Systematic Targetting: Extreme measures, a must to stop coronavirus

Terrifying though the coronavirus may be, it can be turned back. China, South Korea, Singapore and Taiwan have demonstrated that, with furious efforts, the contagion can be brought to heel. Whether they can keep it suppressed remains to be seen. But for the US to repeat their successes will take extraordinary levels of coordination and money from leaders, and extraordinary levels of trust and cooperation from citizens.

There is a chance to stop the coronavirus. This contagion has a weakness. Although there are incidents of rampant spread, as happened on the cruise ship Diamond Princess, the coronavirus more often infects clusters of family members, friends and work colleagues, said Dr David L Heymann, who chairs an expert panel advising the World Health Organization on emergencies.

No one is certain why the virus travels in this way, but experts see an opening nonetheless. “You can contain clusters,” Heymann said. “You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.” In interviews with a dozen of the world’s leading experts on fighting epidemics, there was wide agreement on the steps that must be taken immediately. Those experts included international public health officials; scientists and epidemiologists; and former health officials in both administrations.

Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home. Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.

“The American way is to look for better outcomes through a voluntary system,” said Dr Luciana Borio, who was director of medical and bio-defense preparedness for the National Security Council before her unit was disbanded in 2018. “I think you can appeal to people to do the right thing.” What follows are the recommendations offered by the experts interviewed by The New York Times.

Politicians must step aside and let scientists both lead the effort to contain the virus and explain what must be done. The experts said, briefings should focus on saving lives and making sure that average wage earners survive the coming hard times — not on the stock market, the tourism industry or the president’s health. There is no time left to point fingers and assign blame. “At this point in the emergency, there’s little merit in spending time on what we should have done or who’s at fault,” said Adm. Tim Ziemer, who led the pandemic response unit on the National Security Council before its disbanding.

The next priority, experts said, is extreme social distancing. If it were possible to wave a magic wand and make all freeze in place for 14 days while sitting 6 feet apart, epidemiologists say, the whole epidemic would sputter to a halt. Obviously, there is no magic wand. But the goal of lockdowns and social distancing is to approximate such a total freeze. To attempt that, experts said, travel and human interaction must be reduced to a minimum.

Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected. In the US, people seeking tests are calling their doctors, who may not have them, or sometimes waiting in traffic jams leading to store parking lots.

As soon as possible, experts said, the US must develop an alternative to the practice of isolating infected people at home, as it endangers families. In China, 75% to 80% of all transmission occurred in family clusters. Instead of a policy that advises the infected to remain at home, as the Centers for Disease Control and Prevention now does, experts said cities should establish facilities where the mildly ill can recuperate. Wuhan created many such centers, called “temporary hospitals,” each a cross between a dormitory and a first-aid clinic. They had cots and oxygen tanks, but not the advanced machines used in ICUs.

Because China, Taiwan and Vietnam were hit by SARS in 2003, and South Korea has grappled with MERS, fever checks during disease outbreaks became routine. In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even a restaurant to get a temperature check. Washing your hands in chlorinated water is required.

Finding and testing all the contacts of every positive case is essential, experts said. At the peak of its epidemic, Wuhan had 18,000 people tracking down individuals who had come in contact with the infected. At the moment, the health departments of some counties lack the manpower to trace even syphilis or TB, let alone scores of casual contacts of someone infected with the coronavirus.

China’s effort succeeded, experts said, in part because of hundreds of thousands of volunteers. The government declared a “people’s war” and rolled out a ‘Fight On,Wuhan! Fight On, China’ campaign. Many people idled by the lockdowns stepped up to act as fever checkers, contact tracers, hospital construction workers, food deliverers, even babysitters for the children of first responders. With training, volunteers were able to do some ground-level but crucial medical tasks.

The ultimate hope is to have a vaccine that will protect everyone, and many companies and governments have already rushed the design of candidate vaccines. The process will take at least a year, even if nothing goes wrong. The roadblock, vaccine experts explained, is not bureaucratic. It is that the human immune system takes weeks to produce antibodies, and some dangerous side effects can take weeks to appear.