As state and local officials struggle with constituents restless with measures designed to deal with the Covid-19 pandemic, the next key phases in the battle with the novel coronavirus may prove yet more contentious. How ready are we to accept not just testing but also tracing and isolating infections?
The White House is bolting to a cut-and-run approach to fighting Covid-19, deflecting, denying and downplaying its staggering toll — more than 1 million infections and tens of thousands of deaths.
This already has led to a debacle with what needed to be an effective, widespread regimen of testing, testing, testing — not only to see who is infected now but also who may have been exposed to the disease and potentially have some immunity against it.
With the disease leading to an economic shutdown and joblessness at historic levels, states and local governments have resisted but are giving way to incremental efforts to reopen more normal conditions.
If the campaign against Covid-19 had been conducted in a vastly better, more coordinated, and evidence-based fashion, the nation likely would not be drowning in a tsunami of doubt, as is occurring now for too many Americans.
Instead, as has happened in nations around the globe, a giant wave of coronavirus testing would be rolled out — along with two other key disease-fighting efforts: contact tracing and isolation of those detected with illness. It has gone on in Germany, China, South Korea, Singapore, New Zealand, and in spots like Senegal and South Africa.
These other steps — familiar and proven — also require not only considerable resources but a huge commitment to the greater good.
Tracing involves having an army of health care workers ready to follow up, in person, on the phone, and online, with individuals testing positive for Covid-19 and trying to determine who they might have had close, sustained contact with, notifying those individuals, getting them tested, and helping all concerned then isolate themselves to avoid spreading the disease even more.
The logistics to accomplish this are formidable, as the Vox news site reported:
“The Johns Hopkins Center for Health Security estimated the U.S. needs 100,000 people performing this work for state and local agencies. Former Centers for Disease Control and Prevention Director Tom Frieden told Politico the necessary number of workers could be as high as 300,000. Money is going to be the problem. The Johns Hopkins researchers thought it would take $3.6 billion to hire and train enough people to expand the disease intervention ranks, a figure endorsed by the Association of State and Territorial Health Officials. But state budgets are squeezed, and while people could in theory volunteer for these jobs, there is also record unemployment right now. It makes a lot of sense to put out-of-work people, or people training to work in the medical fields, on these assignments — and to pay them. But state governments would need financial help from Congress to do it.”
States like California and Massachusetts are advancing their plans for this work. With President Trump a skeptic of testing, it is unlikely that there will be a federal push for tracing and isolation. And many states and local governments, even some respected experts, say these next steps may require too many people, too much expertise, and too much money for them to take on — this, even though huge numbers of Americans are available and desperate for work.
In the industrialized world, including this country, hopes also are running high for high-tech innovations from titans in the field like Google and Apple for cellphone apps and other online developments to boost contact tracing.
Privacy advocates, however, have raised serious concerns about cyber snooping and the availability to governments and businesses of vast banks of information about individuals, their movements, and the people with whom they associate.
This brings to the fore a distinctly American issue that already has started to rage in public health measures against Covid-19: Where are the lines for individual freedoms and collective responsibilities?
If demonstrators already are strapping on guns and besieging statehouses when asked to cover their faces, wash their hands, and stay in the comfort of their homes, how will they react when asked to give up information about the many people they know (or don’t) and may have infected? Didn’t tell the Mrs. about the stop on the way home at the golf course tavern? Didn’t mention to your partner about the frequent visits to that “secret friend?” Hard to explain the many sojourns to the card club or high-end clothes store?
How fathomable, too, is it that what follows tracing — isolation — will occur for as many Americans as might be needed?
Let’s be clear: The Covid-19 fight, thus far, has kept Americans in a mostly voluntary way (yes, with official orders overlaid) at home. They could go outdoors and could shop for groceries and other items deemed necessities.
In the test-trace-isolate regimen, those who are infected and tested positive would need to be more locked down still, including from family and loved ones, as well as work and many activities. With Covid-19 this isolation of diagnosed individuals is all the more crucial because the coronavirus has been found to have a long asymptomatic period — individuals can go long periods without feeling ill but shedding and spreading the disease.
In California, officials have swooped into empty hotels and cut deals with their owners to secure rooms not only for weary first responders but also for patients testing positive for the coronavirus to quarantine for 14 days while the disease either resolves or requires them to seek medical assistance.
The quarantine step may require individuals, including the young and old, to be fully separated from families, not just staying in a separate area at home, says Donald McNeil, a reporter for the New York Times for more than three decades and a specialist in covering epidemics and diseases of the poor (having written from 60 nations). He reported that the Chinese learned that families were a significant way in which the coronavirus spread and sustained, and with Communist control, they created large-scale facilities to separate family members and keep them locked down.
He has talked in broadcast interviews about how difficult this would be to carry out in the United States, including for the reason that so many in this country lack personal finances or paid sick leave, vacation time, and working conditions that would let them be out for weeks.
In my practice, I see not only the harms patients suffer while seeking medical services but also the damages that can be inflicted on them by dangerous drugs, and the benefits they can enjoy by staying healthy and out of the U.S. health care system. The coronavirus threatens to swamp our health resources, which, in their better times, already had notable problems with infections acquired in hospitals, nursing homes, and other medical care giving facilities, as well as major challenges with medical error and misdiagnoses. That said, at this difficult moment, we need to support doctors, hospitals, and public health officials as they marshal science, evidence, and facts to battle the global menace of Covid-19.
Contrary to the insistence of the president that the coronavirus will magically disappear, it will not. We can keep our fingers crossed for better treatments for it, or a vaccine to prevent it. But sorry, folks, Covid-19 does not care if you need your hair cut, nails adorned, or body tanned or tattooed. It does not matter to the microscopic specks whether you are a Democrat, Republican, Libertarian, or a Communist. Covid-19 replicates, sickens, and kills us. It will keep doing so until we do the hard work and make sacrifices to stop it. We’ve got a lot of work to do.
