By now, we’ve all heard about “social distancing," the public health measures we should to be taking to slow the exponential spread of the coronavirus by avoiding close contact with other people.
"We have reached a tipping point where the idea that we will be able to contain this in a few spots is just no longer viable,” said Dr. Ashish Jha, the director of the Harvard Global Health Institute, “and now we are going to have widespread infection across the US.”
But if we take action now — as in right now, today — many of us can still protect ourselves and others, particularly our most vulnerable citizens, from infection and avoid overwhelming our health care system with a wave of sick patients. Here’s what epidemiologists and infectious disease experts recommend:
Cancel concerts, conferences, parades, and yes, even the Boston Marathon
“The key thing is to reduce contact between people, and that’s especially true for vulnerable people,” said Marc Lipsitch, an infectious disease epidemiologist and microbiologist at the Harvard T.H. Chan School of Public Health. “And the ways to do that include a lot of different things: The canceling of big events is one — and a really important one — and that includes, unfortunately, things that a lot of us like to do."
Think concerts, music festivals, parades, and yes, the Boston Marathon, Lipsitch said. Jha agrees: “My take is, you know, even after the Marathon bombing, we came back the next year. It’s very painful for me to say we should cancel it, but we should cancel it.”
Justin Lessler, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, also recommends avoiding crowded venues, including movie theaters or churches. "Individuals, as much as public health agencies and the governments, are on the front lines of the response,” he said, especially if we want to avoid extreme lockdown measures, like those taken in Italy and China. "Our shot at stopping that is to do smaller inconveniences now, in order to avoid having to take dramatic actions later.”
Avoid public transportation at rush hour
“Any situation where you’re enclosed in a tight space with many other people and there’s not really the possibility of disinfecting surfaces that have been touched by lots of people in the community” can increase the spread of infection, said Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security. If you can, you should avoid taking public transportation or, at least, try not to take it during the busiest hours when the trains and buses are most crowded. While you’re commuting, "be cautious about what you’re touching,” said Tara Smith, an epidemiology professor at Kent State University in Ohio. “Take hand sanitizer as a stopgap and wash your hands as soon as you get off.”
Work from home — even if you feel fine.
"Even if you are not yet sick and you’ve been exposed and you don’t realize it, you could be incubating the illness,” Smith said. "For me, just in case, I don’t want to be the Typhoid Mary and start spreading that incidentally.” Of course, not everyone can do so. But more people working from home would also reduce transmission in the public transportation system, Smith said.
Give your hourly workers paid sick leave.
“It’s not just that people need to stay home, it’s that business and other employers need to make it possible to stay home when you’re sick,” Lipsitch said. Docking employees’ pay if they miss work “is a great way to spread disease,” he added.
For hospitals, increase capacity: Re-open “moth-balled” wings, cancel elective surgeries.
“I think the challenge right now for a lot of hospitals is figuring out how big this will be,” said Dr. Nahid Bhadelia, the medical director of the Special Pathogens Unit at Boston Medical Center. “We’re all in the same boat, not knowing how many cases we’ll see.”
Jha said hospitals should prioritize keeping their doctors and nurses healthy and safe. “The biggest thing I worry about is how to keep our health care workforce healthy,” he said. “What we have seen in places like Italy and South Korea and certainly in China is that health care workers got sick at alarmingly high rates and became out of commission."
Jha also said hospitals should expand capacity by opening up “moth-balled” wings and canceling elective surgeries. “We want to make sure the health care system is capable of providing that care,” he said, as the coronavirus epidemic worsens. “We’re also trying to buy time, because if we’re lucky, in 12 months, we’ll have a vaccine ... that can shut the entire epidemic down.”
Prepare for months of mitigation measures — not weeks.
“If we look at some of the other experiences from around the world, I think we’re just seeing in the US the tip of the iceberg here and we’re going to see a lot more people become sick in the next couple months,” said Watson. Smith agreed, adding that we should “mentally prepare for doing some of these social distancing measures for months if necessary.”
“I think we are in for a very tough year. I think this is gonna consume a large chunk of 2020,” said Jha. “This is not a story that is going to be gone by early April or even May.”
Don’t panic, but start worrying.
“I wish people were a little more worried," said Lipsitch, of Harvard’s Chan School of Public Health. "Essentially it feels to me like we watched other countries and their health systems almost collapse.... It’s really easy to be complacent. The way to stop those things happening is to act.
“In terms of anxiety, we should try to reduce it because anxiety doesn’t help anyone. The vast majority of us are not going to have very severe outcomes of this. Many people won’t even be infected — and of those who are, the large majority will have comparatively mild cases," he continued.
“I have said, and still believe, that 20-60 percent of the population will get this infection in the coming year. Fewer if we act more intensely to limit transmission.”