Coronavirus: Social distancing to complete lockdown, this is what pandemic handling could look like in US
The World Health Organization (WHO) declared COVID-19 a pandemic on March 11. The same day Dr Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), warned that millions of Americans could contract the infection if the country does not adopt aggressive measures to stem the spread.
"If we are complacent and don’t do aggressive containment and mitigation, the number could go way up and be involved in many, many millions," Fauci, said during a Congress hearing on the country's preparedness for the outbreak,” he said during a House hearing.
The US has over 1,300 confirmed cases and at least 38 have died from COVID-19.
So what are the stringent measures that the US can implement to tackle the pandemic?
Travel bans
Based on previous experiences of tackling pandemic influenza, the US has pandemic plans and documents in place, which could be used as a starting point at what can be done to fight the novel coronavirus.
According to one document, restrictions can be placed on all modes of travel, which include air, rail subway, bus, ferry — a move that could virtually lock down a place.
“Travel restrictions have been shown to reduce geographic spread, as well as total and local incidence during a disease outbreak. Restrictions may be placed on some or all modes of transportation — air, rail, ferry, cruise ship, subway, and bus — and may include a range of increasingly stringent limitations, from issuing travel warnings to closing high-risk stops, limiting schedules, or canceling travel routes altogether,” says the document on preparing for a pandemic influenza.
The 2006 document is a primer for governors and senior state officials — which they can consider as they develop plans to respond to pandemic influenza or other disease outbreaks.
“Besides, residents may be more reassured if it is obvious that states with international points of entry or crowds associated with tourist attractions anticipate their vulnerabilities and inform the public about how they may act during periods when the pandemic is spreading,” says the document.
“When a pandemic occurs, the impact of the disease will join the lexicon of nation-changing incidents on the scale of 9/11 and the 2005 Hurricane Season. In every state, governors and senior officials will be at the forefront of protecting public health, maintaining critical services and infrastructure, and leading the public from crisis to recovery,” it adds.
The recommendations include social distancing and curtailing or canceling social events or mass gatherings.
“Public gatherings can provide a target-rich environment for transmission. Large gatherings (such as sporting events, parades, concerts, political rallies, holiday celebrations, and festivals), as well as smaller social activities (such as weddings, funerals, and religious services), may need to be curtailed, postponed, or canceled altogether. By placing such limitations, officials can reduce social interactions and transmission of disease,” experts recommend.
Closing public facilities
Closing public facilities or facilities where large groups congregate also can reduce opportunities for disease transmission through social interactions, say experts.
Accordingly, government officials have clear authority to close public (but not private) facilities. “Consequently, public facilities — schools, government offices, transportation hubs, museums, libraries, and convention centers — would be the first considered for closing,” say experts.
Private facilities — including shopping malls, concert halls, skating rinks, gyms, restaurants, bars, theaters, and grocery stores — may be closed under general emergency powers or special powers granted during times of public health emergencies.
Limit non-essential movement
Another document — National Strategy for Pandemic Influenza by the Homeland Security Council — says that where appropriate, governmental authorities should be used to limit non-essential movement of people, goods, and services into and out of areas where an outbreak occurs.
It instructs states to establish comprehensive and credible preparedness and response plans that are exercised regularly.
With community spread already happening in the US, Fauci predicts that things are about to get worse. "How much worse will get will depend on our ability to do two things: to contain the influx of people who are infected coming from the outside and the ability to contain and mitigate within our own country. Bottom line, it’s going to get worse," he explained.
Highlighting how serious the pandemic is, Fauci added that COVID-19 is 10 times more lethal than the flu.
(AP Photo/Ted S. Warren)
Regulations during a pandemic
The President may declare an emergency at the request of the governor of an affected State, or a chief executive of an affected Indian Tribe under the Robert T Stafford Disaster Relief and Emergency Assistance Act.
The Department of Health and Human Services (HHS) Secretary may, under section 319 of the PHS Act, determine that a disease or disorder presents a public health emergency or that a public health emergency, including significant outbreaks of infectious disease or bioterrorist attacks, otherwise exists.
“Following a section 319 declaration, the Secretary can take many actions during an influenza pandemic,” says the CDC. This includes making grants, entering into contracts, and conducting and supporting investigations into the cause, treatment, or prevention of the disease or disorder.
Section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act) authorizes the HHS Secretary to declare an emergency justifying the emergency use authorization (EUA) of medical countermeasures during public health emergencies.
“When an EUA is declared, the FDA Commissioner can allow either the use of an unapproved medical product (for example, drug, vaccine, or diagnostic device) or the unapproved use of an approved medical product during an emergency to diagnose, treat, or prevent a serious or life-threatening disease or condition caused by a chemical, biological, radiological, or nuclear (CBRN) agent,” says the CDC.
For example, during the 2009 H1N1 influenza pandemic, the FDA approved the emergency use of antivirals for certain patients and health care settings.
Minimizing risk at community levels
Stating that community transmission is inevitable, Dr Nancy Messonnier, Director of the National Center for Immunization and Respiratory Diseases, CDC, had recommended non-pharmaceutical interventions or NPIs in February. Such measures will be the most important tools in the country’s response to this virus, she said.
“This is the time for everyone to get engaged. This is not just a response for the government and the public health system. It’s a response for all of America,” CDC Director Robert R. Redfield, said at the hearing on March 11.
The CDC-recommended interventions are based on a document — 'Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017.
The agency updated its pandemic influenza guidelines in 2017. It now includes lessons learned from the response to the H1N1 pandemic in 2009. According to the updated guidelines, Americans can look at NPIs at three levels — personal, community and environment.
Personal protective measures reserved for pandemics include voluntary home quarantine of exposed household members and use of face masks in community settings when ill.
At the community level, the interventions translate into social distancing measures. These include measures for schools, workplaces, and mass gatherings.
Depending on the severity of the pandemic, these measures might range from everyday preventive actions to preemptive, coordinated school closures and dismissals. For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options.
Modifying, postponing, or canceling mass gatherings is another guideline. “A systematic literature review of respiratory disease outbreaks related to mass gatherings in the US during 2005–2014 indicated that 40 of 72 different outbreaks were associated with state or county agriculture fairs and (zoonotic) transmission of influenza A H3N2v, and 25 outbreaks were associated with residential youth summer camps and person-to-person transmission of influenza A H1N1,” says the CDC.
States have started implementing strict measures
Travel advisories and targeted travel restrictions, the use of quarantine for individuals returning from transmission hot zones such as China, Japan, and now the Grand Princess, are some of the measures the US has taken so far, said Redfield.
Washington State Governor Jay Inslee issued new community strategies and social distancing plans on March 11 at a news conference in Seattle to minimize COVID-19 exposure, particularly in counties hit hardest by the virus.
Events that take place in King, Snohomish, and Pierce counties with more than 250 people are now prohibited by the state. The order applies to gatherings for social, spiritual and recreational activities. “These include but are not limited to community, civic, public, leisure, faith-based, or sporting events; parades; concerts; festivals; conventions; fundraisers and similar activities,” said Inslee.
He said that COVID-19 is an unprecedented public health situation and “we cannot we can’t wait until we’re in the middle of it to slow it down.” Inslee added, “We’ve got to get ahead of the curve. One main defense is to reduce the interaction of people in our lives."
President Donald Trump also announced on March 11 that the US is restricting passenger travel from 26 European nations to the country. The State Department followed Trump's remarks by issuing a global health advisory that cautioned US citizens to “reconsider travel abroad” due to the virus and associated quarantines and restrictions.
Many others are using measures such as social distancing and banning large public gatherings. Santa Clara County has issued a mandatory order to cancel mass gatherings, which came into effect at 12 am on March 11 and will remain in place for three weeks.
New York Governor Andrew Cuomo also announced the country's first containment zone in New Rochelle, Westchester County, the epicenter of the outbreak in New York. Starting on March 11, there will be a containment zone with a 1-mile radius around the site of the most cases in New Rochelle, for two weeks. Accordingly, large gathering places and schools in this area will be closed for two weeks until March 25.
(Rohini Krishnamurthy has contributed to this story)