Yesterday, in a telebriefing, officials at the Centers for Disease Control and Prevention (CDC) warned that the United States should prepare for the risk of spreading the current coronavirus within local communities. What steps should be taken?
As the coronavirus disease, or COVID-19, continues to spread around the globe, the CDC has issued a statement saying U.S. federal agencies are actively preparing for the potential local spread of the new coronavirus, SARS-CoV-2.
Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, also advised in the telebriefing session yesterday that the U.S. population should take stock of the available preventive measures in the case of a pandemic.
“The situation of the global novel coronavirus is rapidly evolving and growing,” Dr Messonnier said, referring to recent developments in Italy and beyond.
According to the CDC’s own data, there are currently 53 confirmed cases of COVID-19 in the USA. Of these, 12 relate to traveling in China, two stem from person-to-person contact with an infected individual, and 39 are among U.S. citizens repatriated.
There has been no transmission of the virus within populations at local level so far, and the CDC reports that although “COVID-19 is a significant threat to public health,” it is “not known to be circulating in U.S. communities at this time.”
CDC bracing for a pandemic
Nevertheless, the fact that viral infections have spread in European countries and that the number of new cases reported outside of China has now surpassed that of new cases occurring within China has led the U.S. authorities to express growing concern.
“Public spread is often a catalyst for starting to implement new approaches adapted to local circumstances that reduce the effect of the disease and can slow the spread of[ the] virus,” Dr. Messonnier said in a telebriefing yesterday.
“The fact that this virus has caused illness— including death-related illness— and persistent spread from person to person is a concern. These factors satisfy two of the pandemic criteria,” she went, stressing that:
“As community spread is detected in more and more countries, the world moves closer towards meeting the third [criterion]: worldwide spread of the new virus.”
Dr. Messonnier noted that U.S. agencies ‘ methods for avoiding an outbreak within the nation have so far been successful.
“The U.S.[ have] introduced an ambitious control policy requiring as much as possible the identification, monitoring and exclusion of all cases and the prevention of more disease introduction, especially at entry points[ in the country],” she said.
“We have limited travel to the[ U.S.] and provided extensive travel advisories for countries currently experiencing population spread,” Dr Messonnier explained.
“We have also enacted the first quarantine of this scale in the United States and are supporting the State Department[ of Health & Human Services] in the repatriation of high-risk citizens. We’re doing this in order to slow down the introduction of this new virus in the U.S. and buy us more time to prepare for it.”
‘We expect to see community spread’
Dr. Messonnier stressed that the US must put in place a strategy to address potential negative scenarios, even with the current success in keeping community spread at bay.
“Our containment strategies have been broadly successful to date,” she said. “As a result, we have very few cases in the[ U.S.], and no community spread, but if more and more countries experience community spread, successful containment at our borders becomes harder and harder.”
“In the end we expect community to spread in this country,” she warned. “It’s not so much a matter of whether this will happen now, but more of precisely when it will happen, and how many people in this country will have severe illness.”
Dr. Messonnier pointed out that U.S. public health authorities already have a basic framework for a pandemic control plan.
She led the public to the 2017 CDC’s Community Mitigation Guidelines to Prevent Pandemic Influenza Report, which, she pointed out, includes the main steps that individuals and communities should take in case a viral infection spreads widely.
The CDC is currently specifically tailoring these existing guidelines to COVID-19.
Preventive measures
The National Center for Immunization and Respiratory Diseases director of the CDC noted that all necessary interventions would be non-pharmaceutical, given that there are currently no vaccines available against COVID-19.
These should be at the level of individual, community, and environment. For individuals, she said, the first port of call should be “everyday preventive measures” — ones that should be applied to prevent any viral infection, including flu.
“If you’re sick, stay home, cover your cough, wash your hands,” Dr Messonnier said.
More detailed pandemic steps could include “voluntary home quarantine” for people who have come into contact with someone with COVID-19.
Nonpharmaceutical Community-level interventions would vary, as appropriate. According to Dr Messonnier, communities would have to decide what interventions to implement based on how severe disease spread is.
Also, she offered examples of how such interventions might look.
“For colleges, choices include dividing students into smaller groups or, in a severe pandemic, closing schools and continuing education through internet-based teleschooling,” she said.
“Companies should substitute in-person meetings with video or telephone conferences for adults, and expand teleworking opportunities,” she added.’ Communities in towns may need to modify, postpone or cancel mass gatherings on a larger scale.”
Trialing patients differently for healthcare settings, looking at ways to increase telehealth services, and postponing elective surgery.’
From an environmental perspective, the CDC official noted that ‘ everyone should consistently clean frequently touched surfaces and objects.’
12 U.S. localities can test for SARS-CoV-2
Despite this advice’s urgency, Dr. Messonnier has informed the public that U.S. authorities are well prepared for any eventuality.
CDC and other federal agencies “practiced” for a possible pandemic, she noted.
She also addressed some public concerns over a recent incident involving faulty kits for diagnosis. The kits are now being modified by experts, and new ones will be available soon.
“There are currently 12 states or localities around the US that can test samples,” she added, and samples were also being processed by the CDC.
“There is no existing shortage or delay in testing at CDC,” she explained, adding that officials are taking steps to make samples available commercially.
At the Q&A session at the end of the telebriefing, Dr. Messonnier noted that while the shift in the CDC’s strategies may seem disproportionate to the issue, their position is to be safe rather than sorry.
“I still hope we’ll look back at the end and see that we’ve been over-prepared, but that’s a better place to be than under-prepared,” she said.
Hidden dangers of disease spread
While the CDC warned that a possible pandemic— and the consequent response to it — could cause “serious disruption” to people’s lives through missed work and school commitments, or through financial impacts, other public health organizations are concerned about the profound social rifts that a moral panic could cause globally.
Recently, the World Health Organization (WHO) reported that”[ i]n the case of COVID-19, there is a increasing number of reports of public stigma against people from areas affected by the outbreak.”
“Sadly, this means that people are being branded, stereotyped, isolated and/or suffered loss of status and prejudice as a result of a potential negative association with the disease,” the WHO reports, stressing that social stigma may exacerbate the spread of disease.
This is because stigmatization can “drive people to hide the disease in order to avoid discrimination,[ p]revent[ t]hem from seeking immediate health care,[ and][d]encourage them to adopt healthy behaviours,” the WHO explains.
“We don’t simply fight to contain a virus and save lives. We are also struggling to contain the social and economic harm a global pandemic could do,” the organization says in its latest update to COVID-19.
