My husband and I went into social isolation for two weeks the day after the first two COVID-19 cases were reported in Pittsburgh — a couple who had been traveling.
We, too, had just returned through two airports from a family reunion out of state. We had heard about the illnesses in China and in Washington state, but we did not cancel our vacation. It is our best chance to visit with our two young granddaughters and extended family each year. We wondered, will we develop COVID-19 as did those two people after they returned to the city? So we quarantined ourselves and began planning for months in isolation as we watched this story evolve. Fortunately, we didn’t develop symptoms and neither did any of the relatives with whom we visited in early March.
I worked as an anesthesiologist for more than 35 years. I will soon be 70 years old. And I recently wrote instructions not to place an endotracheal tube in me if I get respiratory failure from COVID-19. I don't want to waste resources and then die in an ICU.
That is a dismal thought, but I do see a way to go back to what I want to do in life, from visiting family to the contact sports I used to practice. If only Pennsylvania could follow the lead of Hong Kong, this epidemic could be contained by September.
But right now, we are still in the relative beginning of the COVID-19 pandemic. No matter which day one counts as the beginning of this crisis in the United States, it is clear that the numbers of new COVID-19 cases and deaths each day are not decreasing significantly over a long enough period of time to say we are seeing any light at the end of the tunnel.
Now, before I dive into the Hong Kong model, I’d like to draw an important distinction between SARS-CoV-2 and COVID-19. SARS-CoV-2 is the virus that causes the COVID-19 disease. A lot of articles don’t make this distinction and just use ‘testing for COVID.’ But the distinction is critical. It is not easy to diagnose this disease based on symptoms alone. So testing for the presence of the virus is needed.
Based on the reports from New York City, people had to be admitted to the hospital to get oxygen before they complained of shortness of breath. Profound oxygen desaturation may be present while the patient is still able to talk. So testing needs to happen early to avoid tracheal intubation for respiratory failure and the need for positive pressure ventilation.
Now is the time that reliable and expansive public health efforts, which have shut down this pandemic in other parts of the world, must be implemented in the United States. We need easily accessible, widespread testing for SARS-CoV-2, so that people with positive test results and minimal or no symptoms go into quarantine and do not infect other people unknowingly.
To date, SARS-CoV-2 testing in the United States occurs at less than one-third of the rate it should to contain this pandemic. And in Allegheny County, according to the health department, only 1% of 1.2 million people have been tested.
Contact tracing is another key element that was introduced in Hong Kong. Contacts of people recognized as SARS-CoV-2 positive must be tested as rapidly as possible. If they also harbor the virus, they must go into quarantine for at least two weeks.
If for some reason the contacts are not tested, they should still be quarantined if the contact was significant (i.e. no face mask was used and the distance between them was less than 6 feet for a duration of 15 minutes). This definition of significant contact was applied in Hong Kong.
Professor Benjamin Cowling from the University of Hong Kong was recently quoted when interviewed about the study his group published in the Lancet, saying: “In Hong Kong, we have designated facilities for quarantine outside of the home, and also procedures for strict enforcement of home quarantine. Individuals with higher risk of infection (perhaps greater exposure to infection) would be quarantined outside the home, and those with lower risk would be placed in home quarantine for 14 days.”
According to the Lancet study, Hong Kong — with an approximate population of 7.5 million — had 715 confirmed cases of COVID-19 and four deaths as of March 31.
In Pennsylvania and the United States at large, we need scalable contact tracing and testing to most appropriately place people in quarantine. If it’s not done, COVID-19 will spread here as social distancing guidelines are relaxed.
What are we waiting for? The more delay there is in accelerating the rate of testing for SARS-CoV-2, the more people will become ill and the greater the economic effects and personal suffering will be.
What will happen when the nursery and elementary schools reopen? Children are not able to practice social distancing. Children are likely to have fewer symptoms from SARS-C0V-2, but they will bring this disease to their elders.
Will I ever be able to visit, in person, with my grandchildren and nieces and nephews again? I wanted to visit my granddaughter for her third birthday in May, but I can't. I would have traveled to New York City to visit my son and then continued on to Connecticut to play with the toddler and see the new baby of my nephew and his wife. But I follow orders and stay put.
I wonder just how many of my father’s grandsons will lose their jobs in this economic meltdown.
Hong Kong is the model to follow to get the outbreak under control. Along with extensive testing and contact tracing, aggressive measures of physical distancing and masking have been followed. This is the only way to end this pandemic in our population. If we want to return to something like the health and prosperity that we used to enjoy, we must follow this path.
Barbara W. Brandom is a retired physician with a masters degree from the School of Public Health in the University of Pittsburgh. If you want to send a message to Barbara, email firstname.lastname@example.org.
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