Seven months into the coronavirus pandemic, with more than 8 million positive cases and at least 220,000 deaths in the U.S., questions arise: What lessons have we learned from this unprecedented health crisis? Did we make the right decisions? And will there be a second wave of infections — or has it already happened?
Yahoo Life has teamed with Emmy- and Peabody Award-winning broadcaster Soledad O’Brien to explore those topics in the town hall titled “Coronavirus: The Second Wave” featuring a panel comprising Dr. Oxiris Barbot, the former New York City commissioner of health (in August, she left her position of two years citing “deep disappointment” in the city’s coronavirus response, according to the New York Times); Dr. Abdul El-Sayed, a physician and epidemiologist and the author of the book Healing Politics; and Brian C. Castrucci, an epidemiologist and the president and chief executive officer of the de Beaumont Foundation, a charitable foundation focusing on public health. (Watch above.)
Although there is no scientific definition for an infectious “wave,” the term generally describes a decline, then a surge in infections. According to data compiled by the New York Times, the U.S. has an average of 59,000 cases per day, which is the highest number since August. The 1918 influenza pandemic, often compared to the coronavirus crisis for its severity, experienced three waves while causing 50 million worldwide deaths, says the Centers for Disease Control and Prevention. In July, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said the U.S. is “knee-deep in the first wave.” The CDC, fearing a further health crisis, is urging flu shots as we enter the colder months.
In hindsight, what lessons have we learned as winter nears? “We know that public health officials in many ways are the canaries in the coal mine, and certainly were, at the beginning of this pandemic,” says O’Brien. “As the cases rose sharply, it was public health officials that were doing the warning of shutting things down. But for the most part, I think many leaders listened a little bit too late.”
“What was the red flag for you?” O’Brien asks Barbot. “When did you think, ‘Hey, we need to be thinking about shutting down,’ and when was the city actually shut down in a way that you thought was appropriate?”
After New York City’s first resident tested positive on March 1, health officials documented community transmission and, over the next few days, there was an increase of symptomatic people in emergency rooms, says Barbot. “And so we began the conversations in earnest at that time.”
On March 14, New York City Mayor Bill de Blasio announced the city’s first death from COVID-19. Two days later, on March 16, New York City schools shut down and, on March 20, Gov. Andrew Cuomo implemented the New York State on PAUSE executive order, which closed nonessential businesses and banned nonessential gatherings. With its packed population, the city soon became a pandemic epicenter.
Of the time period between the city’s first infection and the closure of schools, Barbot says, “I think we were slow on making that decision, and a part of what I hope we’ve learned from phase one is that COVID is like a supersonic train. Once it gains momentum, you can’t dither with the decision making. You need to act fast to put into place measures that are going to keep it from continuing to transmit.”
Since the virus has continued to spread across the country, affecting various regions of the U.S. at different times, El-Sayed explains, “Once you become aware, it’s already too late because we’re talking about exponential math, not linear math,” adding, “Science is not a book of knowledge — [it’s] a process by which we ask and answer questions. The SARS-CoV-2 has only been in humanity now for a little bit less than a year. And so it’s really hard to know a lot of things about this virus until you actually start studying them.”
Scientists have learned that the virus is transmissible by asymptomatic and presymptomatic people (the latter of whom will eventually develop symptoms) and that the virus is spread through respiratory, contact or airborne transmission. But early guidance from the CDC was inconsistent.
“We were hustling, trying to understand just very basic questions,” explains El-Sayed. The discoveries underscored prevention strategies like lockdowns, distance learning, handwashing and social distancing.
One controversial strategy has reportedly been praised by White House coronavirus task force adviser Dr. Scott Atlas and the physician authors of “The Great Barrington Declaration,” which suggests, in the absence of a COVID-19 vaccine, reaching “herd immunity” (when enough people become immune to a disease) through natural infection. Dr. William Schaffner, an infectious disease expert at Vanderbilt University, previously told Yahoo Life the move would come “at the price of huge amounts of social disruption, sickness, hospitalizations and, obviously, deaths.”
Sweden, with more than 107,000 cases and at least 5,900 deaths, took this approach, allowing businesses and many schools to stay open as the number of cases increased. But while there have been more than 221,000 deaths in the U.S. from COVID-19, Sweden’s population is 10 million, compared with the 330 million living in the U.S. Barbot called the concept “reckless at best” and “a recipe for disaster” when applied to a novel virus and on a population with many underlying health issues.
These debates have boiled over as many U.S. schools, following state or local mandates, offer in-person, remotely or hybrid lessons while facing outbreaks. Recent science shows that without masks, kids could “facilitate silent spread through a community.” But whether schools are, in fact, superspreader sites, is debatable.
“One of the important things we’ve learned about this coronavirus ... is it just doesn’t seem to be as infectious and as likely to cause severe illness among children,” says El-Sayed. “That being said, there’s a lot of people pushing this argument that children are immune — that is not true,” pointing to a Georgia overnight camp with hundreds of cases that did not require kids to wear face masks.
Health agencies now agree that face masks can protect against COVID-19, but some question their efficacy, including President Trump, who has been erratic in his endorsement. “What will public health do in order to move that out of political debate?” asks O’Brien.
“It’s really hard for public health leadership to succeed when the president, the greatest leader in our land, is undercutting every message that we have,” says Castrucci. “There’s an opportunity for us to ensure that we will never have a moment in our history when health is at the whims of partisanship.”
Due to “a diversity of approaches to tackling the virus” across the U.S., the reality of a second wave isn’t known, Barbot explains.
“We can’t say with one fell swoop: ‘The entire country is still in the first wave’ [or] ‘the entire country is now in the second wave,’” says Barbot. “We’re guaranteed to have a resurgence; there’s going to be an increase in the number of cases — to what degree that is going to affect cities is going to be dependent on individual behavior but also on systems,” such as adequate PPE and the retention of essential workers.
But heading into fall, when people generally stay indoors (where virus transmission could spread farther than six feet, according to October CDC guidance), is concerning, says El-Sayed. “Most of all,” he admits, “I’m worried about pandemic fatigue. I’m worried that people say, ‘You know what? I’ve been there, done that. ... Come what may.’ And the worrisome thing about this is that what may come may be a lot worse.”
Most people will experience milder cases and won’t need hospitalization, says Barbot. “But what we don’t know is the degree to which they will have long-term consequences as a result of the infection,” referencing multi-system inflammatory syndrome (MIS-C) among children, a rare but serious illness that causes multi-organ inflammation that could be linked to COVID-19.
“What I remind folks is that when public health advocates for the use of face coverings, we’re not trying to restrict people’s individual liberties,” she says, but rather “advise on ways in which they can fully exercise them safely.”
Combating pandemic fatigue rests on a philosophy, says Castrucci. “We are staying apart now so that when we can gather again, everyone’s there. If you don’t want to wear a mask, if you don’t want to socially distance, next time you gather with your family, pick the person that you don’t want to be there anymore.”
He uses this grave analogy: “If you are someone who’s watching football, that’s ... two entire stadiums — that’s the entire stadium twice is the number of people we’ve lost. If that doesn’t get you to socially distance or wear a mask, I don’t really know what would.”
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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