The trifecta: Public health experts recommend testing, contact tracing and supported isolation to phase into a reopened world
As The Union continues “Investigating the Impact,” a series of stories that discuss how Nevada County is coping with the COVID-19 crisis, this week’s coverage will focus on health care.
Further discussion in coming weeks will also delve into the impact on government, nonprofits, education, arts and culture, as well as housing and homelessness — to better understand the impact of the crisis, the situation each sector faces and what resources are available to help the community to move forward.
Check back later today at TheUnion.com, or see Tuesday’s print edition of The Union, for more in the series.
As the days turn to weeks, and weeks to months, many Americans have begun asking what is needed in order to transition out of strict physical distancing policies.
That is, when can people meet with friends, hold celebratory events and simply engage in pre-pandemic normality? These questions are buttressed by ones like, how many Americans need to be tested, how much contact tracing needs implementing and, especially, how long until people can move toward a freer social state?
While much remains unknown of the near future, physicians and public health experts have applauded the nation and Nevada County residents for adhering to strict physical distancing guidelines, which has put the region in a better condition.
Their takeaway: it’s working.
Originally concerned of skyrocketing coronavirus cases in Nevada County specifically, CEO and President of Sierra Nevada Memorial Hospital Dr. Brian Evans said on The Union’s Studio U podcast that physical distancing has kept residents healthy and alive.
“The general consensus is, ‘yes, it’s effective,’” he said. “It’s actually one of the few things you can do to slow down an infectious disease like the novel coronavirus.” In fact, Evans then told The Union he was most concerned about residents violating 6-feet distancing measures and that they begin gathering in groups.
Nevada County Public Health Officer Dr. Ken Cutler agreed.
“We have seen a ‘flattening of the curve’ of confirmed cases after the stay-at-home order began in California,” he wrote in an email. “This implies that our physical distancing is working to slow the spread. We have followed models such as covidactnow.org, which allows residents to dive down into projections for Nevada County. It implies that if the stay-at-home order is simply lifted without a thoughtful, phased approach and re-opening precautions in place, we are still at significant risk for a surge in disease that could outstrip our healthcare capacity.”
Specifically, if those restrictions were lifted completely, data scientists and engineers for the website predict Nevada County could see 960 hospitalizations by May 24.
While physical distancing has proven effective, public health experts recommend phasing into more normalcy with the expansion of testing, contact tracing and isolation of those infected.
Gov. Gavin Newsom has recognized the need for expanded testing. At about 25,000 tests per day in the state as of April 29, the governor hopes to test 60,000 people per day in the short-term as the state is in the process of implementing about 86 new testing sites, which is supported by the Testing Task Force in collaboration with university researchers to expand testing capacity.
Nevada County was recently notified that it will maintain one of those sites, according to Cutler, who said the county subsequently reached out to its neighboring counties to ensure people have reasonable access to testing. One of the sites will be in Grass valley, and another will be in the North Tahoe area, wrote Cutler. For now, local health care providers have been sending test specimens to labs like Quest Diagnostics and LabCorp, which takes about three days to retrieve the results.
There are two general tests health-care workers can administer: molecular tests that show if an individual is infected and serological tests — generally considered more effective by public health officials — that detect if an individual has antibodies for the virus. The latter of the two was only generated in America by early April, according to Recode, but experts still don’t know if the antibodies confer immunity.
By late April, the United States was testing about 17 people per 1,000, according to world data statistics, but per state there has been strong variation in the testing rate — mostly due to state and local public health departments often taking the lead to administer and distribute testing, rather than the federal government. Last month, President Donald Trump said he doesn’t “take responsibility at all” for a lag in testing, pointing to an unspecified “set of circumstances” and “rules, regulations and specifications from a different time.”
Locally, Cutler hopes testing is greatly expanded and, ideally, a vaccine or therapeutic is created to allow for the relaxation and eventual end to physical distancing.
“We’d like to get to the point where at least everyone with symptoms gets tested and also have periodic testing of some individuals like health-care workers and first responders who are asymptomatic but give medical care to ill patients,” Cutler wrote. “Having a vaccination or at least very effective treatment is really viewed as the key to being able to lift all restrictions, including physical distancing.”
Until then, physical distancing guidelines will likely persist.
PHASING TOWARD NORMALCY
Recently, economist and Nobel Prize winner Paul Romer said normal life can resume again if widespread testing is instituted. That call has been echoed by scholars across the nation.
Over the last month, a number of reports from think tanks and universities have been published to demonstrate how the country can safely phase into a less socially restrictive lifestyle.
A report from the American Enterprise Institute, a right-leaning think tank, suggested the country aggregate data on how the virus spreads as well as rates of exposure and immunity; expand tools for local and state health-care systems to trace outbreaks; and invest in therapeutics and preventative treatments to slow the virus’ spread to more vulnerable populations. The report emphasized moving through four phases to transition back to a more normal world.
In order to move through these phases, the institute recommends issuing same-day, point-of-care diagnostic testing for frontline workers, including hospital and health care workers as well as those who have had the coronavirus and those exhibiting symptoms of the virus. Moving into phase two — which includes opening businesses and schools but keeping limited amounts of physical distancing and heightened public hygiene efforts — means testing 750,000 Americans per week, sustained reduction of cases for at least two weeks, and hospitals no longer needing to operate at a crisis level of care.
Although a vaccine for the virus seems a ways off, Dr. Scott Gottlieb, who co-authored the institute’s report, recently said millions of vaccine doses could be available in the fall for human trials.
On April 20, Harvard’s Edmond J. Safra Center for Ethics issued a report suggesting that by early June the country should administer five million tests per day to move toward cautious social reopening, which would increase to 20 million per day in order to fully reopen society. If the country only leans on physical distancing, social life and the economy will be shut down for a year to 18 months, estimates the report, which is why its authors recommend expanded testing, contact tracing and supported isolation of infected individuals. The report also urges a path of phases for gradually reopening individuals to economic and social normality. Moving to phase two — which includes expanding the number of essential workers and relaxing physical distancing — would mean testing all essential workers or about 40% of the country.
A pilot contact tracing program has already begun in San Francisco, as outreach and software workers are tracing those who have been exposed to the coronavirus.
Another effort to slowing the pandemic may be a policy of centralized isolation, so infected individuals need not go home and potentially spread the virus as may be happening in the U.S. East Asian countries like Hong Kong, China, Taiwan and South Korea have been using this tactic, likely to their success.
CONTACT TRACING LOCALLY
Nevada County has expanded its team of contact tracers, which includes public health nurses. The county also has plans to expand its team to public health staff, health and human service agency workers as well as volunteers, according to Cutler.
“We’re also exploring the use of a platform developed by the CDC, and we are in communication with the state about the possibility of them supplementing our efforts, but no concrete decisions or commitments have been made yet,” he wrote.
With the added resources implemented in the state, Newsom recently said California is weeks away from “meaningful changes” to its shelter in place order. Grass Valley and Nevada City have already begun partially opening its parks.
Even so, Cutler warned that as the state moves through its reopening phases, this year will not look like the one prior.
“Even as re-opening progresses, we do not expect 2020 to look like 2019,” he wrote. “There will be a new normal until we have an effective and safe vaccine that has been widely distributed.”
To contact Staff Writer Sam Corey email firstname.lastname@example.org or call 530-477-4219.
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Following the addition of the single-dose Johnson & Johnson COVID-19 vaccine to the U.S. vaccine rollout — joining two-dose vaccines produced by Pfizer and Moderna — local health officials have encouraged residents to take whichever of the three first becomes available to them.