In the past couple days I got asked by many of my contacts, friends and relatives what I think of the Corona-situation. In my view, the battle is not lost but swift and decisive actions are needed that require not only actions from the authorities but also the participation of everybody. We still can win the race against the disease as long as we are persistent. It also will be useful to learn from others that were successful such as Taiwan. This country of 23 million had until the crisis a very active exchange of people and goods with its neighbor China. Despite this, Taiwan managed to contain the disease to a few dozen cases (read more in JAMA: https://jamanetwork.com/journals/jama/fullarticle/2749214).
In many countries health authorities start to lose track of transmission chains. But this is not the moment to turn to a fatalistic world view. The population-wide spread of COVID-19 can still be prevented even if we don’t catch every single case. We are not helpless even if models predict the rapid spread of the disease because transfection rates are not a given constant but influenced by our protective strategies. Even if we don’t manage to identify each potential spreader, we can stay in control by decisive and swift measures. Isolation of confirmed cases and quarantine of their contacts must continue but we also require the active participation of the population. Clear communication that reaches both the heart and the brain of the people is key for this.
The three key elements in my view are:
- Continued isolation of confirmed cases and those with symptoms: every patient needs to be isolated to prevent spreading the virus, even if the person’s status does not require hospitalisation. All need to be followed closely by the medical authorities including that their isolation is correctly done. Most countries have this in place.
- Continued quarantine of contacts: all those who were in close contact during the infectious period of the case, which is from 48 hours before the onset of symptoms until the case was declared fully recovered. Healthy contacts can stay at home for the quarantine but need to be isolated. Their health status needs to be regularly checked. What is also needed is to make sure that their basic needs are met, which includes to still have a job when they return to work and an income during the quarantine.
- Participation of the population: People know who they are in contact with. They observe what is going on around them and they will be able to act on their own if they understand why it is necessary and what they can and should do. It is not sufficient to explain good practices. Rather, we must gain the hearts of the people so that they are happy to participate.
Fighting the virus will not be an easy game. Authorities need to have the resources and they need to pace their efforts because this is an endurance race, lasting for many weeks if not months to come. Support can also come from professional societies and practitioners. We also need to think beyond current limitations. For example in Taiwan, when they realised that they are going to run short on protective material such as masks, the government kicked in money to build additional production lines. Now they produce about ten million hygiene masks per day for the local market. Also the budget to fight the virus and its consequences for the country is very large.
One way to increase awareness amongst people is to show what happens when a person gets sick. This will also be effective to counter those who ridicule the efforts. This is not just another flu, and only few would have died anyway soon. A good way forward can be to give a face to the disease by portraying those affected in a way that respects human dignity and privacy. People above 65 are at high risk of dying from COVID-19. The majority of those who risk to die from COVID-19 during a wide-spread epidemic are still in good health. They will die for the sole reason that there will be no bed left for them in the intensive care unit due to the large number of serious cases admitted at the same time.
Finally some counter-intuitive thinking may be worth some research efforts: In Taiwan, wearing hygiene masks in public, at work and in meetings is a basic standard approach. This does not sound logical at first because hygiene masks are considered to „only“ prevent the release of droplets from those already infected, but not effective against inhalation of viruses. However, different from respirator filter masks, hygiene masks can be worn all day long. If we have enough masks for everybody, and we can convince everybody to wear them whenever they are close to other people, they may be effective to prevent many airborne infections simply because the viruses rarely will become airborne. Also, such masks are likely to make touching the mouth and nose difficult, thereby helping to reduce this very common route of spreading and infection. It would be worth to further study these two hypotheses so that we know if wide-spread wearing of hygiene masks could be a strategy to be applied in future crises.