By Jim Hyde
Vermont so far has been spared the worst of the COVID-19 pandemic. The aftershocks, however, are surely coming once stay-at-home orders are loosened, and when they come, they will further challenge the capacity and integrity of our public health and medical care systems.
First, what we know
The COVID-19 virus is a variant of a family of viruses associated with the common cold. Transmission occurs when virus particles are inhaled or reach the mouth, nose or eyes of an uninfected person.
The good news is that proper hand washing, not touching the eyes, face or mouth, social distancing and isolation can stop transmission. The bad news is practicing these same behaviors has serious adverse effects on economic activity.
Unlike, for example, an earthquake, COVID-19 is invisible until people experience symptoms (cough, fever, fatigue, aches— see link for symptoms) or they are tested. But testing for the presence of the virus or for evidence of current or past infection has been shockingly late, inadequately available and, in some cases, unreliable. Testing is the only way to know if someone is currently infected or has been infected. (Less than 1 percent of the U.S. population has been tested, 2 percent in Vermont). Currently, there is no nation-wide testing strategy. As a result, we have only a limited understanding of the prevalence of infection.
As yet, no medications or treatments have been shown to cure the infection and eliminate symptoms. The good news here is that as many as 20 percent of those infected may have no symptoms, although they may still be able to transmit the virus. Roughly 60 percent of those infected may be able to ride out the illness at home. The problem is that the remaining 20 to 25 percent likely will require hospitalization, and roughly half of these will require a ventilator to assist their breathing. The chances of death or serious subsequent health consequences once on a ventilator are extremely high.
Can we relax the rules?
In a joint report, the Federal Emergency Management Agency and the Centers for Disease Control and Prevention suggested four criteria be met before federal and state leaders relax the rules put in place to reduce the incidence of new infections: a low, declining, incidence of infection; an effective monitoring and surveillance system (testing); a public health system capable of investigating new cases (contact tracing); and a healthcare system with sufficient resources to handle a new surge in cases. In our federal system states will ultimately make decisions about how and when to relax controls. As of yet no state has met these four criteria, even as several governors have begun the process of unwinding public health controls.
The fear is that success over the past couple of months with behavioral controls will be undone as asymptomatic but infected people begin to circulate in their communities and beyond, unknowingly infecting others. The New York Times recently reported on a Northeastern University study that showed that at a time when only a single confirmed case existed in New York City, there were likely as many as 10,000 people with the virus in the city.
What should Vermont do with the time our early success has bought us?
Vermont Governor Phil Scott recently announced “measured” steps to loosen restrictions put in place several weeks ago to get people back to work using a controlled and carefully phased approach. Vermont faces special challenges that will make this difficult:
- Common borders with Quebec, New York and Massachusetts, all three of which have experienced unprecedented levels of infection.
- A markedly older population at greatest risk of infection.
- Relatively few cases, which means we have a high proportion of susceptible people.
- We are a vacation destination for people from states like New York, Florida, Connecticut and Massachusetts with a high prevalence of infection
Given all this it will be a major challenge for Vermont to ease restrictions and avoid a reemergence of infection, as has happened in Singapore. The possibility of seasonal flu in the fall and winter could place further pressure on Vermont’s stressed healthcare system.
The ultimate hope is for an effective vaccine. However, most scientists believe that it will take a minimum of 18 to 24 months to develop, test, manufacture and distribute. In the interim, new antiviral treatments may be developed, but that is far from certain. Any return to normal is also likely to see periods of resurgence of disease that will require new directives and new constraints until they pass.
Where does this leave us in Charlotte?
On April 27, the VT. Dept. of Health released a town-by-town breakdown of confirmed coronavirus cases. Charlotte fell into the lowest category, <6.
We still need to follow the guidance and directives of state and local officials, who should be commended for their adherence to evidence-based policies that have bought us some time. We need to resist the temptation to re-open economic activity all at once and instead follow a phased approach with an emphasis on expanding testing, surveillance and contact tracing, and isolating new cases.
If you have not recovered from, or tested positive, for the virus, you have to assume you are susceptible. Continue to use social distancing, wash your hands frequently and avoid touching your face. A cloth mask may offer some protection; at a minimum it sends a message to those around you that you care about protecting them. When you shop, choose your destinations wisely. Go at a time of day or to a place where there are likely to be as few others as possible. Use curbside pickup wherever it is offered. Monitor yourself for symptoms.
Until there is a vaccine we shouldn’t be fooled by the current lull. By staying vigilant and acting wisely, we can slowly begin to re-emerge socially and economically.
Jim Hyde is professor emeritus of public health at the Tufts University School of Medicine. He lives in Charlotte.