Saturday, December 05, 2020

MMWR: Public Health Strategies to Address High Levels of Community Transmission of COVID-19



We find ourselves entering our first full winter season of COVID-19 with nearly 300,000 American pandemic deaths, infections and deaths continuing to rise, and months before any vaccine will have a significant impact on the spread of the virus. 

We are also a pandemic fatigued society, longing for some semblance of normalcy after 9 months of anything but. We see jobs gone, savings evaporated, and for some, hope lost.

And while COVID can be deadly for the elderly and younger people with certain comorbidities, most healthy people appear to recover after a brief illness.  All of which makes it difficult for some people to maintain the daily precautions urged by the CDC against the virus. 

As a result, community mitigation efforts and morale are slipping, just as the worst of the pandemic is upon us.

More than a decade ago, as we were coming off the last pandemic, I addressed the difficulty in getting the public to take a mild-to-moderate pandemic seriously. In None So Blind As Those Who Will Not Listen, I wrote:

The popular `lay’ perception of a pandemic – at least in the western world – seems to be based on novels like George R. Stewarts Earth Abides, Stephen King’s The Stand, and the BBC’s production of Survivors.

George Romero fans would argue that if it doesn’t involve zombies, it doesn’t really qualify as a pandemic. 

By those standards, the status of 1918 as a pandemic would be in doubt.

Although the COVID pandemic appears to be far less impactful than 1918, it is certainly the worst we've seen in the past hundred years. We are a long way from seeing the final chapter of this pandemic, and there is always the possibility of another shoe dropping before this crisis ends.

While it may fall on largely pandemic-weary ears, the CDC's MMWR has published a summary of public health strategies - essentially the only tools we have to mitigate the pandemic right now - to blunt  the impact of COVID-19 until a full roll out of a vaccine can be achieved. 

Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020

Early Release / December 4, 2020 / 69
Margaret A. Honein, PhD1; Athalia Christie, MIA1; Dale A. Rose, PhD1; John T. Brooks, MD1; Dana Meaney-Delman, MD1; Amanda Cohn, MD1; Erin K. Sauber-Schatz, PhD1; Allison Walker, PhD1; L. Clifford McDonald, MD1; Leandris C. Liburd, PhD1; Jeffrey E. Hall, PhD1; Alicia M. Fry, MD1; Aron J. Hall, DVM1; Neil Gupta, MD1; Wendi L. Kuhnert, PhD1; Paula W. Yoon, ScD1; Adi V. Gundlapalli, MD, PhD1; Michael J. Beach, PhD1; Henry T. Walke, MD1; CDC COVID-19 Response Team (View author affiliations)View suggested citation


What is already known about this topic?

The United States is experiencing high levels of SARS-CoV-2 transmission.
What is added by this report?
COVID-19 pandemic control requires a multipronged application of evidence-based strategies while improving health equity: universal face mask use, physical distancing, avoiding nonessential indoor spaces, increasing testing, prompt quarantine of exposed persons, safeguarding those at increased risk for severe illness or death, protecting essential workers, postponing travel, enhancing ventilation and hand hygiene, and achieving widespread COVID-19 vaccination coverage.

What are the implications for public health practice?

These combined strategies will protect health care, essential businesses, and schools, bridging to a future with high community coverage of effective vaccines and safe return to more activities in a range of settings.

In the 10 months since the first confirmed case of coronavirus disease 2019 (COVID-19) was reported in the United States on January 20, 2020 (1), approximately 13.8 million cases and 272,525 deaths have been reported in the United States. On October 30, the number of new cases reported in the United States in a single day exceeded 100,000 for the first time, and by December 2 had reached a daily high of 196,227.*
With colder weather, more time spent indoors, the ongoing U.S. holiday season, and silent spread of disease, with approximately 50% of transmission from asymptomatic persons (2), the United States has entered a phase of high-level transmission where a multipronged approach to implementing all evidence-based public health strategies at both the individual and community levels is essential.
This summary guidance highlights critical evidence-based CDC recommendations and sustainable strategies to reduce COVID-19 transmission. These strategies include:

  1. universal face mask use
  2. maintaining physical distance from other persons and limiting in-person contacts,
  3. avoiding nonessential indoor spaces and crowded outdoor spaces,
  4. increasing testing to rapidly identify and isolate infected persons,
  5. promptly identifying, quarantining, and testing close contacts of persons with known COVID-19,
  6. safeguarding persons most at risk for severe illness or death from infection with SARS-CoV-2, the virus that causes COVID-19,
  7. protecting essential workers with provision of adequate personal protective equipment and safe work practices,
  8. postponing travel,
  9. increasing room air ventilation and enhancing hand hygiene and environmental disinfection, and
  10. achieving widespread availability and high community coverage with effective COVID-19 vaccines.
In combination, these strategies can reduce SARS-CoV-2 transmission, long-term sequelae or disability, and death, and mitigate the pandemic’s economic impact. Consistent implementation of these strategies improves health equity, preserves health care capacity, maintains the function of essential businesses, and supports the availability of in-person instruction for kindergarten through grade 12 schools and preschool. Individual persons, households, and communities should take these actions now to reduce SARS-CoV-2 transmission from its current high level. These actions will provide a bridge to a future with wide availability and high community coverage of effective vaccines, when safe return to more everyday activities in a range of settings will be possible.

          (Continue . . . .)

Like everyone else, I desperately want a return to `normal', the ability to see and hug friends and family once more, and the simple pleasures of being out in the community again.  

But - for now at least - we aren't calling the shots. The virus is.  

We can ignore the CDC's advice, of course.  And some undoubtedly will.  But it will come at a cost; in terms of lives lost, more people disabled (see CDC: Late Sequelae of COVID-19 (Long COVID)), and the possibility of seeing some health delivery systems severely compromised or even collapsed. 

We may not be able to control the virus, but we can control our response to it. Assuming we still have the will to do so.