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Coronavirus cases are skyrocketing. This is what will be needed to get control

November starts to look a lot like last March.

In Europe, where coronavirus has been largely controlled for much of the summer and fall, cases are soaring almost everywhere. Twenty countries, including the UK and France, have restaurants closed, introduced curfews or generally urged people to stay home, although most schools and universities remain open for now.

Cases are also on the rise in the United States, where more than 100,000 new infections are reported every day. As early as November, more than half of the states set records for most cases in a week, and in places like Minnesota, Utah and Wisconsin, some hospitals are about to be reached. In North Dakota, nearly 1 in 14 people have already contracted the coronavirus, with 2,254 cases reported on Nov. 8 alone in a state of 762,000 people.

To make matters worse, “the virus is going to its sweet spot at a time when we’re exhausted by it,” says Jeffrey Shaman, an infectious disease epidemiologist at Columbia University’s Mailman School of Public Health in New York City. That sweet spot is indoors, where people spend more time as the climate in the northern hemisphere gets colder and where the virus can spread more easily.

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Despite such a serious prospect, experts say it is not too late to change the tide.

Closing borders, businesses and schools are among the most drastic measures to do so. However, concern about the economic consequences may prevent governments from issuing widespread orders to stay at home.

U.S. President-elect Joe Biden, who unveiled a COVID-19 advisory board on Nov. 9, has proposed a multiple plan to control the pandemic, including nationwide mask warrants and expanded testing. But Biden will not take office until Jan. 20, and President Donald Trump has repeatedly downplayed the increase in cases.

Although getting a COVID-19 vaccine (or vaccines) is closer than ever (SN: 11/09/20), most experts agree that vaccines will probably not be available to everyone until late spring or early summer. .

See our full coverage of the coronavirus outbreak

This means spending the winter will require returning to family public health tools of physical distancing, use of masks and testing, and isolation of infected people, Shaman says. But all those measures fall short unless everyone is willing to follow the rules.

Living in this reality can be exhausting, acknowledges Aleksandra Zając, a doctor specializing in nuclear medicine in Warsaw. Doctors and patients are tired of not being able to leave their homes and having to wear a mask when they do, she says, but "as a doctor, I really see the need for all those restrictions." People are not powerless against the virus, she says. "We still have some impact on what's going on."

Zając has created a calculator to help people know how much wearing masks and goggles, washing their hands regularly, and keeping their distance from others can help protect them. Alone, none of these measures are perfect, but doing them all together can increase protection, like layers of slices of Swiss cheese so that the holes in one portion are covered by another portion. The idea of ​​Swiss cheese is not new, but it is still relevant to stacking public health measures, says Zając. It also goes for individual actions.

"An individual can't do much" beyond protecting himself, says Zając, "but if we summarize all the individuals together and everyone follows the rules, I really think we can control this pandemic."

Scientists know a lot more about the virus than they did in March, and that knowledge can help us get the most out of all the public health tools available to us.

Mask yourself

Dozens of studies have made it very clear that wearing a mask is one of the most effective steps an individual can take to curb the pandemic. Masks are especially crucial to decrease the risk of someone not knowing you are infected transmitting the virus to another person (SN: 26/06/20).

In addition, scientists are increasingly understanding that masks are also good for those who wear them. The U.S. Centers for Disease Control and Prevention updated its scientific guide on Nov. 10 to recognize that fabric masks can reduce the number of infectious drops inhaled by the user, which offers a degree of protection, especially when the masks they have several layers.

In a study published Oct. 23 in Nature Medicine, scientists estimate that if 95 percent of people wore masks when they were away from home, nearly 130,000 deaths from COVID-19 in the United States could be prevented between late September and late September. February 2021 Researchers estimate that if 85 percent of people wear masks, some 96,000 lives could be saved.

However, the debate over which type of mask is best was encouraged (SN: 12/12/20).

When it comes to ubiquitous fabric masks, only one randomized clinical trial in the world is proving their effectiveness in preventing COVID-19. That trial in Guinea-Bissau is giving the expected 66,000 participants advice on how to prevent respiratory illnesses. Half of those people will also receive two locally sewn fabric masks. The trial is expected to end in November.

Some research on the prevention of other respiratory diseases suggests that the effectiveness of a fabric mask depends on many factors, including the correct use of the mask on both the nose and mouth. Regular washing with hot water is also needed, says Raina MacIntyre, a mask researcher at the University of New South Wales in Sydney.

woman with a surgical mask, with In areas where coronavirus cases are on the rise, some local governments have implemented mask mandates in public to reduce transmission. Masks limit the amount of virus that an infected person emits and offer some protection to the user.Angela Weiss / AFP / Getty Images

In 2015, she and her colleagues published at BMJ Open the results of a trial held in Hanoi, Vietnam. Approximately 1,600 health workers in 15 hospitals were assigned to wear a medical mask at all times during their shift, to wear a two-layer fabric mask, or to follow standard hospital practice, which may or may not wear a mask. The results were not encouraging. At the end of the five-week study, people in the fabric mask group had the highest rate of respiratory infections, such as colds, even higher than the group who did not wear masks regularly. The researchers concluded that health care workers should not wear fabric masks and opt for medical masks.

MacIntyre says the trial was highly controversial, “because the message was that fabric masks could be dangerous. That caused a lot of distress during the pandemic. In March and April, I had many health workers in the United States and Europe contact me and say, "The hospital ran out of respiratory equipment. Is it better not to wear a mask than to wear a cloth mask?"

That prompted MacIntyre and colleagues to examine unpublished trial data. Researchers have found that surgical and fabric masks are contaminated with respiratory viruses. But surgical masks are disposable. If people didn’t wash reusable cloth masks every day, the masks were getting more and more contaminated.

“If you washed the fabric mask in a washing machine with hot water, you would be as protected as wearing a surgical mask,” MacIntyre says. But workers who washed their masks had twice the risk of infection than those who wore a medical mask, researchers reported Sept. 28 at BMJ Open.

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“The bottom line is that washing is part of the protective effect of a fabric mask,” says MacIntyre. She recommends a daily wash in water between 60 ° and 90 ° Celsius, much warmer than anyone could bear to wash by hand. Shrinking hot water also hardens the pores of the mask, preventing the virus from slipping easily.

MacIntyre says health workers should also wear goggles to prevent rare cases of eye infection. But determining if people who make their daily lives need glasses, face shields or other eye protection in addition to masks is a tricky trick, she says. “You have to look at the transmission rates of the community. You have to look at where you’re really going. Are you just going to take a walk outside or are you going to a medical surgery and are you going to be sitting in a waiting room with no ventilation for two hours? "

The best thing most people can do is take all the precautions they can, including avoiding large meetings (especially indoors) with masks and staying away from people they don’t live with.

Lock settings

At the beginning of the pandemic, blockades and social distancing measures (of varying severity) enacted in many countries worked to a large extent. Following some experts (SN: 6/9/20), being at home was starving the virus of transmission opportunities, preventing more than 500 million infections in six affected countries.

Now the circumstances are different. “I don’t think we’re going to lock ourselves in that scale again,” says Michael Osterholm, an epidemiologist at the University of Minnesota in Minneapolis and a member of Biden’s working group. Now that scientists better understand transmission, blanket locks may not be necessary. Instead, restrictions could focus on crowded and poorly ventilated spaces such as restaurants and bars.

However, if cases continue to grow exponentially, tighter blockages may be the only tool left to prevent hospitals from being overwhelmed. But these measures are becoming less and less pleasing to many Americans, Osterholm says. "What the public will accept is key. If they don't comply, it doesn't really matter what you recommend or how you recommend it. "

Limits of locks

Orders to stay home also do not stop transmitting inside a home, where experts are learning that the virus can spread quickly. In a sample of 101 homes with a positive coronavirus test, 53 percent of the other people living in those homes became infected quickly, researchers said in the Nov. 6 morbidity and mortality report.

“We know it’s really close contact meetings that are the riskiest,” says Alison Hill, an epidemiologist at Johns Hopkins University. "There's no reason why if you're in your own home or among family or friends you think the disease can't spread." It says isolating the infected limbs from a home, wearing masks, and improving ventilation.

And not everyone can stay home, which has contributed to inequalities in who gets sick in this pandemic.

In the United States, residents in poorer neighborhoods, often home to racially and ethnically minority minorities disproportionately affected by COVID-19 (SN: 10/10/20), were less likely to remain at home during the first months of the pandemic than residents of wealthier neighborhoods. Mobile phone mobility data suggests that this difference stems from work-related demands, according to a study published Nov. 3 in Nature Human Behavior. Residents in higher-income neighborhoods reduced working days away from home by 13.7 percent, compared to 6.6 percent for residents in lower-income neighborhoods, found Jonathan Jay, a public health researcher at Boston University, and colleagues.

Many residents of lower-income neighborhoods work jobs that cannot be done from home. But when there was an election, people in these neighborhoods limited their activities, Jay says. The data showed that people in all income groups reduced non-work-related outings to approximately similar levels.

Policies like restricting evictions so people aren’t afraid to lose their home if they lose their jobs, expanding unemployment insurance and imposing paid sick leave could help these residents physically distance themselves, Jay says.

Test and track

The blockades by themselves will not end the pandemic. They are only supposed to be temporary measures that gain time for local and state health departments to bolster other infection control strategies. Among them, tests and contact tracking are essential, a proven public health intervention that allows you to quickly identify contacts in positive cases and instruct quarantine (SN: 29/04/20).

“Contact tracking is really key when you have a disease that spreads as fast as COVID-19,” because it breaks crucial transmission chains, says Martial Ndeffo, an infectious disease researcher at the University of Texas A&M at College Station.

Contact tracking and isolation is most powerful when cases are identified at the onset of infection, your contacts are quickly tracked and reported for exposure, and these contacts comply with quarantine requests. This system requires widely available evidence and many contact plotters to do detective work.

person in the car receiving a nasal swab for a COVID testCoronavirus testing sites, similar to this one, have appeared throughout the United States. Easy-to-access tests are key to quickly identifying cases, tracking contacts, and isolating potentially infected people to break transmission chains.Xavierarnau / E + / Getty Images

Otherwise, even with relatively small case loads, contact tracking systems cannot keep up with a growing epidemic. Right now, most of the United States can’t keep up. In October, only three states and the District of Columbia had enough full-time contact tracers to handle the current charges, according to a survey by NPR and the Johns Hopkins Center for Health Security. And as cases increase, even well-equipped systems could be overwhelmed.

“Given the number of cases in the United States, it’s unrealistic to think that most states have the resources and personnel available to lift the army of necessary contact plotters,” Ndeffo says. Biden’s COVID-19 response plan includes efforts to “mobilize at least 100,000 Americans nationwide” to boost the contact tracking effort. There are currently just over 50,000 contact tracers nationwide.

Robust contact tracking systems only work if people comply with public health officials and share their contact history or quarantine if needed. However, it is likely that only 58% of Americans talk to a public health official who contacted them by phone or text message about the coronavirus outbreak, according to a Pew Research survey published Oct. 30. “A substantial number of people do not comply with or provide the appropriate information needed for contact tracking to be effective,” Ndeffo says. A clearer and more consistent public health message could improve these numbers.

Time is of the essence

It’s important to act quickly to introduce social distancing measures when the number of cases begins to increase, as they are now in the United States and Europe, Shaman says, because outbreaks are growing at an exponential rate. “Exponential growth leads to a tsunami-like effect; it gets worse the longer you wait. "

He and his colleagues simulated what would have happened if states had done exactly what they did at the start of the U.S. epidemic in March, just before. The adoption of social distances and orders to be at home on March 1 instead of March 8 would have led to some 600,000 confirmed cases and 32,000 deaths. Acting two weeks earlier would have prevented more than 1 million cases and nearly 60,000 deaths nationwide, Shaman and colleagues reported Nov. 6 in Science Advances.

No one can back down. But countries like Vietnam, Taiwan, Singapore, New Zealand and Australia have shown that acting aggressively can slow the spread of the virus. “In the future, the later you act against this virus, the more damage it does,” for both infected people and the economy, Shaman says.

For example, in late September, 89 Tennessee counties eased or removed restrictions on social distancing. But as COVID-19 cases increased, traffic to bars and restaurants declined, researchers at Vanderbilt University in Nashville reported. Mobile phone mobility data as of Oct. 21 suggests that businesses fell once restrictions were removed and were 24 percent below the same as it was during the same time in 2019. Those findings suggest that infection rates , and not restrictions, have a greater effect on people's choices. the researchers conclude.

"If you don't control the virus," Shaman says, "you won't have an economy."

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