Coronavirus: As efforts to contain virus fails, US scrambles to 'mitigate' damage with local measures
During the mitigation phase, which aims to stop community spread, measures can include social distancing, limiting or canceling large gatherings and even canceling sporting events
As the US struggles to fight the COVID-19 outbreak, numbers show that efforts to contain the virus to a few places have failed. And what the US is doing now is moving to a "mitigation phase". What this essentially means is that to try and mitigate the spread of disease, the country uses measures such as social distancing and banning large public gatherings.
These measures are designed to slow or stop the spread of disease in the community, Dr Brian Labus, assistant professor at the School of Public Health, University of Nevada Las Vegas, tells MEA WorldWide (MEAWW).
US Surgeon General Jerome Adams announced last week that the US is shifting to a mitigation phase of coronavirus response. "Initially, we had a posture of containment so that we could give people time to prepare for where we are right now. Now we are shifting into a mitigation phase, which means that we are helping communities understand you are going to see more cases," he said.
"Unfortunately, you’re going to see more deaths. But that doesn't mean that we should panic," Adams told CNN's 'State of the Union'.
On January 21, 2020, the first case of COVID-19 in the US was announced in Washington State. Since then, the numbers have gone up significantly across the country.
The virus is spreading widely in communities on both coasts and in the center of the country. As of March 10, over 1,000 have fallen sick in the US, and at least 30 have died from COVID-19.
"Two-thirds of US states have reported cases of coronavirus, so it is pretty obvious that the outbreak is not contained to just a few places," says Dr Labus. The numbers are changing rapidly as labs conduct tests and discover new cases.
"This is a virus that was never really containable and it has taken some time for all public health authorities to adopt that position," Dr Amesh A Adalja, senior scholar at the Johns Hopkins Center for Health Security, tells MEAWW.
What is a mitigation phase?
In the containment phase, the idea is every case can be found and the spread can be stopped. Changing from containment to mitigation reflects the fact that the disease is now spreading within the US.
"We have to shift our response to reflect this reality. Instead of focusing on individual cases, we will focus on spread within the community," says Dr Labus.
According to Matt Boyce, a senior research associate at the Georgetown University Center for Global Health Science and Security, pivoting to mitigation strategies implies that containment strategies must think about things on broader scales.
"The response to public health emergencies can be thought of as occurring in three phases: containment, mitigation, and recovery. The containment phase occurs during the earlier stages of an outbreak when it could be possible to isolate cases and at-risk populations," Boyce tells MEAWW.
"The approaches used in this phase tend to focus on individuals. If the outbreak grows, the strategies used during the containment phase eventually become less effective and new approaches are implemented to control the spread," he adds.
He explains, "This signals the start of the mitigation phase, at which point authorities assume that infections are likely no longer isolated and localized transmission is occurring. The approaches used in this phase tend to focus on populations. The final phase, recovery, occurs after these phases and entails scaling down response operations and returning to normal functioning."
Dr Adalja says that mitigation will switch the focus on to preparing communities and hospitals for the eventual spread of the virus to their communities with an emphasis on contact tracing, quarantine, travel bans and airport screening.
He says measures that could be effective during the mitigation phase includes hospital preparedness, nuanced social distancing in certain contexts, public health communication, acceleration of vaccine development, scale-up of diagnostic testing, and antiviral development.
According to Boyce, effective mitigation strategies can include social distancing measures such as quarantine (both voluntary and mandated), canceling mass gathering events, and closing schools and businesses at risk for infection.
Boyce, however, emphasizes that the effectiveness of these measures is likely to be "context-specific" and authorities should evaluate the benefits and consequences -- health, human rights, economic — before implementing any measures.
The WHO also cautions that moving to a pure mitigation approach is essentially saying that the disease will spread in an uncontrolled fashion, and recommends a blended strategy.
What is the US doing currently?
The Centers for Disease Control and Prevention (CDC) is recommending social distancing — avoiding mass gatherings and maintaining distance (approximately 6 feet or 2 meters) from others when possible.
"In US jurisdictions with sustained community transmission, shifting from containment to mitigation conserves public health resources and directs them to where they can have the most benefit,” it says.
The CDC has asked high-risk people to avoid crowds, stock up on supplies, and avoid cruise travel and non-essential air travel. The Food and Drug Administration (FDA) has postponed most foreign inspections through April, effective immediately.
Health officials in California, Oregon, and Washington State have seen the virus turning up in people who have not traveled overseas and have warned that the virus was spreading within the local community, reports the New York Times.
In Washington State alone, 24 have died in the outbreak. Washington's King County — where a majority of the deaths (22 till March 10) have happened — is working with 10 long-term care facilities where residents and/or employees have tested positive.
Washington Governor Inslee issued new rules to protect older adults in nursing homes, living facilities. It says visitors must be adults and the visit must take place in the resident’s room. This does not apply to end-of-life situations.
All visitors must follow COVID-19 screening and reasonable precautionary measures such as wearing personal protective equipment, social distancing or visiting in designated locations.
"Employees or volunteers must be screened for COVID-19 symptoms at the start of each shift," says the rules applicable till April 9.
In Kentucky, Governor Andy Beshear said state-run nursing homes will severely restrict visitors, with private operators strongly urged to follow suit. Six cases have been diagnosed in the state, reports the Associated Press (AP).
Banning large crowds
As the number of cases in Washington continues to grow, Inslee will also announce a ban on gatherings and events of over 250 people in the Seattle area in a bid to contain the coronavirus outbreak, says AP.
Schools may not be affected, but districts will be expected to review sporting events that may draw large crowds.
"The ban would apply to sporting events like Seattle Mariners baseball and Seattle Sounders soccer games. The order would not prohibit the operation of workplaces and is not expected to include school closures, said the person, who spoke on condition of anonymity because they weren't authorized to discuss the matter publicly," reports AP.
The Santa Clara County has already issued a mandatory order to cancel mass gatherings, which will take effect at 12 am on March 11, and will remain in place for three weeks “as more widespread testing becomes available and we are able to learn more about the spread of COVID-19.”
Earlier on Monday, the Public Health Department announced the first death from COVID-19 in the county. The person who passed away was an adult woman in her 60s.
She had been hospitalized for several weeks and was the third case of COVID-19 reported on February 28. Six more cases of COVID-19 were confirmed on Monday in Santa Clara.
"This is a critical moment in the growing outbreak of COVID-19 in Santa Clara County. The strong measures we are taking today are designed to slow the spread of disease," says Dr Sara Cody, Santa Clara County Health Officer.
Dr Cody adds, "Today's order and new recommendations will reduce the number of people who develop severe illness and will help prevent our healthcare system from becoming overwhelmed."
Massachusetts Governor Charlie Baker declared a state of emergency. Such a declaration will give officials the authority to shut down large events, fro example.
NY has nation's first containment zone
New York Governor Andrew Cuomo has announced the country's first containment zone in New Rochelle, Westchester County, the epicenter of New York's COVID-19 outbreak.
"We are implementing new emergency measures in New Rochelle, which has the biggest cluster of #Coronavirus cases in the state. Starting on Thursday for 2 weeks, there will be a containment zone with a 1-mile radius around the site of the most cases in New Rochelle," Cuomo tweeted.
What this implies is that large gathering places and schools in this area will be closed for two weeks, starting Thursday until March 25.
Cuomo said that the State will work with impacted schools to ensure any child who currently depends on food assistance programs will continue to receive those benefits during these two weeks.
"New York is partnering with Northwell Health to open a satellite testing facility there. We will deploy the National Guard to deliver food to homes & help clean public spaces," he said.
Estimates tweeted by Cuomo on March 10 show that there were an additional 31 confirmed cases of COVID-19 in New York State, bringing the total to 173. More positive cases are expected as more tests are conducted.
Democratic presidential candidates Sen. Bernie Sanders and former Vice President Joe Biden canceled rallies in Cleveland, ahead of Ohio's primary next week, citing concerns about the coronavirus.
On Tuesday, Ohio’s secretary of state ordered counties to move polling stations located at long-term-care facilities and encouraged residents to vote with mail-in ballots, reports the Wall Street Journal.
"Ohio Governor Mike DeWine called for sporting events in his state to bar spectators, setting up a potential conflict with college and professional leagues that have big events scheduled this month," says the report.
Switch to online instructions
Many American universities have decided to switch to online instructions.
The Ohio State University, for example, announced the suspension of face-to-face instruction in lectures, discussion sections, seminars and other similar classroom settings and switch to virtual instruction, effective immediately and through at least till March 30.
At Harvard University, students are asked not to return to campus after Spring Recess and that the institution will move to remote instruction beginning March 23.