The Covid pandemic. Daily news conferences, escalating numbers, the first quarantine of our lifetime...it was hard to escape the topic through the spring. As localities progress through phases of re-entry and protests occur across the nation, it is hard to remember sometimes that we are still amidst this public health crisis. We miss our friends, colleagues, school, jobs, travel, routines, and prior lives. But what is the situation now as we head into the summer? What are experts saying?
Q & A Today:
Rebecca Katz, Georgetown University Professor and Director of The Center for Global Health Science and Security
Q: How long have you been researching pandemics and is there something during this time that reminds you of the current pandemic?
I have been studying pandemic preparedness for twenty years. There has been nothing of this size or any outbreaks that compare to this since the influenza pandemic of 1918. Decisions during a pandemic are made within a backdrop of uncertainty. The types of decisions that are necessary here at all levels have not been made at this scale in our lifetime. This public health crisis challenges our imagination. Even for those of us that have studied and taught it, it is different to actually see it; living it is something entirely different. Should some states have canceled mass gatherings earlier? Yes, but I don't think it was easy to fully comprehend the implications and consequences of this current situation which played into the management of it.
Q: What is the current state of Covid cases and what do you expect in the upcoming months?
There are still 16-20,000 cases daily so we have hit a plateau nationally. Yes, in some states the numbers are decreasing but in others they are not. What makes this hard about just looking at your state is the boundaries are permeable. Take Las Vegas as an example. Every part of the country might visit so the rates across the nation matter just as much as the local rate. In smaller more insular towns, the stress is different. It is not as much about travel in and out but the fact that there is little health care, few beds and PPE; health care in these towns can be overwhelmed with low absolute numbers. In Northern Virginia, people may need to go into other places like MD and DC daily so the state to state differences and rules are just as pertinent as the state you live in. Do we expect numbers to rise with re-openings and with protests? The answer is yes. We are already seeing an uptick of numbers in the states with more lenient restrictions. I also do not expect international travel to be thought of the same. It will be a while before someone can fly in and out of an international city in 48 hours for a conference like we used to. With international travel, you now have to worry about local protocols and quarantine procedures once you land.
Q: What does the positive test rate help us to understand (VA: 9.4% and DC: 7.4%) and where are we at with testing?
The WHO recommends a positive test rate of <10% and countries that have been successful with the spread have a rate <3%. The positive test rate captures how much testing and the indicators of prevalence. It does not factor in the quality of the testing. It is calculated by how many are tested and the positive hits. In an ICU setting, you would have a high number of positive hits. The number drops when we get out into the public and test. The prevalence in the US is 4%. NYC numbers are at 14-16% and Montana at .2%. We are still not testing enough, but it is getting better.
Q: How are hospitals doing?
The goal as a nation is not to stop the spread; we are trying to flatten the curve to slow the spread and push the curve out. Doing this assists hospitals in their capacity to care for patients. It can be complicated to measure capacity. For weeks, hospitals ceased elective surgery and took financial hits. Now many have re-enacted elective surgeries which also re-utilizes wings that were previously being held as ICU beds. The further we get in this, the more mechanisms we have to share information and plan adaptive measures. It won't feel as ad hoc as it did this spring.
Q: How are we doing with contact tracing?
Local health departments are overseeing this area. Ideally, when someone has a positive test of exposure, their contacts should be traced and contacted within 48 hours so that they can be tested or quarantined to control further spread. There is a huge need, and in an ideal world, it would be an opportunity for a large group of community health workers to be active in localities across the country. It could be a way to re-purpose furloughed workers in a way that would help them and benefit society long term.
Q: Can you tell us about the variety of ways data collection is assisting right now?
Data is being collected to look at indicators to help us understand what is happening in populations down to the state and county level. It is also assisting us to look at decisions being made by mayors around the world so that collectively this data can serve as a frontline guide. Mapping policies and creating a data set to assist best practices for everything from municipalities to schools to police departments is yet another way data is useful right now.
Thank you to Dr. Katz for the inspiration!
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