The real test of an individually-enforced strategy to control COVID-19
Sure, there was concern at the annual meeting of the Society for Research on Nicotine and Tobacco (SRNT) in New Orleans. No handshakes, conference rooms doors open to avoid touching doorknobs, and ample distance between attendees. Distancing was made easier by the low turnout for what normally is a 1,300 plus gathering of health science researchers, academics, treatment professionals, and government employees.
The purpose of the SRNT meeting is always to review the latest findings on the science of making people stop smoking, but the attention of all attendees was, obviously, also centered on COVID-19. Especially, on what the U.S. Surgeon General, Vice Admiral Jerome Adams, had to say about the outbreak. The Surgeon General is the leading spokesperson on matters of public health in the Federal government of The United States.
At an earlier press conference in New Orleans, Vice Admiral Adams explained the basics of the containment strategy taken by his government up to that moment. “We knew most of the cases were coming from China and we had travel restrictions from China. All the scientific evidence said that it definitely did delay the spread of Coronavirus to the United States”. The U.S. imposed a travel ban on China in late January.
On March 11, President Donald Trump announced a travel ban from most of Europe. “The epicenter of the Coronavirus used to be in China, 98% plus cases used to come from China. Now, Europe is the new China, and very specifically, Italy is the new China.” In fact, he added, in 30 of the 35 States with reported Coronavirus spread, most cases could be traced back to people coming from Europe.
At the SRNT meeting, Adams said that the strategy had moved from a contention phase, that is keeping the disease away from the country, to a mitigation phase. The new phase requires domestic action to control the expansion.
His first message was for social distancing from those who were sick and to implement basic behavior practices.
His intention was not to downplay the seriousness of the COVID-19 outbreak, the Surgeon General said. However, “we have to prepare, not panic.” He anticipated that probably more people will die from disinformation than from the actual virus, and encouraged people to “distribute facts, not fear.”
On the day of the SRNT conference, Friday, March 13, there were 1,264 cases in the U.S., far from 80,991 cases posted by China and 15,113 by Italy. Perhaps that’s why those listening to the Vice Admiral were somewhat somber, but not in shock like most audiences in Madrid or Milan would have been at that time.
The Surgeon General explained three basic practices that he recommended individuals follow during the mitigation phase.
- Know your risk: Be more cautious if you are older and have a chronic disease. Eighty percent of people diagnosed will develop a mild disease or be totally asymptomatic. They do not need medical attention. “Most people will be just fine,” Adams said. “20% will have a severe disease or die,” he clearly added. “We know that people with chronic medical conditions over the age of 60 are most likely to need medical attention. We know that people with chronic medical conditions over the age of 80, are most likely to die,” he added. Children and young adults have a very low mortality rate from COVID-19. They are less likely to die from a Coronavirus infection than from the flu. Hence, the main thrust of public policy was centered on protecting those who are most vulnerable, and those who are most at risk, the Surgeon General noted. In part, protection can be self-guaranteed: “Someone 60 or over with a chronic disease should not be here now,” he mentioned as an example.
- Understand your circumstances and your environment: People at risk should avoid large crowds. “If I am in the high-risk group perhaps I should not ride a train.” Adams encouraged the audience to review the conditions of their workplaces, their churches, and of their social gatherings to seriously consider options like teleworking or not attending. Environments differ widely, he said. Thus, a judicious review of individual conditions and specific environments makes sense.
- Know how to protect yourself: Vice Admiral Adams suggested visiting www.coronavirus.gov frequently. “I have attended many press conferences these days. There is not one question that you could not find an answer for there.”
The winning moves?
The recommendations from the Surgeon General on mitigation are in stark contrast with the strict confinement measures taken in cascade by China and by many European and Latin American cities.
Could the U.S.’s lighter approach to flattening the curve be as effective as the war-like approach of other countries? If persuasion, individual risk assessment, and self-control work, it would probably be a much cheaper approach to a problem that clinically has no easy solution in sight yet. However, there is no proof that it will.
On March 19, less than a week from the SRNT conference, the number of confirmed COVID-19 cases had climbed to 7,087 in The United States, 81,174 in China and 35,713 in Italy.