Since the small cluster of cases broke out in Wuhan, China nine months ago, the world has profoundly changed. With each passing moment, there seems to be a new COVID-19 milestone. 1 million deaths worldwide. 215,000 deaths in the United States. A White House outbreak. Rather than tell you reassuring lies or downplay the virus, I am going to tell you inconvenient truths. But if you are struggling to cope, know that the final destiny of COVID-19 has not been set in stone.
I’m often asked what to do and what not to do to, both individually and as society, to deal with our brave new world.
As a responsible citizen, here is my advice on how to best enjoy life with a sense of normalcy. First, get outside as much as possible when seeing other people. Most “super-spreading” events occur indoors, and transmission outdoors is relatively minimal. If an indoor setting is poorly ventilated, crowded, and with others not wearing masks, then it is probably best to skip it. Outdoor hospitality, such as dining outside and shops, appear relatively safe with the use of masks. Travel, by means of flying or train, still has risks. The longer the flight, the longer the risk of possible exposure. Instead, you can consider visiting nearby parks and supporting local businesses. However, if you choose to travel, it is essential to wear your mask the entire time and practice good hand-hygiene. While flying, keep the time with your mask off to a minimum. And no, even if you wear a mask 24/7, you will not get CO2 poisoning.
If a virus spreads from person to person, then it makes sense that the more contacts you have, the more likely you may acquire the virus or need to isolate because someone tests positive. Close contact typically means remaining physically close for an extended period of time, more than 10 minutes, at a close range. Ask yourself how many people are you in close contact each day? I typically follow the quality over quantity rule for interactions.
For the younger readers, we have been seeing a mentality of just wanting to have COVID-19 to get it over with. I want to remind you that just because you get it once does not guarantee you have immunity for life. We are not sure how long immunity lasts, but there are already a number of cases of reinfection reported. Also, there is still a gamble of serious illness. Just last week, a 28-year old colleague of mine died from complications of COVID-19. Some people aged 30 to 59 are suffering for months with symptoms, such as fatigue and lung damage, dubbed “long-haulers” or “long covid.” This can majorly impact the ability of working-age populations to be productive and burden the economic and health services. Why risk possibly years of poor health instead of putting up with a few weeks or months of inconvenience?
Our actions also can affect those most vulnerable, such as the elderly. If we look at COVID-19 as a chain of infections, spreading from one person to another and then keeps getting passed on, others may die because of your role in the chain of events. We recently saw a wedding in Maine, where more than 270 people contracted COVID-19. Eight people died who were not even at the wedding, but instead were in contact with those who were.
As we are witnessing in Florida, restrictions can quickly change as the government tackles how to best control the spread of COVID-19 while minimizing economic harm in the process. Every country in the world has some sort of restrictions in place. The lockdown narrative is no longer feasible as neighboring cities have moved to differing forms of restriction.
As a society, in order to live with COVID-19, we must modify our own behavior to avoid lockdowns. Lockdowns simply pause the virus. In the short term, it does suppress the spread, but it is easily imported back once lockdowns are unpaused. The main objective of a lockdown should be mass testing, identifying, tracing to eliminate community transmission (such as with New Zealand and South Korea), which has not really occurred in the U.S. yet.
Instead, we need to have people understand how to do their own risk assessments, including their own personal health assessment and the actions they choose to do. We need people to understand how to prevent themselves from getting infected and also understand how to protect others from getting infected. Lastly, we must protect those with comorbidities to help them take precautions.
We need a national long-term COVID-19 plan, one that includes economic strategy. The United States is one of the richest countries in the world, yet it does not have a fully functional testing system with quick results. The $300 million reportedly being used for an ad campaign for the administration’s handling of COVID-19, would be better invested in providing free masks and rapid testing kits. We must get back to shoe-leather epidemiology: test, isolate, trace, quarantine.
COVID-19 is here to stay, with or without a vaccine. The longer we deny or ignore its existence, the longer it will be a problem. We must learn to live with this virus today, so we can be prepared for tomorrow. The pandemic has been a hard time for everyone, and most of us are grieving our lost normalcy. We must plan for the years ahead with honesty about the severity of the crisis. But above all, we must be remain patient and compassionate.
Jesse O’Shea is an infectious disease fellow.
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