When I was in school studying infectious disease epidemiology, none of the cool kids worked on flu. We all wanted to chase Ebola, HIV/AIDS, drug-resistant tuberculosis, malaria, and other exotic killer bugs.
Everyday, ho-hum killers like influenza, pneumonia, and other respiratory illnesses were just too mundane for globetrotting adventurers like us. Who wants to spend her life hand-sanitizing and finger-wagging about vaccines when you could be wearing those cool space suits, chasing monkeys, and hoping you don’t start bleeding out of your eyes?
So the flu experts are generally overworked, underfunded, and always in demand. Wouldn’t you know it, they just happen to be who you need in a coronavirus pinch. They’ve spent decades jumping up and down trying to get everyone to plan for The Big One.
I’ll never forget my White House colleague, the inestimable Dr. Lu Borio, always trying to educate everyone about the need to modernize our flu vaccine investments. Her efforts led to President Trump’s important but underreported executive order on the subject. The infrastructure has been built by dozens of unthanked Lu Borios over the past 20 years to combat pandemic flu, and later, coronaviruses such as SARS and its Middle Eastern cousin, MERS.
Political Correctness Doesn’t Stop Pandemics
Infectious disease control, no matter the pathogen, is a time-tested science that resists political correctness. The Obama administration’s rejection of old-fashioned quarantine measures like travel restrictions as un-woke racism may have contributed to the unrestrained spread of Ebola in 2014 more broadly across Africa than might have been necessary, including the couple cases that found their way to the United States (one of which led to two other cases).
It is refreshing to see the Trump administration deploying basic outbreak control measures to interrupt the cycle of transmission in the coronavirus crisis. What some are calling a “travel ban,” public health experts have long referred to as an essential step that communities or nations take to slow the spread of a disease. The word “quarantine,” from the phrase “40 days” in Italian, referred to the 14th-century practice of requiring ships arriving in Venice from ports infected by the plague to sit at anchor for 40 days before landing.
The textbook example of disrupting transmission that we all learn in public health school is the 19th-century London cholera epidemic that was arrested when physician and early epidemiologist John Snow (no, not THAT Jon Snow) removed the handle from a contaminated well, stopping a disease transmission point.
It is true that travel restrictions won’t stop every single coronavirus infection from crossing the border, just as shutting down one water source didn’t eliminate every cholera case in 19th-century London. However, infectious disease control is a mathematical exercise. If you can reduce the number of undetected cases roaming the countryside, you can slow the progression of disease through the population, with quantifiable lifesaving results.
Smart Measures Are Being Taken
One of the bright spots in the otherwise ominous coronavirus conversation is Vice President Mike Pence’s appointment of Ambassador Debbie Birx as the new response coordinator. If everyone had the pleasure of knowing what I know about Dr. Birx, the stock markets would immediately rebound and coronaviruses everywhere would cast their coronas at her feet.
A physician, researcher, and former HIV/AIDS program chief at the Department of Defense and then at the Centers for Disease Control (CDC), she is best known, loved, and respected for her unparalleled leadership of the lifesaving global AIDS program first established by President Bush in 2003. She held the job during the Obama administration and now the Trump administration, where she has steered from politics toward simple public health math: find and treat every case so it can’t transmit the virus to new people, rinse and repeat, for less money the next year so you can serve more people over time for the same dollar. And keep scouring the data for the people you’re missing, adjusting your program until you get them, too.
She is shrewd, she is winsome, she knows how to move money fast toward the things that matter, and to hold all recipients of that money, whether or not they’re under her authority, accountable for ambitious results. The White House is to be commended for conscripting her into service, and if they know what’s good for them, they’ll do whatever she says.
Still, Things Are Going to Get Worse
The need for Dr. Birx’s gravitas is dire. The administration’s travel restrictions and robust use of quarantines likely adequately contained or delayed community transmission until recently. But there are now a few “untraced” cases in California and Oregon that aren’t directly linked to a known traveler from an affected area, meaning there is unchecked transmission in the community beyond our knowledge or control. That picture will get worse before it gets better.
If this virus starts spreading unabated the way it is in other countries right now, one of the likely interventions that civil authorities would consider is a regional or even national lockdown. In this scenario, citizens would be “invited” to stay at home long enough to wait out a few incubation periods of the disease—probably between two to six weeks. Governments would likely use curfews and transportation restrictions to starve the virus of new hosts through isolating people in smaller groups, with little contact between the groups.
What does this mean for you? It means that you should prepare to be at home for at least a few weeks. Unlike in most natural disasters, we can expect to have power and water, but non-essential activities and other gathering places will be shut down, including schools, coffee shops, non-emergency health-care facilities, churches, and gyms. That includes shuttering Walmarts, grocery stores, and Amazon deliveries. It’s time to think through how you and your family would get by during those weeks.
Here’s an Outline of What to Do
Obviously, it’s good to have a solid month’s food supply. That should include a number of electrolyte-balancing drinks, canned or frozen fruit and vegetables, and other healthy food mixed in with the Cheetos, in order to maintain strong immune function. Stock up on pet food, cat litter, and for apartment-dwellers, pet soilage pads. Having enough heavy-duty trash bags will be as essential as a plan for how and where you will store trash securely without having to leave your home.
First aid and medical supplies will be important, as health-care facilities could very well be the most dangerous place for the uninfected, not to mention the aggravation and delay you’ll face of needing to explain to law enforcement why you’re on the streets. Best to handle as much medical mayhem as you can on your own.
Speaking of mayhem, businesses and homeowners should double-check their security systems and stock up on their self-defense instruments of choice, including ammo and firearm maintenance supplies. Don’t forget to get some practice time in at the range before a quarantine is enacted, if it’s been a while. There will always be those who try to take advantage of the situation to commit crimes.
People dependent on prescription drugs or other medical supplies, such as diabetes test strips or oxygen tanks, should talk to their physicians about getting extra refills prescribed. Physician offices may be on answering service-only status during a quarantine. Go through the hassle now rather than later with insurers and pharmacies to get those refills in hand, even though such stockpiling may not normally be covered. If you can afford to do so, don’t hesitate to pay out of pocket to get an extra couple months’ supply.
Families should think through who will take care of Aunt Susie’s dog if Aunt Susie is sick, who will cook for Grandpa if Grandma falls ill, or how childcare will be handled if parents are sick or have to live at their essential job for a month. Families with loved ones in hospice care or nursing homes should talk to those care providers now about whether their plans are adequate. Don’t be afraid to pester if you’re not reassured by what you hear at first.
Apartment dwellers might wonder how they can avoid transmission of a respiratory disease when they share a communal ventilation system. For those in temperate climates, close your vents, and seal them off with duct tape and plastic wrap (or trash bags). Open your windows for fresh air instead.
Those who need their HVAC systems, try to seal off as many vents as you can, if you can sacrifice the use of some rooms. You might also consider duct-taping filmy or lightweight fabric over the vent so air can get through but droplets that might be carrying the virus have a greater chance of being captured on the fabric.
Parents, don’t forget to stock up on indoor-activity supplies like coloring books, audiobooks, videos, academic, and recreational games. Check out these ideas at your taxpayer-funded public broadcasting site. And get some toys for Fido, too—pent-up canine energy is its own form of natural disaster for your shoes or furniture!
Essential personnel such as certain government officials, health-care workers, first responders, and utility workers won’t be able to stay home. Start talking now to your employers about how a month’s worth of staff might be housed on-site at these workplaces during a quarantine. This will minimize the chaos of all these folks commuting each day, requiring a massive permitting operation to allow them on the road, and risking many more contacts among them than would otherwise occur if they slept where they worked.
Despite Democratic presidential candidate demagoguery, the Trump administration has handled this crisis competently so far, even with some hiccups that happen in every emergency. Perhaps the most encouraging sign is their transparency.
Rumor has it that the White House is doing a lot of handwringing about undisciplined messaging, whether it’s over-positivity from the president, or doomsday speculations from CDC and National Institute of Health officials. But we should worry far more when we get official lies about the state of the science, or when political agendas supplant time-tested public health measures.
The frequent press avails, the daily reports on case counts and characteristics, the honesty from officials about both their accomplishments and their fears, the robust use of appropriate quarantine measures, and the appointment of a supremely capable response coordinator—all this bodes as well as we could hope in the face of such an unknown and lethal threat.
In the meantime, as the saying goes, we should pray like it all depends on God and prepare like it all depends on us.