COVID-19: As spread outside China rises, CDC warns community transmission in U.S. is likely

Message marks significant escalation in tone, as WHO China mission team leader describes scope, impacts of country's response, calls for global "shift in mindsets"

Federal officials expect to see community spread of the novel coronavirus that causes COVID-19 in the United States, and are preparing for the potential need to launch measures that could include closing schools. Indicating for the first time that locally generated transmission of the virus in the U.S. is inevitable, Dr. Nancy Messonnier of the U.S. Centers for Disease Control and Prevention, urged "people and their families to start planning for this," adding "we want to prepare people for their lives to be disrupted."

Saying data from other countries where the virus has begun to spread among people without a recent history of travel in China "has certainly raised our level of concerns and expectations," Dr. Messonnier described how, in the absence of a vaccine or proven treatments to mitigate the effects of COVID-19, large scale "non-pharmaceutical interventions" -- NPIs -- on personal, community and environmental levels would become the first line of defense against the spread of the disease. While personal measures would include hand-washing, staying home when sick, and maintaining distance from sick people, and environmental levels would include "surface cleaning," community measures could include remote work, use of telemedicine and delaying elective surgery and canceling mass gatherings, as well as closing schools and employing internet learning, Dr. Messonnier said.

She spoke today as the leader of a WHO-organized mission of international disease experts just returned from China described over the course of a two-hour briefing how that country used "old-fashioned public health tools applied with rigor on a scale never seen," to turn the trajectory of the COVID-19 epidemic there. "You can change the shape of this," he said. "It takes a very aggressive and touch approach."

China measures included mass containment and movement limitation, with locally tailored approaches that included closing commerce and travel to and within entire cities, he said, describing trains speeding past stations in still and silent cities of skyscrapers. While he said the success of those measures was empowered by collective cooperation, he did not describe what the alternative to that cooperation was, in a country with an ongoing record of confronting dissent with firm and silencing measures. It also, he said, was enabled by technology that allowed swift responses to outbreaks, and it was driven by science, which sped the release of six successive COVID-19 clinical treatment guidelines over the course of six weeks.

The steep downward curve of new infections shown in data was validated by the experiences of those on the front lines that included "fever clinics" without lines, and hospitals with available beds. The data suggest that "not a lot of evidence that there's a lot more disease than what we're seeing," he said, pointing the steep drop in cases since the middle of February. "Would you be able to get to that if there were a lot of unseen cases?"

The number of cases and weeks of surveillance also have yielded information on the severity of the disease and its outcomes, he said, showing that while most cases have not been severe, even mild cases originally recognized as mild ended in deaths.

"This virus kills people," he noted. "It kills the most vulnerable."

Containing its spread and impacts would require a "shift in mindsets" everywhere he said, "Where this goes is within the control of our decisions."

As the team left China, the possibility that the virus will surge again remains, he noted. But it will find a changed landscape, he said. "They had this downward trajectory, and what were they doing? Building hospital beds, buying ventilators, being prepared."