Dr. Anthony Fauci said this, “Anything could, but I must say that the degree of efficiency of transmissibility of this virus is really unprecedented in anything that I’ve seen. It’s an extraordinarily efficient virus in transmitting from one person to another. These kinds of viruses don’t just disappear.” These worlds by the great physician should literally introduce us to the new post-covid-19 world.
Those were not his exact words but that captured his message to Americans and the world at large. I know some countries like Australia have declared victory over Covid-19 but to me it sounds as hollow as a man proclaiming victory over death. For a virus like Covid-19 control at this point in time without an effective vaccine is just one battle won. I say this because I believe that much as all of us are hoping to go back to the world as we knew it prior to the year 2020 that is unlikely to happen. We need to forget about that and start thinking of a post-covid world.
As at today May 5th, 2020 there have been 255,486 deaths from Covid-19 and 3.6 million reported cases worldwide. In the United States the death toll stands at 70,646 with almost 1.2 million cases. Australia a nation that recently declared victory over Covid-19 currently reports daily cases well below 20 and total deaths well below 100. The situation as I see it from my vantage point is really complex and may be a reflection of many different social, demographic, policy and health system factors. Overall though it may also show how much a nation has invested in its public health infrastructure over the years.
In the US even without a consistent 14 day drop in daily cases and a coordinated ramp up of testing as recommended by many public health experts including the CDC many states have already started reversing social distancing rules and moving towards a post-covid-19 world by opening up the economy. There are many who are concerned that this may lead to a spike in new cases and deaths from the virus. As I said in a prior post Covid-19 control requires more coordination than we have been willing to exercise.
The questions that most individuals may be asking is what processes are required to keep us safe in this post-covid-19 world?. One important intervention that can keep most of us safe is an effective vaccine against the virus. There are prospects but as already reported this would take at least a year and half. Trials are ongoing though. However at this time we should hope for the best and plan for the worst. Thus as we work towards a vaccine we should plan for and start living in a world in which we are going to coexist with SARS-CoV-2 without a vaccine.
Below are some of the things we must consider as we plan for this new world which looms right in front of us:
Surveillance and Containment.
Our state and municipal public health authorities must start working on developing effective surveillance with a ramping up of testing contact tracing and effective isolation. Here we must consider modifications of plans used in Taiwan and South Korea. These plans must me modified to fit the American psyche as well as taking cognizance of our constitution. We have a model already working in TSA security whereby individuals provide more information on themselves to TSA or affiliates for quicker security checks at airports.
Personal Protective Equipment
Just like health care workers all citizens must wear face-masks in public places to reduce infectious fomites and aerosol spread of the virus though close contact. Wearing of mask by the general public though not proven; is believed could reduce person to person transmission in work places, school, supermarkets, and places of worship.
Developing Good Cleaning Protocols on Public Transportation
Public transportation is very important for the effective function of any large community. The transport authorities must ensure at least daily cleaning of the interior of buses, trains and trams. Such protocols will ensure these key parts of our infrastructure do not act as source of infection to commuters in a post-covid-19 world. The city of Seattle instituted such a protocol in its buses.
Religious Ceremonies and Places of Worship
If churches feel a need for face to face services they may need to reduce congregation numbers and supplement this with virtual services. Religious authorities and other organizers of large gatherings ie > 20 people must develop a system for determining who is attending these events either by developing invitations that can be associated with individual attendees. This information could assist in effective identification should there be a need. Our congress should enact laws to protect such information from any unlawful uses outside of disease surveillance and control. Individuals must be prescreened prior to attending such events.
Air Travel & Airports
Air travel over the years has evolved to a point where we are all closer to other passengers than most of us will want to be with our high school sweethearts. Unfortunately for the airlines this practice would need to stop for public health reasons. With what we have to deal with getting through security most of us are so tired by the time we get into our flights that all we want is some peace to doze off not flirt with the other passengers. This maybe why Warren Buffett just dumped his airline stocks. Some of the airline company’s gimmicks to maintain profits may not fly in a post-covid-19 world. Pre-screening passengers may work but will still miss a lot of potentially infected individuals. Air travel guidelines to reduce spread of Covid-19 must take account of evidence suggesting both pre-symptomatic and transmission from asymptomatic persons. Until airlines make changes to accommodate these risks air travel will pose a risk to Covid-19 transmission.
Schools and Day Care Facilities
These institutions do pose a major risk of transmission and must be well monitored once opened. They however offer one advantage in having mostly younger individuals who rarely experience severe Covid-19 infection. One other feature of such facilities is the fact that most of them are already set up to have systems for tracking attendance these should be stepped up and improved for accuracy. Where possible classes must be structured to limit person to person contact and use of live-online learning must be encouraged and improved. Online self screening prior to school could be used to determine who participates online or in-person.
Health Care Facilities
These already have a lot of protocols for handling patients with suspected Covid and will need to move towards developing systems that limit unnecessary in-person visits. There are many systems now that are already investing in Telemedicine to assist in this change. In person visit are going to be prioritized for visits that require key physical examinations. Most non-acute care follow-ups that would not require a full physical exam may be done using telemedicine. Pre-screening as already done by many centers must be more comprehensive taking cognizance of atypical Covid-19 presentations.
Civil Rights and Election Integrity
November is bearing on us very rapidly and I have still not heard anyone talk about the fact the elections may occur under the dark shadow of Covid-19. I do not believe we will have a vaccine by November no would we have achieved herd immunity if there is something like that for Covid-19. At this time we do not know if there is post infection immunity and if there is how long that would last. Our Election Officials should this be planning ahead for the post-covid-19 world to save lives and prevent another spike of new infections post elections. All our states and municipalities should seriously consider development of secure and effective electronic voting mechanisms. In the absence of such systems we must consider increasing the number of election centers by about 4 to reduce the crowds. One very sure way to reduce crowds is to make the day a holiday to ensure people do not rush into centers at certain time just before time for work. We should encourage as much early voting as possible as well as the use of mail in ballots. All these initiatives need bipartisan support and must not be another issue that gets polarized.
Whilst some of these suggestions are already in place or been implemented to various degrees in certain places some are just good conjectures and thoughts of what could or might be. The hard truth that most of us will however need to face is this; WE ARE NEVER GOING BACK TO THE PRE-COVID WORLD OF 2019. We did not go back to the Pre-9-11 world of 2001, 2,996 American died in that tragedy as at today Covid-19 has killed more than 70 thousand Americans why should we expect things to return to normal?
Leonard Sowah is a physician in Baltimore, Maryland
Feature photo : A man wearing a medical mask at a South LA COVID-19 testing site, by Ted Soqui for KCRW.