Coronavirus Precautions Must Make Sense, Says Public Health Officer

Has the time come to close schools, keep everyone home from work, and seal the borders? No, said Dr. Henning Ansorg, the public health officer for the County of Santa Barbara. “It’s very unfortunate that this virus can kill and make people really sick, but the vast majority who get COVID-19 recover very well,” he said, giving some perspective to a pandemic that has gained a foothold in the United States and every continent save Antarctica. “But if you’re in the vulnerable population,” he warned, “judge very carefully what you are exposing yourself to.”

Dr. Anthony Fauci presented early findings that said much the same thing in a New England Journal of Medicine editorial on February 28. Based on two Chinese studies on Wuhan, Fauci — who heads the infectious disease institute at the National Institutes of Health and is a well-respected immunologist who led the U.S. fight against AIDS — observed that patients with mild or no COVID-19 symptoms are presumably overlooked in the patient count. The death rate based on that count may be incomplete and is likely much smaller, much less than one percent and possibly closer to the seasonal influenza rate of 0.1 percent. However, given the known patient numbers, the rate of death stands at about 2 percent.

The deaths in Washington State from COVID-19, which jumped from one to six between Saturday and Monday, illustrate what has come to be understood about the novel coronavirus. People who are elderly or have health issues are susceptible to the worst of this new disease. In Washington, four who died were elderly residents of a nursing home. The first fatality was a man in his fifties known to have underlying health problems. The sixth person was in their forties and information their on health status is so far unavailable. How any of them got the disease was unknown as of Tuesday — it appeared to be community spread — and others at the facility were diagnosed but less acutely affected.

The mass spread of the disease in China, where the virus broke out in December, alarmed the world, but tracking the epidemic enabled health officials to grasp what they were dealing with. Of those who tested positive for the virus, 80 percent had mild symptoms. Like seasonal influenzas that strike in the wintertime, COVID-19 attacks the respiratory system. The people admitted to the hospital tended to have chronic health issues like diabetes, heart or lung disease, asthma, cancer, or obesity. The new virus can develop into bronchitis or pneumonia and can lead to a widespread infection that affects the body’s systems.

As people have tried to figure out how to handle fears of flu, misinformation has proliferated and animosity against Asians has been reported by Asian Americans. To pour cold water on such activities, Senator Dianne Feinstein called the rise in racism “unconscionable” and “not the American way,” adding, “People of all ages, races, and ethnicities are susceptible to this disease.” Making the rounds, apparently, is the thought that coronavirus can arrive in the mail from China. Feinstein pushed back, saying, “The World Health Organization reports that the coronavirus cannot survive for long on objects in the mail and it is safe to handle packages and letters from China.”

To avoid this flu and others, Dr. Ansorg advised that people — especially those with chronic illness — pass up events that involve close contact with a large group: “I wouldn’t travel or go to the movies. I wouldn’t get on the bus or go to church,” he said. “You could go to a restaurant, because you’re probably more than six feet away from other customers, but maybe not stand in line. And avoid sick people.” So far, the evidence showed that people became contagious only after symptoms like coughing and sneezing developed, he added.

One measure of the severity of a disease is how many people one patient can infect, the doctor noted. The worst are whooping cough and measles; one person can infect 11-15 others. In the case of seasonal influenza, the rate is 2-3 people, which is also the rate so far for COVID-19.

Santa Barbara reacted to the first reports of deaths with quick trips to the grocery store. Some markets reported their canned goods and toilet paper shelves has been wiped clear by Sunday, and others were low on disinfectants. People worried aloud about contagion in schools and from passengers on cruise ships, 12 of which are scheduled in the next few months, including one on March 4.

Dr. Fauci pointed out in his editorial that early research found no patients who were younger than 15 years old — a larger study found less than one percent were that young — which led to his conclusion that people with mild or no symptoms were overlooked as COVID-19 patients. For Santa Barbara parents, the concern could be greater for themselves and teachers than their kids. 

“COVID-19 is not killing healthy kids,” Dr. Ansorg said, unlike the seasonal flu. “To put this in context, since October 1, 18,000 to 20,000 people have died of influenza. With COVID-19, of the 16 cases outside the repatriation efforts [the 24 people in California airlifted from Wuhan], they’ve all recovered. Most people recover well. As of now, it seems to be similar to the flu, with symptoms like sneezing, sore throat, muscle ache, and fever.

“What we do to keep ourselves and our community healthy has to make sense, has to decrease the transmission rate,” he said, “one with the best effect and the least detrimental effects.” What concerned him most were the vulnerable, the elderly, and the chronically ill, who needed the most protection. “Closing schools has a big impact on parents, the economy, a whole lot of things,” Dr. Ansorg noted. “Isolating an infected child and testing close contacts would be hugely important. And if anything, close the school for a day for a deep cleaning.”

When it comes to cruise ships, Dr. Ansorg recalled a ship that was quarantined in the past 20 years for an overwhelming case of norovirus, a gastrointestinal disease that was among passengers. It would be a drastic measure, he said, but a local health jurisdiction has the authority, with evidence, to block a ship from entering the area.

This virus will probably take its place among the 30 to 40 influenzas that get passed around every flu season, Dr. Ansorg surmised. Several vaccines are in the works: The antiviral remdesivir is beginning a clinical trial at the University of Nebraska. That news sent the stock price of its maker, Gilead Sciences, zigzagging upward, a bright spot in a bleak Wall Street week. But given the usual track of human trials, Dr. Ansorg believed it would be the next flu season before a vaccine will give people an edge over COVID-19. 

Keep the Virus at Bay

The statistics and information on COVID-19 change with every update, but some things remain evergreen, including Centers for Disease Control’s guidelines to protect against contracting the virus.

• Avoid close contact with people who are sick.
• Avoid touching your eyes, nose, and mouth.
• If you’re sick or don’t feel well, stay home.
• Cover your cough or sneeze with a tissue.
• Clean and disinfect frequently touched surfaces.
• Facemasks are not necessary or helpful for healthy people and should only be used by those with coronavirus symptoms.
• Frequently wash your hands with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing.
• If soap and water are not available, use an alcohol-based hand sanitizer with at least 60 percent alcohol.