Former CDC director: A coronavirus pandemic is inevitable. What now?

Covid-19 will become a pandemic. We don't yet know how severe it will be, nor do we know if the virus will spread to all continents, but it's already spreadi...

Posted: Feb 25, 2020 5:24 PM
Updated: Feb 25, 2020 5:45 PM

Covid-19 will become a pandemic. We don't yet know how severe it will be, nor do we know if the virus will spread to all continents, but it's already spreading widely in China, South Korea, Italy, Iran and elsewhere -- and thousands of undetected and infectious patients have been and continue to travel around the world.

This is unprecedented. Other than influenza, no other respiratory virus has been tracked from emergence to continuous global spread. The last moderately severe influenza pandemics were in 1957 and 1968; each killed more than a million people around the world. Although we are far more prepared than in the past, we are also far more interconnected, and many more people today have chronic health problems that make viral infections particularly dangerous.

Based on extensive planning for an influenza pandemic by many national and international experts, we must do eight things -- some immediately and some in the coming months -- as we shift from the initiation phase of the pandemic to the acceleration stage:

  1. Find out more about how Covid-19 spreads, how deadly it is and what we can do to reduce its harms. As many as half of people with infection have no symptoms, and at least 80% of those who do feel ill have only mild symptoms. In Wuhan, China, the reported proportion of diagnosed patients who die is now 3%. That's a substantial over-estimate; many patients weren't tested, many infected people don't have symptoms and hospitals were overwhelmed. The proportion could be as low as less than 1 in 1,000 -- 30 times lower -- and is unlikely to be more than 1 in 100. The actual rate makes a huge difference, not only to patients but also to decisions about interventions.
  2. Reduce the number of people who get infected. If it turns out that many of those infected become severely ill, this would justify drastic measures such as closing or curtailing hours of schools, limiting public gatherings and reducing social contact. The lower the risk of death from infection, the less sense it makes to take these and other actions that disrupt social and economic stability. In any case, spread can be minimized by quickly isolating those who are ill, cleaning potentially contaminated surfaces often and changing common routines. We need to get serious about little things that make a big difference: washing hands, covering coughs and, if we're sick, staying home or wearing a mask when we go out. Let's stop shaking hands for a while. I prefer the traditional Southeast Asian hands-together namaste greeting, although the elbow bump is fun.
  3. Protect health care workers. Even before Covid-19, far too many health workers and patients got infections in health care facilities. We need fast and drastic improvements in triage, treatment, cleaning and overall infection prevention. A shortage of medical masks is likely; we need to ensure health care workers have enough, as should household members caring for sick relatives and people who are ill and need to go outside. For health care workers, newer, longer-lasting technologies such as elastomeric and positive air pressure respirators could address an otherwise inevitable shortage of medical masks.
  4. Improve medical care and prevention of Covid-19. A vaccine is at least a year away, and success is uncertain. Treatments that hold promise need to be evaluated rigorously. In a moderately severe pandemic, there wouldn't be enough ventilators to support patients' breathing. Health facilities and health departments in the United States can prepare for a worst-case scenario by preparing -- with training, equipment, and detailed operational plans -- for a surge in the number of patients who seek care and for the subset of those who need to be mechanically ventilated, including through ventilators available from the Strategic National Stockpile.
  5. Protect health services. During the 2014-2016 Ebola epidemic in West Africa, more people died because of disruptions of day-to-day health care than died from Ebola. Telemedicine needs to become much more accessible, and people with chronic conditions should receive three months of medications whenever possible, in case there are supply disruptions. Routine vaccinations and other preventive services need to be preserved.
  6. Support social needs. Patients and their families will need support, especially those who are isolated and less familiar with virtual or delivery services. Continuing to support individuals and groups ranging from community centers to nursing homes will require detailed plans.
  7. Protect economic stability. Continuing to plan, teach, learn and work will reduce disruption. Businesses need to be ready to maximize telecommuting, increase cross-training and operate with as many as 40% of their staff ill or quarantined. Mission-critical enterprises need practical plans to continue to operate.
  8. Invest in public health. It will cost about $1 a person per year for at least a decade to build the health protection systems needed in Africa and Asia. That's a lot of money -- about $25 billion -- but a tiny fraction of what a preventable epidemic such as this one can cost. (SARS cost $40 billion; estimates for the potential cost of Covid-19 exceed $1 trillion.)

The virus and appropriate interventions will behave differently in high-resource than in low-resource areas, depending on crowding, capacity for diagnosis and treatment, and ability to reduce spread. We don't yet know if Covid-19 will result in thousands, hundreds of thousands, or millions of deaths.

Above all, we must do no harm. We don't shut schools every year for seasonal influenza, and we didn't shut them for the 2009 H1N1 influenza pandemic, for good reason: The severity level didn't merit it. If the virus did emerge from the wet market selling exotic animals for food in Wuhan, then China's failure to close such markets after SARS is the fundamental cause of this outbreak.

On the other hand, China's extraordinary cordon of Hubei province and other areas bought the world at least a month of lead time to prepare. The past week's news means that the world must take these steps, and fast, to limit the health, social and economic harms of the COVID-19 pandemic.

Indiana Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 77565

Reported Deaths: 3105
CountyConfirmedDeaths
Marion16304733
Lake7840283
Elkhart499287
Allen4103164
St. Joseph368183
Hamilton2941104
Vanderburgh208215
Hendricks1972109
Cass18099
Johnson1800119
Porter139139
Clark133350
Tippecanoe126312
Madison104866
LaPorte95730
Howard93865
Kosciusko87212
Bartholomew84447
Floyd83750
Marshall80123
Monroe77732
Delaware76852
Vigo75213
Dubois71812
Noble70829
Boone70446
Hancock69439
Jackson6065
Warrick60030
Shelby57228
LaGrange56910
Grant53230
Dearborn52228
Morgan49235
Henry46020
Clinton4564
Wayne40210
White38011
Montgomery36321
Lawrence35827
Harrison35524
Decatur34732
Putnam3288
Daviess28420
Miami2792
Scott27810
Jasper2592
Greene25634
Franklin24915
Gibson2434
DeKalb2424
Jennings23212
Ripley2208
Steuben2173
Fayette2057
Carroll2033
Perry18813
Posey1810
Starke1817
Orange17924
Wabash1795
Wells1782
Fulton1742
Jefferson1722
Knox1681
Whitley1606
Tipton15416
Sullivan1521
Washington1481
Clay1415
Spencer1393
Randolph1325
Huntington1303
Newton12110
Adams1202
Owen1101
Jay940
Rush914
Pulaski841
Fountain762
Brown752
Blackford662
Pike660
Ohio656
Benton630
Vermillion610
Parke591
Switzerland560
Martin500
Crawford480
Union410
Warren251
Unassigned0207

Ohio Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 105426

Reported Deaths: 3755
CountyConfirmedDeaths
Franklin19124533
Cuyahoga13999519
Hamilton9917260
Lucas5544324
Montgomery4544101
Summit3712224
Butler307064
Marion295245
Mahoning2644258
Pickaway240442
Stark1931142
Warren187739
Lorain186777
Columbiana169960
Trumbull1578111
Fairfield144933
Delaware137819
Licking136751
Clark121815
Lake115443
Wood110158
Clermont98111
Medina97736
Miami88139
Allen81746
Tuscarawas80114
Portage78063
Greene74212
Mercer66813
Belmont62826
Richland62612
Erie61928
Ashtabula58046
Madison58010
Wayne56759
Geauga56545
Ross5204
Darke42529
Huron4135
Hancock4103
Sandusky40717
Ottawa40527
Athens3642
Holmes3316
Lawrence3230
Auglaize2866
Union2771
Scioto2601
Muskingum2561
Seneca2424
Jefferson2403
Preble2192
Shelby2194
Knox2189
Putnam21517
Washington21222
Coshocton1999
Champaign1922
Morrow1852
Hardin18012
Crawford1775
Clinton1746
Highland1692
Logan1692
Perry1643
Fulton1581
Ashland1563
Defiance1554
Wyandot1559
Brown1502
Williams1393
Fayette1260
Henry1242
Hocking1229
Guernsey1217
Carroll1145
Monroe9418
Pike800
Gallia781
Jackson780
Van Wert732
Paulding720
Adams682
Meigs630
Vinton322
Morgan310
Harrison261
Noble190
Unassigned00
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Huntington
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Decatur
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Van Wert
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