There is clear evidence of community transmission of SARS-CoV-2, the virus that causes COVID-19, in the Quad-City metro area — not much yet, but it’s here. Since my last letter, a lot has changed locally, nationally and globally. The recommendations and requirements for social distancing interventions are greatly expanded and I certainly don’t need to list them here — you are living them — but I can’t get a beer and a tenderloin in Lindsay Park (that’s what the East Village was called when I was a kid).
You were asked as a community, on behalf of "public health," to accept and cooperate in these efforts to contain and reduce spread of the virus and have — pretty spectacularly to my eye. Thank you from me and all my colleagues at every level of public health.
In the United States, we are barely two weeks into serious-minded efforts to control the virus. The evidence from places like China, Korea, Singapore and Hong Kong suggests that what we are doing and what we are asking of you, ad nauseum, are appropriate and can succeed, but must be maintained for the foreseeable future.
• Cough etiquette and stringent hand washing;
• Reasonable environmental cleaning/disinfection;
• Limit commerce, travel, your interaction with high-risk loved ones, congregation in groups and maintain a distance of 6 feet or more from others;
• Remove yourself from society with any symptoms that might be COVID-19 until you know what is going on;
• Help your neighbors when you can.
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Testing is not yet up to the capacity we would like, but remember a few things:
• Immediate access to testing when you have mild illness does not often change how we would care for you — we will still ask you to self-isolate — false negative tests early in illness do happen;
• Testing that does not change what you will do uses up test kits and puts you face-to-face with a health care worker who may make you cough or sneeze, and that may increase their risk;
• Access to needed testing will improve in coming days and weeks, and when it does we may be able to tailor our recommendations with a little more finesse, but we’re not there.
To the media, I am giving you a strong B+ for your coverage — avoiding the sensational (mostly) for the factual. I would give you an A but for one thing. On the subject of testing: please stop asking about the number of tests being done — we don’t and won’t know anytime soon. Access to data from private labs is incomplete, so the data will not be accurate at this point. We know about positives, and will know more about negative tests in the future, but for now please stop asking.
I am aware of a number of poisonings in the U.S. and worldwide of people using drugs that might eventually be shown to be useful but have not yet been — take nothing not recommended by your health care provider. The internet and mass media, including from folks who should know better, are rife with stories about the next panacea that have little or no basis in evidence.
We are doing the right things, but they are things we have to maintain for weeks and months, I think, not days and weeks before we can measure impact. As our understanding of the evidence evolves and new approaches are suggested, these interventions will change in ways both subtle and glaring. Remember the 1918 flu. In St. Louis, where "draconian" measures were undertaken, the impact was moderated. In Philadelphia, where they were not, it was catastrophic. Things may get harder before they get easier.
Resist complacency about the observation that community spread in our area seems limited — it is not clear that what we have done has had time to work and is responsible for that fact. Do not be seduced — resist uninformed suggestions from any quarter that it’s time now to back away from the frankly painful things we are asking of you. An American hero said it well in 1776: "We must, indeed, all hang together or, most assuredly, we shall all hang separately."
Get your information from reliable public health experts, especially your state and local health departments and the U.S. Centers for Disease Control and Prevention at https://www.cdc.gov/coronavirus/2019-ncov/about/index.html.
Louis M. Katz, M.D., is medical director of the Scott County Health Department.
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