What We Don’t Know About COVID-19 Can Hurt Us

Countries around the world have introduced stringent control measures to stop COVID-19 outbreaks growing, but now many find themselves facing the same situation again. From Melbourne to Miami, the relaxation of measures had led to increasing flare-ups, which in some places has already meant reclosing schools, businesses or travel routes. Within the U.S. and among…

What We Don’t Know About COVID-19 Can Hurt Us
COVID-19 outbreaks growing, but now many find themselves facing the same situation again. From Melbourne to Miami, the relaxation of measures had led to increasing flare-ups, which in some places has already meant reclosing schools, businesses or travel routes. Within the U.S. and among different countries, places with wildly varying public-health policies have experienced wildly diverse outcomes. Most ominously, infections are rising rapidly in many places where they once were falling.

So how do countries avoid an indefinite, unsustainable, cycle of opening and closing society? What is needed to prevent a future of strict social distancing and closed borders? To escape this limbo, we need to know more about each step in the chain of infection: why some people are more susceptible or have more symptoms, how our interactions and surroundings influence risk, and how we can curb the impact of the resulting disease. Research around the globe has yielded some promising insights into these questions, but also some contradictory findings. Some studies suggest children are less susceptible to disease, while others suggest they are less likely to spread infection too. There is evidence that some aspects of immunity against the virus may wane quickly, while others persist. Based on certain datasets, few individuals are truly asymptomatic; according to other studies, a larger proportion may be.

Often when a new disease outbreak declines, we only later discover precisely why it took the shape it did. In 1854, John Snow famously took the handle off a water pump in the London neighborhood of Soho to tackle a cholera outbreak. What happened next is less well known: by the time the handle was removed, the outbreak was already in decline. From SARS to the 1918 influenza pandemic, history shows that many crucial insights only come long after the battle is over. Unfortunately, we don’t have that luxury for COVID-19. To effectively and sustainably control the disease, we will need a better understanding of the infection that causes it.

As the COVID-19 pandemic has grown, so has the apparent diversity of the disease’s impact on individuals, with susceptibility and severity varying enormously with age and medical history. New medical insights could help shrink this diversity for the better. An effective vaccine would reduce susceptibility, stopping the infection taking hold; an effective treatment would reduce the impact of infection in its final stages in hospital, preventing severe or fatal outcomes. But to know what is truly effective, we need large clinical trials that can roll out before cases decline, as studies have for hydroxychloroquine and dexamethasone in the U.K.

If we can’t change susceptibility or severity, then we need to look at what happens in between: how people are exposed to the virus. That means understanding the range of human surroundings that drive transmission. However, lockdowns were the equivalent of treating a patient with everything at once; something worked, but it’s still not entirely clear what. From schools and shops and bars and workplaces, each type of closure changed our interactions and the transmission opportunities they create—but we still don’t have the data to say for certain which of these changes mattered the most.

To successfully avoid ongoing disruption, we need to harness the variability of COVID-19 outbreaks—and the control measures countries have introduced—to make more sense of how the infection starts, spreads and ends. This variability was damaging and unpredictable in the spring, but going into the fall, this same diversity could help us target the weak links in the infection process.

As with any noisy data source, researchers detected the strongest signals about risk first: the meatpacking factories, the cruise ships, the nursing homes. Countries like Taiwan, Japan and South Korea have avoided untargeted lockdowns in part by refining this knowledge, collecting the data required to know where and how outbreaks are happening. There’s evidence that most people infected with COVID-19 don’t pass the infection on to anyone; even if risk can’t be avoided entirely, smarter structuring of interactions and lifestyles could limit superspreading events. Venues in several countries have introduced check-ins to help flag emerging clusters, while routine, rapid testing in workplaces could help get ahead of flare-ups before they happen.

Uncertainty about risk can translate into uncertainty in behavior, as we saw on the way into lockdown and are seeing on the way out. The virus seems to thrive indoors, particularly at crowded, loud, and lengthy gatherings. It’s becoming clear that a day at the park is very different to an hour in a bar. But the multiple dimensions of transmission are often ignored in favor of a focus on single measures. Is six feet enough distance? Should face masks be worn everywhere? Media reports show pictures of crowded beaches and parks, which are likely seeing little transmission, while superspreading events are happening in bars and workplaces. As measures are relaxed, this uncertainty means some are unwittingly heading once again into risky environments, while others, remembering stay-at-home messaging, are avoiding surroundings that are now known to be relatively safe.

Although local variation in control measures may appear to create uncertainty, it can actually help reduce it, by providing faster insights into what behavioral changes are effective. Take the introduction of face mask requirements in Germany, where different states rolled them out over a 10-day period. One concern with introducing mandated face mask usage was that it might lead people to become complacent in their behavior. By staggering the timing of when masks were introduced, Germany created a ‘natural experiment’ that could reveal what happened across multiple locations. The results suggested that when states introduced compulsory masks, it didn’t lead to a subsequent increase in visits to public spaces.

There won’t be a single, perfect dataset that will reveal how to sustainably tackle control COVID-19. Whether we want to reduce susceptibility and severity or understand infection and immunity, we will have to learn from the diversity of outcomes and dynamics we are seeing globally. That means having surveillance systems tracking infections from multiple directions, research studies set up to monitor potential cases, and disparate data streams linked together. As the second epidemic wave hits several countries, it’s crucial to collect the information needed to prevent a third.

Source : Time More   

What's Your Reaction?


Next Article

Coronavirus is Placing College Sports on Hold, Putting Students, University Budgets, and Entire Towns At Risk

On college football Saturdays, tiny Clemson, South Carolina (pop. 17,000), turns into a city of 150,000 when fanatics pour into downtown and swarm Memorial Stadium, home of the Tigers. Some don’t even have a ticket to the game, but they come with money to burn. “It’s well north of $2 million in economic impact per…

Coronavirus is Placing College Sports on Hold, Putting Students, University Budgets, and Entire Towns At Risk

On college football Saturdays, tiny Clemson, South Carolina (pop. 17,000), turns into a city of 150,000 when fanatics pour into downtown and swarm Memorial Stadium, home of the Tigers. Some don’t even have a ticket to the game, but they come with money to burn.

“It’s well north of $2 million in economic impact per game,” says Susan Cohen, president of the Clemson Area Chamber of Commerce. Hotels sell out rooms at $400 a night; some shops bring in 50% of their year’s revenue during the seven home-game weekends. Add in massive broadcasting contracts and apparel deals that enrich schools directly, and there are hundreds of millions of reasons that universities with large athletic departments and the towns they occupy don’t want to lose even one season to COVID-19.

And that’s just the dollars. There is also the intangible value of a community rallying behind a shared passion in particularly bleak times—to say nothing of the life-changing impact of scholarships to students who might have no other chance to shine or get a college education.

College sports are a multibillion-dollar industry, but in 2020 they’re being brought down by the same forces that have hobbled the rest of the economy. Events like football games make for an ideal environment to spread a highly contagious disease. And even if the games end up taking place in empty stadiums, players can still infect one another—they’re in close contact for long periods inhaling one another’s sweat and saliva droplets—as well as their team staffs and the communities where they study and live.

So university presidents and athletic directors are now playing defense amid a constantly changing landscape of the pandemic, rather than driving any sort of solid plan forward.

“We’ve developed seven different budget scenarios, ranging from pretty normal to sports being out of the picture for a long time, and one of those, hopefully, will be close to what we are ultimately dealing with,” says Kevin Blue, athletic director at the University of California, Davis.

Uncertainty over the season has also derailed the plans of scores of current and incoming college athletes. When the National Collegiate Athletic Association (NCAA) in March canceled all of its spring sports championships, it granted the athletes in those sports an extra year of eligibility and eased some scholarship limits. The association could do the same if fall sports are canceled—but it’s up to the schools to decide whether to offer extra scholarships. Some say they won’t. “Those are dollars we don’t have,” Long Beach State University athletic director Andy Fee told the New York Times.

Christian Molfetta, a graduating senior and catcher on the Stanford baseball team, had scholarship offers from multiple schools to play for them next season as a graduate transfer. But with so many of those programs’ older players now returning for another year, “most of those offers disappeared,” Molfetta says. He plans to play for the University of Michigan, which will cover the cost of his books as he pursues a master’s degree in kinesiology.

Other athletes have been told they may return without their scholarships, which may range from a small stipend to tens of thousands of dollars, while some are getting money that would’ve gone to incoming freshmen, who are suddenly denied the financial aid they had been promised, Molfetta says. The trickle-down effect is wicked. “We’re getting questions from kids in the 2023 and 2024 recruiting classes, asking if there’s going to be any scholarship money for them,” says Pat Bailey, assistant baseball coach at Oregon State University.

When the pandemic started to spread to the U.S. this past spring, college football cheered for business as usual. Americans are going to “rise up and kick this thing in the teeth,” Clemson head coach Dabo Swinney predicted in April. Then 37 of his players tested positive—just one of a number of football-related outbreaks at schools like the University of Texas, Kansas State, and defending national football champion Louisiana State University.

Now, the reality of a fall without sports is sinking in. Already, the Ivy League and many smaller conferences have canceled their fall schedules. Members of the so-called Power Five conferences—the SEC, Big Ten, Pac-12, Big 12 and ACC—have waffled, holding out for abbreviated seasons while discussing how to restrict travel and exposure. The NCAA, meanwhile, has been conspicuously absent from most of the conferences’ conversations about the fall season, leaving university presidents and athletic directors to hash it out for themselves.

The result is a patchwork of decisions, and the dividing line is usually money. For conferences like the Patriot League, for which football revenue is not major, canceling the season was perhaps an easier call. “It is clearly the right thing to do,” says Colgate University athletic director Nicki Moore.

For the Power Five, the cancellation of football would be a budget-breaker, with potentially $4 billion in revenue at stake, money that helps keep some athletic departments afloat while minimizing the annual losses of others. Still, many of these schools also have the resources to conduct repeated tests on entire rosters of athletes and staff, totaling more than 100 people—and have begun to do so.

The cost of regular COVID-19 testing for entire rosters of athletes, plus coaches, staff and support personnel, would swamp all but the largest university sports budgets. Testing an entire football team and staff could cost $20,000 to $25,000 per week, says Zachary Binney, an epidemiologist at Emory University’s Rollins School of Public Health in Atlanta.

And what the tests reveal—and how quickly—means everything. The NCAA recently released guidelines that call for testing within 72 hours of competition in “high-contact risk sports” like football, but Binney says the tests must be done the day before a game, with a quick turnaround of the results, or else they’d be meaningless. “Unless you test the day before, you would have no idea whether you were about to seed an epidemic on somebody else’s campus,” says Binney. “To do it any other way is just pointless.”

Professional sports have begun to return, with robust testing regimes and strict rules about what players and staff can and cannot do. Similar “bubble” setups won’t work in college sports. Pro clubs can pay for the ability to closely monitor and control the movement of their players and staff, but “college sports occur on college campuses, where people arrive from all over,” says Binney.

With conferences left to their own devices, each school’s testing policy is essentially the result of a standalone decision. Stanford reported that as of July 24, it had conducted 505 tests on members of the football team and found 11 players to be positive, with five of the athletes since recovered and six others currently isolating. But four other schools in the Pac-12 have said they will not report their test results. If a conference’s schools cannot agree on basic reporting methods, then finding common ground through an entire season is but a remote possibility.

The idea of a college season retains tremendous appeal—and in places like Clemson, it’s absolutely necessary. “We are the epitome of a college town, and many local businesses are already struggling and may not survive through the end of the year without fall sports,” says Cohen, president of the Clemson Area Chamber of Commerce.

Ultimately, though, such a return to normalcy depends on the continuing path of COVID-19, and the nation’s response to it.

“The virus doesn’t care what you want or how much you wish you could do something. It does not care about your convictions,” Binney says. “It only cares about opportunity.”

This story was produced by (Kaiser Health News), which publishes , an editorially independent service of the . KHN is not affiliated with Kaiser Permanente.

Source : Time More   

This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies.