U.S. public health officials have gotten off to a rocky launch with their plans for more routine testing in at least five cities for Covid-19, the respiratory virus that has sickened tens of thousands and killed thousands, mostly in central China around the city of Wuhan.
The American screenings signal how authorities around the globe have begun shifting from one big C in combating the coronavirus — containment — to a new focus on another big C: clusters.
Uncomfortable questions already are jumping up about efforts to detect viral outbreaks of any size outside of China due to problems with the accuracy of available tests for Covid-19. American plans for screenings, for example, may be hampered by lack of supply and “inconclusive” results produced by test products. Public health officials had hoped to use these screens in the existing system for flu detection to find scattered viral infections to prevent them from spreading.
Controversy continues to dog China’s infection fighting, especially its sweeping quarantine, the authoritarian nation’s effort to lock down tens of millions of people for weeks now to slow or stop the spread of Covid-19. The Beijing government, which also is trying to jump start the temporarily decommissioned Chinese economy, continues to catch international and domestic flak for its constantly fluctuating figures and reports on when the Covid-19 outbreak began, how it spread, how many people may be infected, how many have died, and how long the disease takes to run its course.
Health officials outside of China, however, also are finding how readily criticisms fly and how difficult it can be to cope with a fast-spreading, debilitating, and potentially deadly disease outbreak.
Concerns are rising about Covid-10 “clusters,” dozens of cases popping up in select areas of Korea, Singapore, Italy, and Japan, where authorities are taking high levels of heat for their chaotic quarantine off Yokohama of a cruise ship with thousands of crew and passengers aboard. Passengers, other governments, and experts in epidemics attacked the Japanese decision to lock down the cruise ship, creating what critics say was a viral hothouse.
The Japanese eventually relented just before an announced two-week quarantine was to end, allowing frail and vulnerable passengers to disembark for hospitalization ashore. Other nations, including the United States, stepped in and evacuated their citizens in airlifts home. Japanese officials have apologized for the bungled lockdown, including allowing ill and untested ship passengers to depart the quarantine.
As two passengers aboard the ship died in Japan of Covid-19, a dispute flared between the U.S. State Department and the federal Centers for Disease Control and Prevention. The CDC, with globally respected medical expertise, fought the State decision to mingle sick and well, tested and untested cruise ship passengers on the same flight home. Passengers also have said they did not know that some of those aboard their flights home were sick. This dispute not only has raised eyebrows about its public disclosure but also concerns about the Trump Administration’s readiness and capacity to run a large virus response, should it become necessary.
If the Diamond Princess lockdown has become a subject of expert study for fostering Covid-19’s spread — and authorities are examining how the illness was transmitted, including by individuals without symptoms and contact with the bug on surfaces not sanitized — the cruise ship also may go into the books at the first site of a large cluster of infections outside of the disease epicenter in China.
Japanese medical investigators are scrutinizing their nation’s dozens of Covid-19 infections, tracing them in painstaking fashion to the cruise ship, individuals who had contact with individuals connected to the vessel, or to travelers to China and Hawaii, too.
In South Korea, Covid-19 infections have burgeoned in Daegu, the nation’s fourth largest city in the southeast. Hundreds of cases have been confirmed, making this one of the largest disease clusters outside of China and exceeding those linked to the Diamond Princess. Authorities are uncertain how the disease spread into Korea, though it may have occurred due to contacts in China. Many of the infections are linked to a controversial church (see photo above, from video posted by the Telegraph of London.) As Time reported:
“Most of the new cases in the southeastern region are linked to a church in Daegu. The Shincheonji church, which claims about 200,000 followers in South Korea, said it has closed all of its 74 sanctuaries around the nation and told followers to instead watch its worship services on YouTube. It said in a statement that health officials were disinfecting its church in Daegu and were tracing the woman’s contacts. The Daegu church has about 8,000 followers. Shincheonji, which translates as ‘New heaven and new Earth,’ is a controversial new religious movement established in 1984 by Lee Man-hee. The church describes him as an angel of Jesus sent to testify about the fulfilled prophecies of the Book of Revelation.”
The continuing spread of the virus, including with fatalities in Iran and worries about how the infection might ravage the developing world, also is increasing fears about the potential for major harms to the global economy.
The virus’ next course remains difficult to forecast, even with big improvements in computer-driven modeling and analysis. Has the much-reviled Chinese quarantine actually been a boon to the world’s health, giving authorities around the world more time to halt Covid-19’s explosion into a lethal pandemic? Can health officials detect than pour resources into localized outbreaks or clusters of infections and hold the line there? Or will the virus slip containment and become an illness akin to a terrible flu? As a former chief of the federal Centers for Disease Control and Prevention has written:
“If the virus is not containable, spreads widely, and continues to have a case fatality rate in the 1% range, then we will be in uncharted territory – similar to an influenza pandemic, but caused by a different virus. Fortunately, extensive analysis and planning has gone into preparing for an influenza pandemic, and most of this planning is relevant in this worst-case scenario. Here’s what communities can do to blunt the health harms of a pandemic with a high case fatality rate, well outlined by CDC for influenza. In this worst-case scenario, first, reduce the number of people who get infected. This can be done by closing or curtailing hours of schools, limiting public gatherings, and increasing social distancing; encouraging hand washing and cough etiquette; quickly isolating those who are ill or who are at risk for becoming ill and infecting others; and cleaning frequently touched surfaces. Reducing spread to health care workers, patients, and visitors in hospitals is particularly important.
“Second, improve the chances of survival for those who are infected. This will require rapid diagnosis, learning about and applying optimal management for patients severely ill with the virus, and scaling up supportive care, including supplemental oxygen and mechanical ventilation to support patients until their infection subsides.
“Third, maintain essential services, including both health care and broader social and economic activity. For example, public and private sector institutions may need to plan to continue operations if 40% of their employees are ill or quarantined—again, in the worst-case scenario.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the benefits they can enjoy by staying healthy and out of the U.S. health system with its significant problems with medical error, preventable hospital acquired illnesses and deaths, and misdiagnoses. That system already is treating hundreds of thousands of patients infected with another virus — the seasonal flu, which has killed at least 14,000 Americans, including more than 100 children. Can the world’s most expensive health system stand up, if tested by Covid-19, which, by all accounts has a higher fatality rate than the seasonal flu (H1N1 or B varieties)?
We need to ensure politicians and public health officials do not panic or create one, while asking for and getting, then marshaling the appropriate and needed resources to keep us safe and healthy. We’ve got a lot of work to do.