are affected by the prevalence of the virus in our region. We can track the prevalence in our area through a number of dashboards:
We can look at the number of confirmed cases and deaths (if any) in our region. We can also look at the rate at which the number of confirmed cases is growing (or not) in our region. These will give us a sense of how likely we are to get infected.
In any case, if we are symptomatic, we should follow the guidelines to minimize spread above.
To prevent risk of getting infected, in regions with low prevalence, we may be a little more confident going to places with other people, sending our children to school, etc. In regions with higher prevalence, we would probably want to try and avoid contact with others as much as possible.
Currently, across the world, policy decisions are being made based on one of two conflicting viewpoints.
The proactive view focuses on taking measures to stop the spread of the virus at the cost of other socio-economic considerations. In this view, people are isolated and separated from each other — schools are shut down, businesses work remotely or are shut down. If feasible, whole areas are quarantined to prevent spread to other areas. Some countries like China, Hong Kong have taken this approach and managed to control the spread.
The reactive view takes a more balanced approach — it reacts to each incident only when it is severe enough, thus reducing the spread at a slower pace, while trying to also minimize the impact on socio-economic factors. Schools are not shut down unless incidents are detected. Attempts are made to run business as usual. Some countries like Italy and the US are taking this approach.
Read A tale of two outbreaks: Italy and Hong Kong contrasting the proactive and reactive views.
I am personally biased towards the proactive approach, especially for areas where the virus is spreading actively — the main reason is that it minimizes the early spread more aggressively, and buys time to find more permanent solutions such as treatments, vaccines, etc. This post by Trevor Bedford from Fred Hutch’s Bedford Lab argues that the Seattle area (mostly King County and Snohomish County at the time of this writing) is now at the place China was before the spread grew out of control, and that with the right measures, we may be able to contain this to prevent the same thing happening in Seattle.
Policy is also influenced by the feasibility of an approach in a given region — for example, some of the measures implemented in China may not be easy to implement in the US, and vice versa. Each region at each level must determine what works for them.
Any policy also needs to balance lofty goals with the ability to execute on them — in some cases, setting a high bar drives the execution — in other cases, failure to execute may lead to more damage than if the initial goals were set to be more achievable. Again, the best approach depends a lot on individual circumstances. In my region, one very commendable school district has laid down and started to execute on a plan to combat coronavirus by keeping kids home, and rapidly enabling remote education to keep the school going. Most other school districts have decided to keep schools open. There are pros and cons of both approaches. Only time will tell which one is effective.
Remember that, like all the challenges we have endured in the past, this too, will end. Life will return to normal for most of us. How and when it ends, and how much damage it causes and leaves behind, will be driven by the choices we make today — individually, and as a community. I sure hope we make the right ones.
I am very grateful to the wonderful people and communities in the Seattle area on different social groups who shared many of these links, and continue to support each other in so many ways.