The Coronavirus Fight From Social Distance to Shelter in Place
(Bloomberg) -- The first phase in the fight against the coronavirus was containment -- efforts to keep it from entering or spreading in a community. In many places, the task has shifted to mitigation -- slowing the spread once the virus is established within a population. Mitigation means adjusting old-fashioned approaches like quarantines or travel barriers, turning to newer tools such as “social distancing” and even adopting a tool from other sorts of disasters called “shelter in place.” The World Health Organization is calling for such “non-pharmaceutical methods” to be used at a scale never before seen to fight a pathogen moving at “astonishing speed.” Here’s a look at some of what mitigation means.
Reducing human contact means reducing the chances for the virus to be spread from one person to another and thereby from one community to another. Social distancing is an approach to doing that while stopping short of a full-scale quarantine. For example, in China, about 280 million students across the country from the elementary to university level have been at home for weeks watching their teachers live-stream classes, interacting online and submitting homework via apps. Nightclubs livestream DJ sets on social media for at-home dancers, who can comment and even leave a tip. Tech companies are rolling out contactless delivery, even using self-driving vehicles, to spare customers direct contact with human couriers. Large public gatherings were banned in many countries, including parades, theater performances and sporting events. Schools and universities closed; bars and restaurants in some cities closed or were restricted to deliveries or faced curfews. Employers were encouraged to have as many workers tele-commute as possible.
Shelter in Place
It’s a concept adopted from protocols developed for extreme weather events or mass shootings, times when lethal danger can catch people unprepared. The advice is to find the safest place close at hand rather than moving to a more ideal or familiar location. In terms of the coronavirus, it’s being used to emphasize a more extreme version of social distancing, akin to universal home quarantine. In Italy and France, residents were ordered to stay inside unless carrying a pass showing them to be on essential business or seeking food or medical care, and police were enlisted to enforce the order. In the U.S., the six largest counties in California’s Bay Area became the first localities to issue a shelter-in-place order. The moves reflect the calculation of authorities that caseloads will rise beyond the capacity of health care systems without drastic action to cut down on the interactions that permit transmission of the virus.
Expanded testing allows officials to determine how widely the disease, Covid-19, has spread and where the risk of outbreaks is greatest. Diagnosing individuals is not only important for arranging treatment, but for getting them out of contact with others to reduce their risk of spreading the virus. Testing kits were rapidly developed after China provided access to the genetic fingerprint of the virus, though countries including China, Japan and the U.S. stumbled in providing enough of them quickly. In some hard-hit places, testing more recently has taken a back seat to handling the deluge of cases presenting at health care facilities.
Patients infected with coronavirus who are at greatest risk of becoming gravely ill are put in special wards where health care workers use greater levels of protection. Other patients are asked to isolate themselves at home –- something that was described as common in Wuhan and other hard-hit parts of China, where hospitals were initially unable to keep up with the patient load. Health officials acknowledge that this practice can put family members in danger, and recommend precautions to reduce the risk of infection. Some places are working to set up special areas for patients who don’t have a safe place to recover, whether by converting unused buildings or setting up tents.
Quarantines that restrict the healthy along with the sick in a given area are the oldest method of containment. In China, the government imposed the most extensive quarantine in known history: more than 60 million people were largely confined to their homes in Wuhan and the surrounding Hubei province. As a containment strategy it failed, but it had value as a mitigating tactic, slowing the virus’s spread around the country and the world by two to three weeks, according to the WHO. Italy has attempted to quarantine the northern region of the country where its outbreak first began, but acknowledged that the purpose is more mitigation than containment, given the extent of the spread. It’s imposed a looser set of rules on the rest of the country, further blurring the line between quarantine and social distancing.
In containment efforts, health authorities try to track down everyone a new patient may have exposed, to break a nascent chain of transmission. Once the virus has spread through a community, that can become impractical to do for all cases. Instead, people who have been told or think they’ve been exposed -- exposure is defined as being within 6 feet (roughly 2 meters) for at least 10 minutes -- are asked to “self quarantine” by voluntarily remaining at home or another isolated location for 14 days from the time of exposure. In some cases, health workers are able to check in daily via telephone calls, texts or in-person visits. Since most people self-quarantine at home, the risk to family members is highest. Both they and the potentially infected person may be monitored for signs of a fever. Several members of the U.S. Congress self-quarantined after being informed that they had been in contact at a political conference with someone who later was diagnosed with Covid-19, including two who had interacted with President Donald Trump.
Obstacles to entry have been rolled out in two waves. The U.S. initially barred entry to non-American travelers from China, then later imposed the same restrictions on most foreign nationals who have been in Europe, the U.K. and Ireland. Some countries inside Europe’s passport-free travel zone -- known as the Schengen area -- have reintroduced border checks for the first time since 1995. Italy, the biggest focus of the pandemic outside China, has become increasingly cut off. Russia and Norway joined more than 50 nations that were banning foreigners, halting flights or requiring travelers to self-quarantine. India suspended most visas. But many of the later steps were best seen as mitigation measures rather than containment -- since the virus had already established itself in the country, keeping out new cases was yet one more tool in slowing the pace of increase, rather than avoiding the virus altogether.
Health officials have struggled almost everywhere to get such steps put in place before cases have reached an alarming point. But deploying measures early, as places like Hong Kong and Singapore did, can have a dramatic effect. Research on the 1918 influenza pandemic in the U.S. showed cities that had implemented multiple “non-pharmaceutical interventions,” including closing schools and churches, experienced death rates that were as much as 50% lower -- as well as less severe outbreaks -- than those that did not. Medical researchers estimated China could’ve reduced the number of confirmed Covid-19 cases by as much as 95% if officials had implemented non-pharmaceutical interventions -- from containment and isolation to social distancing -- just three weeks earlier than they did. Even implementing them one week earlier would have reduced China’s cases by 66%, while the number could’ve jumped 18 times if such measures came three weeks later, according to the study this month funded in part by the Bill & Melinda Gates Foundation.
The Reference Shelf
- QuickTakes on the overall epidemic, on how the virus is transmitted, what a pandemic declaration means and whether to wear face masks.
- An examination of how Seattle’s patient zero spread the virus.
- The WHO’s main page on the novel coronavirus, and a roundup from the World Economic Forum.
- Report of the WHO-China Joint Mission on Covid-19.
- A tracker of U.S. cases compiled by the Centers for Disease Control and Prevention.
- A CDC report on the outbreak in China.
©2020 Bloomberg L.P.