COVID-19: Invest now, or pay later

A storm is blowing across America. A storm that has swept Asia and Europe and now threatens to pull the rug of calmness from under the United States approach to managing its COVID-19 outbreaks.

It started with the return of a few seasonal travelers, whose risk of exposure and illness was underestimated in early January. It continued with the calm return of 800 Americans who had lived in Wuhan City, three of these will later test positive. This was followed by the return of 14 people with COVID-19, evacuated from the Diamond Princess Cruise ship, and who were equally split to share two chartered planes with passengers  who had not tested positive for this virus, against the advice of the Centers for Disease Control and Prevention, and unknown to the other passengers. Ultimately 45 of these cruise ship returnees tested positive for SARS-CoV2, the virus that causes COVID-19. What started as a soft breeze gently brushing the cheeks of a nation is quickly changing into the loud hissing of mighty rushing wind and a darkening of the sky as lives are getting lost in America. A hissing wind that should cause us to clutch our beach gear and head for shelter. Within 24 hours of the first United States COVID-19-related death, a 50-something-year-old man with no travel history from an affected country, there is an outbreak investigation involving more than 50 people in a nursing home with vulnerable patients. A high schooler is ill. The elderly and healthcare workers - two demographic populations the World Health Organization warns we should protect the most - have been affected.

The hissing of the wind is the sound from many quarters: Death in a second patient in his seventies in Washington State, and four more by the end of the next day; the first confirmed case of a person in Rhode Island with 40 potential contacts; a new confirmed case in New York of a 39-year-old healthcare worker  who had just returned from Iran. When those infected from community acquisition supersede those acquired in other countries can America soon have widespread disease like China?

In the rest of the world, confirmed cases in France and Germany tripled from 57 to 165 and 57 to 191 respectively in 48 hours. The number of cases in Hubei province in China  increased two days in a row after a slight period of decline, while on March 2 it reported 206 new cases, the lowest since Jan 22. In the meanwhile United Kingdom confirmed 12 new cases on March 1 and four more who had returned from travel to Italy on March 2.In the meanwhile Italy’s confirmed cases have topped 2000 with 52 reported deaths with the largest spike of a 50% spike between Feb 29 and March 1. In Africa, four of the six countries affected have one patient each directly related to travel from Italy. New cases in Brazil, Ireland and Switzerland had all returned from travel to Italy. Almost all the countries who evacuated their citizens from Wuhan City at the height of the epidemic are fighting to contain the infection as there is evidence of community spread. African countries that did not have the resources to evacuate their citizens and place them in quarantine seem to be relatively free of disease and community transmission except for eleven travelers who arrived from other countries, mostly from Italy, France and China. Most of these African countries have reported single digits with no evidence of community spread as contact tracing gets underway: one in Tunisia, five in Algeria, one in Nigeria, one in Morocco, two in Egypt, one in Senegal and one in Tunisia. In the last 24hours, the total number of countries affected is approaching 70 with new member states Tunisia, Morocco, Senegal, Armenia, Czech, Dominican Republic, Luxembourg, Iceland, and Indonesia reporting cases.

All of this is telling us something: If we don’t fight this virus together, it will continue to gain ground.

Some of the most affected places have established mass quarantines or restricted travel to, from, and within their borders. Vietnam has had no cases in 18 days after calling a time out to all travel. A 20-day mass quarantine in Son Loi Province will end March 4. These are firm measures that experts said may have turned the trajectory of China’s epidemic, but that require sacrifices and resources that not every nation can muster. Few smaller nations would have the economic muscle to lift the weight of individual travel bans, and few governments have the political muscle to limit their citizens movements. Almost all potentially affected countries have examined their capacities and sought to increase them. Measures both large and small scale have, in many places, come too late to avert illness and loss of life – but were indispensable steps. Some learned through bitter experience that they didn’t have what they needed. As we fight this pandemic potential threat, we must also prepare for the next.

These are some of the reasons that the World Health Organization has called for an infusion of $675 million for international responses that coordinate efforts and ensure resources and train health workers in in countries where health systems aren’t sufficiently prepared to confront the spread of a respiratory disease. It is why the Infectious Diseases Society of American, the physicians association of which I am a member, and that produces this blog, has joined other associations of health providers and advocates to ask the U.S. Congress to produce enough immediate, new funding to face the challenges ahead.

It is already getting late, as the events of this last weekend have shown us. The later it gets, the greater the cost will be – in lives, and in the economic impacts of this storm, if it becomes a pandemic.