By Anne Zeiser,
Founder of Azure Media
Founder of Transmedia Marketing: From Film and TV to Games and Digital Media
All of us have a responsibility to understand the science behind COVID19 and in particular, the value of the available public health protocols: diagnostic testing, surveillance testing (contact tracing), mask wearing, social distancing, hand washing, isolating if infected, and quarantining if exposed. Following these proven public health measures is a matter of life and death. Already, this virus has killed nearly a quarter of a million people in the US (I’ve lost two friends to this virus and had four family members sick with it).
Here is some of the undeniable math and facts of COVID19:
1) COVID19 is a deadly virus.
The R0 value of COVID19 is close to 3.0 (significantly higher than MERS, and on par with SARS, which caused a global epidemic in 2003). That means an infected individual will spread COVID19 to about three people, each will spread to three more, and so on. Within several generations of spread, the outbreak becomes uncontainable. Once public health officials had this alarming R0 data in January 2020, they issued the clarion call for a possible pandemic. COVID19's high E0 is due to the virus’s airborne and sleuthy asymptomatic spread. Part of the virus's lethal profile is that many people have no or limited symptoms, and those who develop symptoms, don't until an average of six days after they're infected. These asymptomatic people are super spreaders.
People who “feel fine,” yet are positive make COVID19 more dangerous than Ebola. Although Ebola kills about half of the people who contract it (about 50% mortality rate), it only spreads through bodily fluids and those who get it have such pronounced symptoms they’re easier to identify and isolate. While frightening and gruesome, Ebola results in significantly fewer total deaths — 11,300 worldwide since the first outbreak in 1976. A virus like COVID19 can kill a quarter million people in just over half a year because it can reach more people, even though it kills a smaller percentage of those infected (about 5% mortality rate). The mortality rate of the Spanish Flu of 1918 was 2.5% (half of COVID19’s), yet it killed almost 50 million people worldwide. A virus's low mortality rate per infection doesn't mean it's less deadly overall. Its exponential spread is a lethal weapon.
Also, comparisons of COVID19 to the yearly flu are duplicitous and dangerous. Influenza has a much lower spreadability (R0 of about 1.3) and kills 35,000 people in the US yearly, while COVID19 already has killed 220,000 people in the US in just seven months. Coronavirus is 11+ times more deadly than the yearly flu.
Epidemiologists, infectious disease specialists, and public health experts say that COVID19 is the most dangerous disease they’ve seen in their lifetimes. It’s clearly the greatest public health scourge of the past century. A healthy dose of fear, combined with fully understood and implemented scientific information and guidelines, are the most valuable public health tools available.
2) The US is not consistently following public health guidelines.
Our country's response to and public health behavior around COVID19 has been woefully inadequate, especially when considering the resources and know-how we possess. The US represents just 4.25% of the world’s population, yet we account for a shockingly disproportionate 20+% of the world’s deaths. We have higher death rates than many developing nations because we're not aggressively testing, consistently wearing masks, and uniformly social distancing in the face of an incurable deadly virus. Some of these basic proven public health behaviors like face covering, social distancing, and isolation/quarantine were used effectively to slow the spread of the Bubonic Plague. We're not acting as wisely and responsibly now as people did in the 14th century.
Wear a mask. Stay apart. COVID19 is harbored in the respiratory system. That's why the virus's diagnostic test swabs your nasal passage. It is mainly transmitted through respiratory droplets or airborne aerosol particles carrying the virus, which easily spread when you breathe, speak, laugh, sneeze, or cough near someone else. It's aerosol transmission makes it more contagious than many other viruses. The further away you are from someone else, the more their respiratory droplets or particles are diffused in the air ➔ social distancing. The better the circulation of your environment, the faster they're diffused ➔ outdoors is safer than indoors. The more the respiration from your mouth and nose are covered, the more everyone's droplets and particles are blocked ➔ mask wearing.
Many peer-reviewed studies prove the efficacy of masks. Your wearing a mask protects both you and me. N95 masks and FDA-approved KN95s protect the wearer from 95% to 90% because they're tight-fitting and filter most of those particles upon inhalation. Hospitals need them for their staff because they do a good job of keeping workers safe even when they're exposed to ongoing, high viral loads. Surgical masks are second best in preventing the spread. Cloth masks are reasonably effective. Bandanas are only somewhat effective. Many infectious disease specialists say if they had to choose between a mask and a vaccine, they’d choose a mask (Dr. Christina Brennan. Dr. David Ho says they're on par with a vaccine).
Check out the studies and guidelines about masks and social distancing at the CDC, NIH, WHO, Johns Hopkins, American Medical Association, Infectious Disease Society, JAMA, Lancet and other credible sites with peer-reviewed information. As you research COVID19, learn about the scientific method -- the empirical process (to question, research, hypothesize, experiment, analyze, conclude, report) that explores observations and answers questions. It has accounted for almost every scientific and technical advance in human history. Understand how peer review has replicated and validated scientific research and built scientific facts for 350 years. Armed with in-depth scientific understanding and research you’re less likely to fall prey to opinion and disinformation campaigns about COVID19 that are rampant on social media. Masks and social distancing are about science (and public health best-practices that apply that science); they’re not about opinion, belief, or politics. Those are entirely separate purviews.
While ill-informed and selfish, not wearing a mask is not breaking the law in most places. CVS and Walmart have more power of enforcement in denying you entrance to their premises without a mask. As we head into a winter with more indoor confinement and proximity, it's likely there will be more local enforcement of mask-wearing and revised CDC mask-wearing and social distancing guidelines. Whether mandated or not, use common sense and follow the science and public health guidelines: wear a mask, social distance, wash your hands, limit social gatherings, isolate if sick or exposed. Simple. Proven. Humane.
Test for the virus. The more reliable and immediate the COVID19 data from widespread diagnostic and surveillance testing, the better we can plan. With accurate testing and mitigating behaviors, we can lower the virus's R0 and manage the pandemic until herd immunity is achieved from a vaccine.
The R0 is lower in countries and regions that strictly follow the science for preventing COVID19's spread. In lockdown and with careful adherence to public health best-practices, populations have been able to achieve an R0 of below 1.0 – the difference between exponential spread and containment. With an R0 above 1.0, the virus is winning the evolutionary arms race of its spread; below 1.0, science and human will are winning.
Last April — after Germany’s swift and uniform implementation of ongoing testing, masking, and social distancing measures — the Robert Koch Institute determined that Germany’s R0 had dipped to 0.7 from a high of almost 3.0. With this data, Chancellor Angela Merkel carefully relaxed lockdowns and reopened small businesses. South Korea, Japan, New Zealand, and much of Europe regularly test their citizens and use their regional COVID19 R0 factor to inform policy decisions for managing fluctuating virus infections. With adequate testing infrastructure, molecular testing results are provided within 24 hours. Today, Australia, China, Denmark, and Israel are still maintaining an R0 below the critical 1.0 value.
But with the limited money, infrastructure, consistency, and emphasis on testing in the US, we are still behind the curve of understanding and managing the virus’s spread. A twisted form of political protest denies the science of COVID19 by flouting masks, ignoring social distancing, and quashing contact tracing (Donald Trump refused to let the CDC contact trace the October 2020 super spreader events at the White House and subsequent rallies). As a result, 40 of the 50 states have R0 values above 1.0 and deaths continue to rack up. Donald Trump's statements that COVID19 “is disappearing” or is "rounding the turn" simply are not true. With the average R0 value in the US at 1.3, we continue to be in an exponential growth pattern of a full-on pandemic as a second or third wave approaches. (Sacramento and San Bernardino, California are noteworthy areas of the US where the R0 is still below 1.0).
To calculate the R0, researchers need regular and comprehensive data about infection rates. The metric that determines whether we're doing enough testing (a more important metric than the total number of positive cases) is the positivity rate – the percentage of total diagnostic tests conducted that are positive. The World Health Organization indicates that when positivity is above 5%, the level of testing is not keeping up with levels of disease transmission. Higher positivity rates suggest the likelihood of more people with coronavirus in the community who haven’t been tested yet. Generally, the higher the positivity rate, the higher the R0 value.
The US’s positivity rate is above that 5% threshold, at 6.25%. No surprise our R0 is above 1.0. We're simply not testing enough. India, Chile, Uganda, Russia, Zimbabwe, Japan, Serbia, Finland, Canada, Turkey, Nigeria, Taiwan, and El Salvador, are just a sampling of the 44 nations with better positivity testing rates than the US. Super COVID19 tester countries with a positivity rate below 1% are South Korea, Norway, Saudi Arabia, Cuba, Kazakhstan, New Zealand, Australia, Singapore, and Fiji. They are consistently and aggressively testing and contact tracing to stay ahead of the virus.
3) We're in this time of risk and uncertainty for the long haul, so follow the science.
COVID19 likes a cold dry climate and a contained environment for spreading. That's the definition of this upcoming winter in much of the world. Indoor mask-wearing may be in the offing. Unfortunately, beating COVID19 will take much longer than we hope or most people tell us. Epidemiologists and infectious disease specialists predict we're in for a super spreader winter and another year of COVID19-constricted life.
Here’s why it may take that long. There are many “what ifs” yet to be determined for a COVID19 vaccine. While researchers are moving faster on vaccine development than with any other vaccine and several vaccine candidates look promising, there are huge logistical and practical hurdles to the world’s population achieving herd immunity. Things like:
- If we’re lucky enough to identify some vaccines that are safe and work, what is their efficacy?
- Based on that percentage of efficacy, what percentage of the population needs to vaccinated to reach the herd immunity threshold? (The lower the efficacy of the vaccine, the higher the percentage of the population that needs inoculation. The most contagious of the widely known diseases is measles with an R0 of 15, so 95% of people need to be vaccinated to reach herd immunity).
- Does the vaccine require one or two shots for efficacy? (If two, it may incur much more cost, effort, and time. Multiple shots require careful contact tracing of who's received the first vaccine to ensure the second dose is administered in the recommended time. Three of the current vaccine candidates require two doses).
- How long will immunity last? (The shorter that timeframe, the more likely new outbreaks will occur and the greater the need for more vaccinations).
- Does the vaccine need to be refrigerated? How many days after shipping does it need to be administered? (Cold temperature requirements limit the storage and shipping options for distribution, especially in rural areas, warm climates, and the developing world. This will require more money, personnel, and infrastructure. Pfizer's vaccine candidate needs to be stored at -94°F and Moderna's at -4°F).
- Who gets the limited supply of vaccines first and in what order?
- How long and what kind public-private partnerships will it take to manufacture enough vaccines and get everyone vaccinated?
- Will enough people take the vaccine to achieve herd immunity? (According to a Harris-STAT survey, 42% of Americans would not take the vaccine right away based on safety fears).
- When is it safe to travel when only some populations have been vaccinated?
- How do you prove someone’s vaccinated in order to more safely open up schools, restaurants, courtrooms, movie theaters, airplanes, etc.?
- Who pays for all this, including in the poorest regions of the world?
This list goes on. Altogether, this is Herculean. It will take time.
You might want to rail against this information. That’s understandable because you’re not hearing the truth much through the vitriol. But it's time to deal honestly with the facts of the most important issue at hand right now — an ongoing global pandemic. The truth is powerful. It can prepare us to hunker down for the slog ahead, as safely as possible.
The good news, many of the best minds worldwide are working on developing an effective vaccine for COVID19. We have a better understanding of how the virus acts. Healthcare providers have more resources and are more knowledgeable about treatments for the very sick. But, it will be a long time before the world's population has been vaccinated and it's safe to go back to life as we knew it. We must exercise personal responsibility and do our part. Follow the science — wear masks, socially distance, wash hands, get tested, isolate if sick, quarantine if exposed — for as long as it takes. Don’t expect a jab in the arm for COVID19 in the next few months (but please get your flu shot to avoid the flu and minimize the confusion between the two illnesses). Do your best to keep each other safe and respect each other along the way.
By adhering to these public health best practices and aggressively conducting diagnostic and surveillance testing, we can limit and isolate pockets of infection. This can hold back transmission rates and save lives. Also we can boost the economy by avoiding national lockdowns and massive restrictive movements. More businesses and schools can stay open. It’s a win-win-win — improved physical, psychological, and financial health.
We’ve got to dig deep, pull together, and use the tools we have at hand. They are considerable: sound science and human will.