The initial reaction of the U.S. government to the threat of coronavirus is well-traveled ground. While people were getting the real story on the virus back in January through Tinder, action simply wasn’t being taken here. There were rules restricting testing. Test kits were being developed late, and many of those were defective. As a result testing was being rationed. There’s still a shortage of the chemicals needed to process tests. We do not even know how widespread the virus is here in the United States.
The key now is to ‘flatten the curve’ so that even if we do not ultimately reduce the total number of infections, we delay the spread so as not to overwhelm health care resources that lack the staff, masks, and ventilators necessary in the event of a major spike in cases the way Wuhan, China experienced and the way we’ve seen progression in Northern Italy and Iran.
We need to practice social distancing, focus on science-based evaluations of risk, and focus public policy accordingly. Flights from Europe are less of a risk than concerts. Many countries of the world are less of a risk than the U.S. is. And we need flights for cargo, including for the chemicals needed to process COVID-19 tests.
Coronavirus Spread Is No Longer Based on International Arrivals
The virus is already here and spreading without any obvious link to where patients picked it up. The barn door has, in some sense, shut. The risk is that infected individuals spread the virus in large gatherings, not that there are incrementally more infected people. Cancel large events, not dinner parties.
Don’t cancel your dinner parties.
Canceling, postponing, and/or rescheduling large-scale events should be considered – now.
Code/analysis for figure:https://t.co/8UCuw5cZbx
3/3@FinalFour @marchmadness @ajc pic.twitter.com/7BJyxXT50q
— Joshua Weitz (@joshuasweitz) March 11, 2020
Europe, which itself was late in addressing the severity of risk from the virus, slams the move noting that Italy has imposed a quarantine (of sorts) on the entire country. I’ve criticized flight attendants union head Sara Nelson for politicizing the response to the virus, but her members are indeed the ones traveling most between the U.S. and Europe and she might criticize airlines for requiring this. Instead she too slams the ban.
There’s no meaningful difference from a public health perspective between European residents and U.S. residents who have been in Europe, but there’s a legal difference. The President can more easily stop the former than the latter, and in doing so issued a finding that the U.S. cannot screen people coming into the U.S. in sufficient volume.
The Schengen area allows travel between member states in the majority of cases without immigration checks, hence the focus on that area (versus non-Schengen Europe). The U.S. is treating Iceland the same as Germany and France and Italy.
Even with immigration-free travel it seems as thought he focus could be on residents of specific countries and screening which wouldn’t overwhelm U.S. resources in the manner claimed by Administration.
The Warning Against All International Travel Makes No Sense
Banning travel to the U.S. by any non-U.S. resident that’s been to Europe in the last 14 days is unlikely to be helpful. However the U.S. warning against all international travel is simply not based on science.
I warned that people traveling abroad should come home and I did not want that warning to get confused so I didn’t go into detail there about why I believe the U.S. State Department’s message is unwise. However we are getting mixed messages from the u.S. government itself.
Just like the President announced one policy live on television (a ban on flights from Europe to the u.S.) while implementing a different policy entirely (a ban on travel to the U.S. by non-residents who have been to Europe), the U.S. government’s Centers for Disease Control does not agree with the State Department’s recommendation against international travel. Instead, while the State Department calls all international travel ‘level 3’ the CDC continues to list countries separately by risk level.
The CDC – in brand new updated warning levels Friday night – continues to list much of the world at levels 1 and 2 (and not all countries of the world make the list).
2. I put the @CDCgov #Covid19 related travel alerts into a table. There may be others, but these are the ones I saw. Lots. pic.twitter.com/TXcsnVezgc
— Helen Branswell (@HelenBranswell) March 12, 2020
South Korea and China have managed to slow new infections to a crawl, they are past their peak although of course there is no guarantee against a second wave of infections. Iran and Italy have the most confirmed cases among other nations, followed by France, Spain, Germany and then the U.S. Containment has been effective in Hong Kong, Singapore, and Taiwan.
There are places – including the U.S. – where spread is probably greater than reported. That’s especially true in places as I’ve previously discussed like Pakistan, where people don’t generally go to the doctor and the health care infrastructure isn’t what you likely think of. And there are places inside the U.S. where risk is not insignificant like Washington State, Northern California, New York and Boston. A passenger on a JetBlue flight from New York to Florida tested positive for coronavirus. Now isn’t the time for sledge hammer approaches, or fear of foreigners. Let’s keep this as science-based as we can.
Hi Gary,
As someone working in this area, you should understand that not everything has been released to the public and that science is, well science. Simply because one study states concludes something, doesn’t mean that the respective study is conclusive. Also, with the limited population that we have and unreliable information from places like China, our models are limited. Furthermore, understand that testing kits aren’t developed overnight. In fact, the sensitivity and specificity of the tests out there are in question amongst health professionals.
The best we can do right now is be as safe as possible. We don’t know how many people have the virus and amongst those tested, how many are false negatives. I don’t think anyone wants to bring the disease in contact with those most susceptible to it. I know that my hospital isn’t prepared for this virus and we’re a level 1 trauma center in a major American city. Think about what happens when the waiting rooms are overflowing (we’ve even moved triage to accommodate this). Then think about the physicians who are over 60. My institution has stated that they can defer to younger positions when interacting with patients who might have the virus. Now think younger physicians with families amongst other healthcare workers. If this thing gets out of hand, the biggest scare that we have is that doctors and nurses will start calling in sick. Then what?
There is a lot more going on than you think. My colleagues and I are not really afraid of the virus as much as we are with the panic that the mainstream media may cause. Closing the boarders is a far assessment in light of everything going on, that has been communicated to myself and my colleagues, and that hasn’t been communicated to the general population.
Oy vey…you really tell it like it ain’t.
“South Korea and China have managed to slow new infections to a crawl, they are past their peak ”
As far as China goes
not reporting numbers numbers being smaller
Supposed to be the not equals sign between
not reporting numbers
and
numbers being smaller
but the html gods ate it
Please focus on your expertise-travel writing.
Neither the current occupant of the White House nor his VP truly believe in science (climate change denial, former Gov Pence hoping to just pray the HIV away, Agent Orange just saying “all is fine, it’s getting better”, etc.)
Why would anyone think they would make a scientifically reasoned decision and action?
One travel-related aspect to this crisis:. At this point in the spread, China was building isolation hospitals from scratch. We’re going to need isolation wards (not to mention ventilators) soon.
Can unused travel infrastructure such as cruise ships and hotels be converted for this use and rented by the government? As in China, non-medical people could be trained as aides and in sterilization procedures. This wild would get us the beds we need, help keep the companies afloat without just giving them money, and keep otherwise unemployed people employed.
Any idea what “appropriate screening” for returning U.S citizens means when returning from an international destination?
Dr. View – is spot on. This is a media frenzy is crashing our global economy. I think the US (actually much of the Americas), has handled this much better than China , Korea or the EU. We would have over 50,000 cases in the US if we handled it like Italy has. Note here in AZ, we have had 9 cases, 4 recovered from the 9, no deaths and 100 others tested that were negative. That tells me more than the panicked, uneducated media every will. Let’s just hope in the next 30 days, cooler heads prevail and we start to rebuild the damage to lives and our economy.
The ignorant comments of “we barely have any cases in the US!” are insanely stupid.
It’s because we haven’t been testing 10K people daily like S. Korea has – we got caught w/our pants down, and the Ignoramus in Chief isn’t helping things
Sorry, but international travel is what caused the mess we are in now. The first cases in the US from from international travel. I went to Auckland two weeks ago, which had no cases, and sure enough, the flight that landed ahead of me and one the next day (travelers from Iran and Italy) were New Zealand’s first two cases. The President should have gone one step further and included Americans, because sadly, Americans are the ones who are infecting other Americans when they get home.
A leaderless country run by sycophants, devoid of science with plans developed by Stephen Miller and Jared Kushner, what could go wrong?
The lack of testing is a big problem. A doctor wasn’t even allow to use a test kit on a patient until they exhibited more symptoms because they were essentially being rationed.
Bottom line, our medical system is broken. Too many patients, too few doctors. I called the other day to try and schedule an appointment (not a GP/Internist but a specialist) and I was told by an automated voice I was #10 in the queue. All I wanted to do was make an appointment.
Without significant changes in leadership and people in this country the future is not good. Another crisis that we keep pretending isn’t a big issue is the debt. It will be an issue one day and it won’t be fixed overnight. Warnings about not being prepared for a pandemic have been given for years and largely ignored.
Until more leaders get sick nothing will happen. Sad that you have to almost root for some people to get sick in order to get something taken seriously but that is how people behave.
Science? No need for science because Trump “has a natural ability” for medicine.
Lets not mention that Patient 0 in New York had just come home from ITALY. now over two hundred people are sick and a town is in quarantine. Little details need not matter
Given that we are rationing test kits and 80% of infected don’t seek medical help the actual infection rate is at least x5 the confirmed rate and probably much higher (since we limit testing due to kit shortages). The Italian leaders thought that the best thing to do for them was to quarantine the entire country to slow the spread. The quarantine was their best option! We need to shut down all significant gathering nationwide And not wait until a nationwide quarantine is the governments best option…
I’m sure scientists and doctors are involved in these national recommendations. Nothing in this article is very scientific.
If science is telling us that less people with the virus coming to the U.S. isn’t a good thing then your science is worthless. Less European tourists and businesspeople mean less people in hotels going out to tourist attractions, it means less vectors for the virus, and it means less strain on screeners at airports. People who live in the U.S. can be more easily isolated in their homes for 14 days after arrival than a tourist.
Literally there is no reason to be upset that less people from areas with the virus are coming to the U.S. People have an irrational hatred of Trump and his sensible immigration and economic policies that they let it cloud every other action he takes.
UA-NYC —
Neither does most of the Democrat party believe in science as it has been scientifically demonstrated that a fetus can feel pain well after the period where abortion is permissible.
So, each party’s adherents have their own oxen to gore — and yes, I do believe in a woman’s right to an abortion in the early stages of pregnancy.
Gary — you accept without questioning China’s claims that its infections are past peak.
Even if true, I would not trust that murderous regime that harvests organ from political prisoners — including lungs for the Wuhan virus afflicted — as well the forced labor of Uighurs to produce face masks and other infection control equipment.
Although our country’s leadership has made mis-steps, they are nothing like those that have been perpetrated by those who stuck their heads in the sand and tried to cover up the initial outbreak of Covid-19, nor who allowed it to flourish in the first place in the unsanitary and torture chamber like slaughter houses of these “Wet Markets” that are found throughout a good part of Asia.
You want to stop the next outbreak that could be even more deadly and more easily spread than the current outbreak??
Well then, direct your anger, words, and wallet at the country most responsible for its spread — The “so called” People’s Republic of China.
Just watch: Johns Hopkins doctor today on CNBC. Get ready for 1000 deaths per day.l
China has been relatively open and transparent, after the initial outbreak. Don’t believe me? Search for the study released by the WHO after 25 international experts spent a week and a half in China, poring over the data. It’s pretty clear that the coronavirus outbreak has peaked in China, and outside Wuhan, life is rapidly returning to normal.
Meanwhile the US has a massive lack of testing. My favorite comment above was the one from AZ guy- we’ve tested 100 people, only found 9 infected (9%!) and all is OK.
Personally, I think it makes sense to cut off flights from infected areas, particularly when there’s potentially large numbers of untested carriers. But luckily the rest of the world doesn’t see it that way, and still accepts flights from the US.
When this ends, it’s pretty clear to me the country that will be at the top of the list, in terms of infections and deaths, will be the US. The lack of testing, the lack of preparation, the inability (or unwillingness) to quarantine, and finally the underlying bullheadedness that somehow this is all someone else’s fault means that when the peak comes, and it’s coming soon, it’s going to be a complete shitstorm.
@ Gary. OK, both you and Trump are to be complimented for your ability to withstand the insults hurled your way. There seem to be many “experts” yet they are reading your blog and not writing their own. Do not mistake me, I think they are entitled to their own opinions, just not their own facts.