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The latest on the coronavirus

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For the Harvard Chan community: Find the latest updates, guidance, useful information, and resources about Coronavirus Disease 2019 (COVID-19) here.

 Coronavirus | New Scientist

In the wake of an outbreak of coronavirus that began in China in late December 2019, Harvard T.H. Chan School of Public Health experts have been speaking to a variety of media outlets. We’ll be updating this article on a regular basis. Here’s a selection of stories in which they offer comments and context:
Many experts have called for frequent testing of the entire U.S. population in order to shed more light on the number and severity of COVID-19 infections, but there are not enough supplies, infrastructure, and human resources to get the job done. In this op-ed, David Bloom, the Clarence James Gamble Professor of Economics and Demography, and David Canning, Richard Saltonstall Professor of Population Sciences and Professor of Economics and International Health, recommended instead that COVID-19 tests be conducted on a representative sample of the population. In Massachusetts, a random sample of 5,000 residents out of the total population of nearly 7 million would be large enough to determine the prevalence of COVID-19 infection within a margin of error of 1.5 percentage points, they wrote. “The information yielded by testing such a sample would contribute decisively to our epidemiological projections and related policies to prevent and control the spread of this too-often deadly virus,” they wrote.
There are significant gaps in data about COVID-19, according to this blog co-authored by Nancy Krieger, professor of social epidemiology, Mary Bassett, director of the FXB Center for Health and Human Rights at Harvard University, William Hanage, associate professor of epidemiology, and colleagues. They argued that it’s crucial to improve data collection to inform who currently needs help, to help estimate the likely spread and impact of COVID-19, and to assess the racial/ethnic, economic, and gender inequities associated with the disease. They recommended the adoption of a short digital form for COVID-19 testing and surveillance — to replace a long form that is currently in use — with data being reported in real time.
Previous modern viruses — such as Ebola, SARS, MERS, and swine flu — were tragedies but didn’t cause the huge level of societal and economic disruption that COVID-19 is causing. SARS and MERS didn’t cause the same level of devastation mostly because they’re not as transmissible as COVID-19 and don’t spread presymptomatically. Swine flu spread easily but wasn’t as deadly as COVID-19. And Ebola was deadly but harder to contract. “If you want to see illnesses which are controllable, they all have transmission very much tied to symptoms, and this includes SARS and Ebola,” said epidemiologist William Hanage.
Opening up society after worldwide lockdowns aimed at curbing the spread of COVID-19 will take a long time and will be marked by trial and error, say experts. “How to relax the lockdown is not something around which there is a scientific consensus,” said Caroline Buckee, associate professor of epidemiology. Governments can use various tools to keep the virus in check, including isolating patients and tracing their contacts, restricting their borders, and social distancing—but there are challenges with all of these methods, experts say. As authorities around the world choose different paths forward, it will shed light on what works and what doesn’t, said Marc Lipsitch, professor of epidemiology and director of the Center for Communicable Disease Dynamics. “I think there’s going to be a lot of experimentation, not on purpose, but because of politics and local situations,” he said. “Hopefully the world will learn from that.”


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The true death toll from COVID-19 in the United Kingdom is likely about 15% higher than the toll previously published by the government, according to broader official data that includes deaths in places such as nursing homes. “I am not remotely surprised there would be an undercounting,” said epidemiologist William Hanage. “The UK Hospital death toll that you are seeing — the one on the news each night — is a composite of things that have been trickling in over a period of time. It is not an exact number and does not include the numbers dying in places such as nursing homes.” He added, “The UK response [to COVID-19] was fractured and it was too late, and allowed a large number of people to become infected who didn’t need to become infected.”
April 14: Our Pandemic Summer (The Atlantic)
In order to suppress the coronavirus until a vaccine is developed, regular life cannot fully return, according to experts. There are ongoing challenges, including a lack of tests, medical supplies, ventilators, and respiratory therapists; diminished ranks of health care workers, because they’re falling ill from COVID-19; and a lack of data about what percentage of the U.S. population has been infected. Experts quoted in this article said they weren’t comfortable with the return of crowded public spaces anytime soon. “It’s hard for me to imagine anyone going to Fenway Park and sitting with 30,000 fans,” said Ashish Jha, K.T. Li Professor of Global Health and director of the Harvard Global Health Institute (HGHI). “This isn’t going to look like a normal summer in America.” Serology tests—which check for antibodies to COVID-19—could signal if someone has been infected, but can’t definitely confirm if the person is immune to reinfection or won’t go on to infect others. Michael Mina, assistant professor of epidemiology, said he worries “that a lot of employers are just assuming that having antibodies or having been infected means you’re good to get back to work.” Research fellow Stephen Kissler, research fellow in the Department of Immunology and Infectious Diseases, said that, over the coming months, we need “to normalize COVID in the public psyche, and reinforce that this will be a part of our day-to-day lives.”
Public health experts say that a Trump administration decision not to tighten regulations on fine particulate (PM2.5) air pollution disregards clear scientific evidence that such pollution harms health, particularly for people with COVID-19. Previous studies have suggested that PM2.5 pollution contributes to tens of thousands of premature deaths each year. A study released April 7 from Harvard Chan School researchers found that people living for many years in regions with high PM2.5 levels are 15% more likely to die from COVID-19 than people living in areas with just one unit less of such pollution. Study co-author Francesca Dominici, Clarence James Gamble Professor of Biostatistics, Population, and Data Science, said she was “disappointed but not surprised” by the administration’s move. She said that “it is an unwise decision in light of the pandemic. There has been a constant tactic over the last few years by the administration to dismiss science in general.”
On-and-off periods of social distancing will likely be needed into 2022 to ensure that hospitals have enough capacity for future COVID-19 patients in need of critical care, according to a new modeling study from Harvard Chan School researchers. Even if one 8- to 12-week period of social distancing is successful in “flattening the curve” — keeping the infection rate low enough so that hospitals aren’t overwhelmed — many people will remain susceptible to COVID-19, and there could be a resurgence of infection among this group in the absence of other interventions. “I think social distancing interventions of some sort are going to have to continue, hopefully lightened and in conjunction with other interventions,” said epidemiologist Marc Lipsitch, co-senior author of the study.
Experts said they don’t know yet whether people who recover from COVID-19 develop a strong immunity to the disease or how long such immunity would last. They also said that developing a vaccine could take months — if it can be developed at all. “There are a lot of very smart people working very hard to come up with a vaccine,” said Yonatan Grad, assistant professor of immunology and infectious diseases. He said it’s “likely” that one will be developed, “but it’s not a given.”
In this Q&A, social epidemiologist Nancy Krieger discussed how the COVID-19 pandemic is highlighting health inequities that have existed in the U.S. for many years. She commented on preliminary data showing that African Americans are dying from COVID-19 at higher rates than whites, even though they make up a smaller percentage of the population. A variety of factors put people of color at greater risk, she said — such as living in crowded conditions, working in service jobs that put them in close proximity to others, having pre-existing health conditions that increase the risk of COVID-19, and lacking access to health care and health insurance.
Among the 1,000 “contact tracers” being recruited by Massachusetts — people who will help reach everyone in the state who may have COVID-19 so they can be tested and moved into isolation or treatment if needed — are student volunteers from Harvard Chan School who are working with local boards of health. Stacey King, director of practice, said that the contact tracer may be the first person to let someone know that they may be infected with COVID-19, and that it will be challenging to build trust while asking people about their symptoms, who they’ve been in contact with, their recent activities, and the health of members of their family. “Especially when people are under so much stress right now, I think it will be one of the hardest things that we experience,” she said.
In this op-ed, co-author James Hammitt, professor of economics and decision sciences and director of the Harvard Center for Risk Analysis, argued that a standard benefit-cost analysis is not sufficient in making difficult decisions during the coronavirus pandemic — for example, decisions about rationing medical supplies. The authors wrote that such analyses should take into account a variety of factors that matter to people, including longevity, income, and health.
April 13: Tensions skyrocket as COVID-19 fears grip Arizona detention center (Arizona Center for Investigative Reporting)
Experts are concerned that COVID-19 is spreading in the nation’s immigration detention centers. Detainees at some facilities are reporting that they’re being held in close quarters where they can’t practice social distancing, that communal spaces are not properly sanitized, there’s a lack of soap and personal protective equipment, they’re not always cared for when they fall ill, and that detention center authorities are not always forthcoming about the spread of disease. “An outbreak of COVID-19 in a rural detention center could be disastrous,” wrote Ashish Jha in a federal court document on April 8. He recommended that officials pause immigration court proceedings and release as many detainees as possible.
Florida Surgeon General Scott Rivkees said on April 13 that Floridians should continue with social distancing and wearing face masks for up to a year, until there’s a vaccine for COVID-19, although it’s unclear if Florida Gov. Ron DeSantis agrees with that strategy. Epidemiologist Marc Lipsitch said that governors should strongly consider the advice of public health experts, especially when so many agree on the importance of taking strong measures to slow the spread of the virus. “As a general matter, public health is a type of expertise,” he said. “Most governors don’t have (that) expertise. They should seek out the people who do have the expertise, otherwise they’re not  getting the best advice.”
Recovering from COVID-19 can be an up-and-down experience. Both symptoms and severity can vary widely. Some people start to feel better after a few days, only to feel sick again. The Centers for Disease Control and Prevention say that people with COVID-19 can stop isolating themselves after being fever-free for 72 hours, after their respiratory symptoms have improved, and at least seven days from the onset of initial symptoms. After returning to work or public spaces, recovered patients should still avoid groups and wash their hands frequently. It’s unclear how long people are infectious after recovering, and also unclear if they become immune to reinfection and how long any immunity lasts. “Based on immunity to SARS [and] MERS, and seasonal coronaviruses, a reasonable expectation is that most, and maybe nearly all, people who been infected with SARS-CoV-2 will have immunity for a year or more,” said epidemiologist Marc Lipsitch. This immunity will likely protect people “at least against severe disease and against shedding a lot of virus that would make them highly contagious.”
Experts expressed doubt about a disease model from the University of Washington’s Institute for Health Metrics and Evaluation (IMHE), cited by the White House, that predicts that COVID-19 deaths will stop this summer. The model suggests that social distancing will only have to last until the end of May because strategies such as mass screening, testing, and contact tracing will be put into place and will keep the disease from spreading. Epidemiologist William Hanage said, “Unfortunately, there is no way that amount of control could happen by the summer. Even in the best scenario, we assume there will be flare-ups, and we will have to remain extremely vigilant.” Ashish Jha said it’s unrealistic to think that the epidemic will somehow be over for the next few months. “We know that’s not true,” he said. “We know that the number of cases will continue. The virus is not going away.” Thomas Tsai, assistant professor in the Department of Health Policy and Management, said the model is useful but added that “it’s still just a model of what the world could look like. And there are a lot of parameters that the best models can’t account for.”
In this opinion article, three professors — epidemiologist Marc Lipsitch and Joseph Allen, assistant professor of exposure assessment science, both of Harvard Chan School, and Harvard University’s William “Ned” Friedman, director of the Arnold Arboretum — argued that public green spaces such as parks, botanical gardens, and arboreta need to stay open during the COVID-19 pandemic. Closing such spaces because of overcrowding and disregard for social distancing “should be a temporary, last-resort measure for disease control” because “the benefits of getting outside vastly outweigh the risk of getting infected in a park,” they wrote.
April 13: Who Is Immune to the Coronavirus? (New York Times)
In this opinion piece, epidemiologist Marc Lipsitch wrote that there are many uncertainties about how the human immune system responds to COVID-19 and what that means for the spread of disease. In the absence of clear data, scientists can use current knowledge about how the immune system works and about viruses related to COVID-19 to develop models as to how immunity may develop for COVID-19 patients. One “educated guess,” said Lipsitch, is that most people will develop some sort of immune response after infection, some better than others, and that the protection could last about a year. But many questions need to be answered, including how many cases of COVID-19 there are, what an immune response means for a person’s risk of getting reinfected or their contagiousness to others, and whether or not infections are leading to “herd immunity”—when enough people develop immunity so that the virus can be contained.
Although California was preparing to deal with pandemics in the 2000s, those plans petered out after the recession hit in 2008. According to models of hospital surge capacity developed by Ashish Jha, researchers at Harvard Chan School, and the news site ProPublica, most communities in California will face severe shortages unless local authorities manage to curb the spread of disease. Jha said that having the capacity to deal with a surge of disease involves planning. “If you had planned for it for years and know … how to turn a convention center into a hospital, know how you are going to get the extra staff, you can get through it,” he said. “When you haven’t done any of that planning it is much, much harder — and that’s what we are experiencing right now.”
April 11: The only way this ends: herd immunity (Boston Globe)
The only way the COVID-19 pandemic will end will be when a high percentage of the population develops immunity — so-called “herd immunity” — either through a vaccine or through exposure to the disease, according to experts. In this opinion piece, writer Jeff Howe discussed disease models from epidemiologist Marc Lipsitch and immunologist Yonatan Grad which show that intermittent periods of social distancing may be the best option to control the pandemic. This on-again, off-again approach would protect hospitals from being overwhelmed with sick patients, buy them time to gather adequate medical supplies, and allow the population to slowly gain immunity, the article said.
It’s possible that social distancing measures aimed at slowing the spread of COVID-19 could be eased sometime in May, according to epidemiologists. But easing these measures won’t include allowing large-scale gatherings, and people will likely still have to take precautions such as frequent hand-washing and maintaining physical distance from each other in places like stores and restaurants. The key to easing restrictions will be implementing much more testing, say experts. “The more we know about the prevalence of the virus, the closer we’ll get to being able to reopen,” said epidemiologist Michael Mina. Thomas Tsai said his best estimate for when businesses can reopen would be early summer, and that large gatherings should be allowed only if there’s a thorough testing and quarantine regime in place. “We know there’s a high chance that there could be another recurrence,” he said. “We need to be very careful about how we proceed, and dial up our responses as they’re needed.”
Decades of air pollution have had negative health impacts on Americans with conditions such as hypertension and asthma. Those diseases have now been associated with severe cases of COVID-19, according to a pre-print study from Harvard Chan School—and minority populations are bearing the brunt of the harm. Evidence suggests the reason for this is that black and Hispanic people are often exposed to more air pollution than other groups because of socioeconomic disparities. Rachel Nethery, assistant professor of biostatistics and co-author of the pre-print, said the study found that race was “the largest effect, hugely statistically significant. It was pretty shocking.” Minorities’ unequal access to health care may also be playing a role, said social epidemiologist Nancy Krieger. “That makes quite the whammy.”
April 10: Obama: In trying times, truth first (Harvard Gazette)
A virtual seminar offered advice for municipal leaders on how to handle the COVID-19 pandemic, featuring speakers including former President Barack Obama, former New York City Mayor Michael Bloomberg, and Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention. One speaker was Kimberlyn Leary, an associate professor in the Department of Health Policy and Management. She noted that recent data shows that people of all ages and from all walks of life are facing new or worsened mental health issues because of the pandemic. She said that city leaders could help by promoting available resources, acknowledging the difficulties, and expanding services when possible.
April 10: Relearning ways to grieve (Harvard Gazette)
Hugs are out and funerals have gone virtual during the COVID-19 pandemic. In an April 8th online forum, experts spoke about learning new ways to mourn. “Losses are ubiquitous in a world closed down by the virus,” said Christy Denckla, research associate in epidemiology. “The scope of this loss is truly global and unprecedented.” She said that the sense of bereavement and dislocation has been compounded by job losses and the cancellation of events such as graduations and sports matches. Columbia University psychiatry professor Katherine Shear spoke about the problems that can occur when coping mechanisms — processing grief and resuming a changed life — are disrupted. She offered approaches to help clinicians, family members, and the bereaved navigate grief during our changed reality.
The Centers for Disease Control and Prevention is now recommending that everyone wear a homemade face mask when they are in public places where it’s hard to maintain social distancing, such as grocery stores and pharmacies, in order to curb the spread of COVID-19. According to epidemiologist Marc Lipsitch, the general consensus is that the main benefit of homemade masks is that they can keep a sick person from spreading germs—which can happen without them knowing it, because evidence suggests that COVID-19 can be spread even when people don’t have symptoms. Although there isn’t strong evidence that homemade masks can adequately protect the wearer, Lipsitch said that wearing them is “a common-sense precaution [that] should be at least partially protective.” He added that homemade masks can also remind us not to touch our faces, and serve as a visible reminder of the need for good hygiene.
Eric Rubin, Irene Heinz Given Professor of Immunology and Infectious Diseases and editor-in-chief of the New England Journal of Medicine, and Harvey Fineberg, former president of the National Academy of Medicine and former dean of Harvard Chan School, discussed efforts to contain the coronavirus. They spoke about the prospects, and the timeline, for a successful vaccine; the need to expand testing; adopting a wartime strategy for combating coronavirus; the wisdom of instituting a “smart quarantine”; and the sacrifices medical workers are making every day.
In this radio interview, epidemiologist Michael Mina discussed COVID-19 testing—both testing for the virus itself and serologic testing, a blood test that can determine whether a person has previously been infected by checking for antibodies to the virus. Mina said Massachusetts now has almost enough tests for the virus, but not enough swabs to take samples from patients, because of a global shortage. As for the antibody tests, he said they won’t be widely available for at least another month or more.
Michael Barnett, assistant professor of health policy and management, spoke about how the COVID-19 pandemic is affecting patients and clinics. He discussed telemedicine and virtual health services, the economics of private doctors’ offices, and shortages of regular medications.
Postdoctoral fellow Arpit Sharma wrote about feeling worried after COVID-19 arrived in Boston and Harvard instituted mandatory work-from-home policies. “My lab mates and I think of our workspace as a home away from home, where we enjoy interacting at lab meetings and over coffee. I felt a pit in my stomach as I realized all that was over for now. I was afraid of feeling isolated.” But after participating in virtual seminars and connecting with colleagues online, he wrote, “I feel more connected than ever. … I now realize that I am part of a global research community that can thrive online.” He said that the tough times have provided “an opportunity to rethink how we interact with one another, in ways that will benefit the scientific community in the long term.”
April 9: Harvard health scholar shares insights on pandemic (Martha’s Vineyard Times)
In this Q&A, Jennifer Leaning, professor of the practice of health and human rights, discussed a range of topics about the coronavirus, such as the United States’ lack of preparedness. She noted that the U.S. disbanded its pandemic task force in 2018 and so was blindsided by the coronavirus. “I would say it’s a failure of judgment, a failure of vision, a failure of will that we’re in this situation,” she said. She spoke about the importance of protecting health care workers from infection, because if they get sick they could be out of commission for weeks, which could lead to a shortage of people to care for patients. She said that if hospitals do become overwhelmed, it could lead to a triage situation in which “you have to decide who you do not take care of even though they’re very sick and that is brutal. That is war surgery. … I fervently hope that we don’t get to that point.”
A computer simulation from Belgian researchers seems to suggest that droplets spread by exhalations, coughs, or sneezes from runners, walkers, or cyclists can potentially infect people behind them. The simulation went viral. But experts are questioning the simulation’s findings, which have not been vetted because no specifics were published about it. “On the epidemiology side — where the droplets are is much less relevant than the amount of transmission that occurs via this route,” said epidemiologist William Hanage. “Advice on physical distancing is really about reducing the risk of transmission rather than eliminating it altogether.” He added, “The amount of transmission from this route, even if it is possible, will be dwarfed by that from others.”
Social distancing measures may have worked well enough so that Massachusetts General Hospital will be able to avoid being overwhelmed with COVID-19 patients. Paul Biddinger, EPREP director at Harvard Chan School, medical director for emergency preparedness at Partners Healthcare, and vice chairman for emergency preparedness in Mass General’s Emergency Medicine Department, said that recent modeling suggests that the pandemic’s peak will stretch but not overwhelm the hospital. “We are cautiously optimistic that, with the numbers we are anticipating, we will have enough ventilators and we will have enough Intensive Care Unit spaces,” he said.
Hospitals in Massachusetts have been furloughing employees, cutting pay, and withholding salaries for health care workers. Leonard Marcus, founding co-director of the National Preparedness Leadership Initiative (NPLI), said that even though hospitals are busy with coronavirus patients, they’re losing money on medical procedures that would normally be generating revenue. “If we look at a hospital like any business that has to pay its people at the end of the day and meet its financial obligations, this is an absolute nightmare,” he said. He said it’s unclear which hospitals will emerge unscathed when the pandemic ends.
Leaders around the U.S. have been making life-disrupting decisions in order to navigate the coronavirus crisis, but in doing so they’ve had to take into account widely varying disease models. The reason for the differing models is that there’s uncertainty around questions such as COVID-19 transmission and fatality rates, and because of variations in social distancing measures in different parts of the U.S. “I think we should use all data to inform our views, but we shouldn’t be overconfident in the results from any one data set or even any combination of data sets,” said epidemiologist Marc Lipsitch.
COVID-19 is affecting communities of color disproportionately. Experts say it’s because of entrenched racial health disparities that have led to higher rates of diseases such diabetes, high blood pressure, obesity, and asthma in minority populations. FXB director Mary Bassett said that black and Hispanic communities face greater risk of exposure to COVID-19 because they often live in crowded conditions, have to travel on crowded public transportation to work, and have roles as essential workers in which they may not be able to keep six feet away from others. They also are more likely to lack health insurance. She recommended gathering data on COVID-19 disparities in order to help direct resources to where they’re needed most; conducting clinical trials for potential COVID-19 drugs in hospitals serving marginalized communities; and having employers house their essential workers in hotels near their work to minimize their commuting time and potential disease exposure.
It’s known that older people are vulnerable to COVID-19, but so are younger people, particularly people of color and poorer Americans, because they’re more likely to have underlying health conditions such as heart disease or diabetes. These medical conditions are often the result of socioeconomic disparities such as poverty, racial segregation, differences in employment and education opportunities, limited access to fresh food, and lack of access to health care, say experts. David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health, said that those who are most disadvantaged will likely be hit hardest by the pandemic—they may lose their jobs as businesses close, making it even harder for them to see a doctor if they get sick. “The people being most hurt by this epidemic are the very people who at the beginning of this epidemic were the most vulnerable,” he said.
Some leaders have suggested the rapid pursuit of “herd immunity” as a way to help slow the spread of the coronavirus. Herd immunity occurs when a certain fraction of the population becomes immune to a particular disease so that person-to-person transmission is unlikely or even impossible. For COVID-19, experts think herd protection could be achieved if 50% to 66% of the population were immune. But experts say that, without an available vaccine, the only way to achieve herd immunity quickly would be for many people to become infected. “What really matters is how you get to herd immunity,” said epidemiologist William Hanage. “And it will be impossible to get there without a large number of deaths.” He said it’s unclear how many people who’ve recovered from COVID-19 are immune. “We don’t even know how much immunity the disease generates and how long it lasts,” he added.
Harvard Chan School students are volunteering with both the Massachusetts Department of Public Health and Harvard University Health Services (HUHS) to help fight the COVID-19 pandemic. They’re helping the state with contact tracing efforts and helping HUHS with health communication and promotion. Doctoral students Christina Alonso and Eric Coles are co-leading the student volunteer workforce for the state. Coles said he hopes student support for local boards of health will help decrease hospitalizations. Lucas Buyon, president of the Harvard Chan Student Association—which is organizing the effort to help HUHS—said that more than 200 students responded to an initial call for volunteers in the first 72 hours.
Even though the number of confirmed cases of COVID-19 appears to be slowing in some states, epidemiologists said it’s still too soon to stop social distancing. Eric Feigl-Ding, a visiting scientist, noted that the possible decrease is only significant if there’s enough testing to show the actual number of cases. He said that the numbers will hold more significance if they slow for at least a week, and that social distancing is “even more important” right now. Using the example of battling a wildfire, he said, “If you are super aggressive and put out a raging wildfire before it starts, people will think, ‘Oh, you overreacted. Nothing happened.’ Well, nothing happened because you were aggressive.”
During the COVID-19 pandemic, it’s crucial that federal, state, and local leaders provide messaging for the public that’s consistent and transparent, according to leadership and preparedness expert Leonard Marcus. He noted that the federal government has been inconsistent in its messaging on certain orders and advisories, and that states are also pursuing different courses of action regarding the pandemic. “The concern … is that the public could be confused,” said Marcus—for instance, about who should wear masks and under what circumstances.
As COVID-19 blankets the U.S., most routine doctors’ appointments and elective surgeries have been canceled—which could lead Americans’ health to deteriorate during the course of the pandemic, wrote health policy expert Michael Barnett in this opinion piece. He predicted that a “second, hidden pandemic” will follow the coronavirus, because people will stop dieting and exercising, avoid filling prescriptions out of fear of pharmacies or inability to pay, and suffer from mental health issues because of the worsening economy and being stuck at home. He urged: “If you have a medical concern, reach out to your doctors. … Though we may not be battling covid-19 in the intensive care unit, primary care doctors are supporting the front-line medical troops by keeping everything else out of the emergency room.”
In a wide-ranging Q&A, epidemiologist Marc Lipsitch discussed the coronavirus—its trajectory, the impact of social distancing on disease spread, when the U.S. can open up again, testing for COVID-19, and immunity. He said the key to easing social distancing measures and getting people back to work and school will be using serologic testing—testing for antibodies to COVID-19—to determine if people have developed immunity. Then scientists will have to determine how much protection immunity confers, and whether it varies from person to person. He also predicted that increasing fatigue with social distancing will prompt some regions of the U.S. to ease restrictions, which may in turn prompt a resurgence of infections. “There are ways to avoid that, but they all involve this very long and destructive process of social distancing,” he said. “It’s easy to say as the public health person, this is what we need to do for public health. But I’m acutely aware that there are also other considerations, and I don’t see a really good answer.”
India is considering next steps after a lockdown to tamp down the spread of COVID-19. In a Q&A, HGHI director Ashish Jha said that easing the lockdown isn’t a good idea unless there is widespread testing so that the country can determine where disease hotspots are. “If you open up without good data of how much disease there is in your community, what will happen is that the disease is going to come right back,” he said. “Lockdown doesn’t cure the disease. It just reduces the burden.”
What will it take to open up the U.S. again without a resurgence of COVID-19? Ashish Jha wrote, “The single most important tool we’ll need is an extensive testing infrastructure. … Without adequate testing, we don’t know how many are infected, where the virus is spreading or where the hotspots are. We’re on a battlefield wearing blindfolds.” He said that without enough testing, sweeping social distancing measures are necessary. “While the price of social distancing is high, the price of reopening without the right testing infrastructure would be higher,” he wrote.
Although 1,800 people in the U.S. died from COVID-19 on April 7—the highest daily death toll so far—the number of new hospitalizations in New York, the state hardest hit by the virus, was starting to plateau. Some computer models suggested that the overall death toll from the disease in the U.S. will be lower than originally thought. But experts warned that the nation should not let up on social distancing anytime soon, because doing so could prompt infections to spike. They also said that states beyond New York could soon experience a surge in disease. “The pandemic is only just getting its boots on in other places,” said epidemiologist William Hanage. He said he is “incredibly anxious” about smaller communities around the nation, which have fewer resources than cities “and probably won’t be testing until too late.” Hanage was also quoted in another Washington Post article that explained that disease models frequently change, and that different models can produce different results.
The COVID-19 pandemic is expected to devastate the world’s most vulnerable people. Natalia Linos, executive director of the François-Xavier Bagnoud (FXB) Center for Health and Human Rights at Harvard University, said that in order to achieve the United Nations’ Global Goals by 2030, there should be a worldwide conversation about how COVID-19 will impact inequality and poverty. “Unless governments do something explicitly to focus on the poor, we would be silly to think that wouldn’t impact achieving goal one — solidarity and global commitment to fight poverty — which I think already is going to require a lot,” she said. “Now there’s this additional challenge.”
In this Q&A, healthy buildings expert Joseph Allen discussed ways to minimize the spread of COVID-19—through wearing face masks; lowering the density in office buildings; making sure that fresh air circulates in homes workplaces, and stores; and following cleanliness precautions around those who are infected. Asked about the role of aerosols—the fine particles that can be expelled when people cough or even just breathe—in the spread of COVID-19, Allen said he thinks they are a frequent form of transmission.
Florida has so far opted out of expanding Medicaid under the Affordable Care Act, primarily because of concern about the impact on the state’s budget. But some public officials and public health experts are now calling for the expansion of Medicaid, the public health insurance program for low-income people, because during the COVID-19 pandemic more people need medical care, safety net hospitals need reinforcement, and thousands of people in Florida have fallen into low-income brackets. Benjamin Sommers, professor of health policy and economics, called the lack of expansion in states like Florida “pretty galling.” Sommers argued in a recent New England Journal of Medicine article that expanding Medicaid in the 14 states that haven’t done so yet would not harm state budgets.
The U.S. is testing nearly 700,000 people every week for COVID-19, but experts say that’s still not enough. In addition, labs across the country have a large backlog of patient samples. And some are questioning the accuracy of new antibody tests that could potentially tell if someone has been infected with the coronavirus. Experts say that significantly increasing the amount of testing, curbing the spread of new infections, and boosting health care capacity are all necessary before social distancing measures can be eased. “There are going to be a lot of places, if not everywhere in the U.S., that are still not meeting those criteria by the end of this month,” said epidemiologist Marc Lipsitch.
COVID-19 will be defeated forever only when enough people develop immunity to it so that it can no longer spread easily from person to person, according to experts. This so-called “herd immunity” can happen in one of two ways. A vaccine—the preferred way—is at least a year away. The other way happens naturally, when a large percentage of the population becomes infected and develops antibodies to the disease that protect from reinfection. The problem with the second way is that many will die in the process. In addition, it’s unknown what percentage of the population needs to become infected to provide herd immunity. Even for those who have developed immunity, “we don’t know how effective it is or how long it will last,” said William Hanage. He said that, until a vaccine is available, repeated rounds of physical distancing may be needed.
April 7: How Scientists Track Us to Help Tame Covid-19 (Bloomberg Quint)
Researchers are using anonymized data from social media companies to determine whether people are complying with government policies around the globe aimed at slowing the spread of COVID-19. For example, the COVID-19 Mobility Data Network is using data sets from Facebook that show the location of people’s cell phones to study the effects of social-distancing advisories. “We have no idea what they actually do in terms of subsequent epidemiology of disease,” said epidemiologist Caroline Buckee, who leads the effort. “Policy makers want to know things like, ‘Which of these policies actually work? And how long are we going to have to do them?”
People with COVID-19 who live in U.S. regions with high levels of air pollution are more likely to die from the disease than people who live in less polluted areas, according to a new nationwide study from Harvard Chan School researchers. The study found that a small increase in long-term exposure to fine particulate air pollution, or PM2.5, leads to a large increase in the COVID-19 death rate. Study co-author Francesca Dominici said the study suggests that counties with higher pollution levels “will be the ones that have higher numbers of hospitalizations, higher numbers of deaths and where many of the resources should be concentrated.”
Given the difficulty in keeping COVID-19 from spreading in settings such as hospitals, cruise ships, and nursing homes, epidemiologist Michael Mina thinks that the virus is more transmissible than previously thought. He recommended moving people out of nursing homes if possible, and stepping up surveillance at the facilities, such as by testing employees every few days. He also said that additional testing for the virus is needed everywhere, and that scientists need serological tests to show how many people have been infected and recovered. “We have to get to an order-of-magnitude-understanding of how many people have actually been infected,” he said. “We really don’t know if we’ve been 10 times off or 100 times off in terms of cases. Personally, I lean more toward to 50 to 100 times off, and that we’ve actually had much wider spread of this virus than testing … numbers are giving us at the moment.”
Data suggests that cases of COVID-19 are beginning to level off in New York, but experts cautioned that social distancing policies need to stay in place to avoid a resurgence of infections. Among the state’s 20 million residents, 130,000 have been diagnosed, and undiagnosed cases could mean that as many as 1 million were infected, said epidemiologist Marc Lipsitch. But even that number, representing roughly 5% of the population, would be too low for herd immunity to offer protection. “It’s premature to say whether we have reached the peak of the first wave [of infections], or the overall peak,” he said. If cases are peaking, “it means social distancing is working, because cases are going down before herd immunity has kicked in. But then people are still vulnerable. That’s the fundamental dilemma of social distancing. The better it works, the more susceptible people remain in the population.”
Facebook has stepped up efforts to share anonymized data about people’s movement patterns with COVID-19 researchers, in order to better understand the spread of disease and the effectiveness of social distancing measures. “Measuring the impact of social distancing policies is absolutely critical at this stage, and aggregated data of this kind provides insights that protect individual privacy but are actionable for policymakers and researchers building predictive models,” said epidemiologist Caroline Buckee.
A new smartphone app—the COVID Symptom Tracker—is helping track the onset and progression of COVID-19 symptoms of millions across the U.S., with the goal of shedding light on the nature of the disease, identifying those at risk sooner, pinpointing virus hot spots, and helping slow the spread of disease. Andrew Chan, professor in the Department of Immunology and Infectious Diseases and a cancer epidemiologist at Mass General, is the lead U.S. researcher for the multi-institutional project.
Most houses of worship across the U.S. have stopped holding large gatherings to limit the spread of COVID-19, but some continue to meet, prompting lawmakers, religious leaders, and health experts to consider whether religious freedom means the freedom to risk people’s health. Epidemiologist Michael Mina said he thinks worship services should be curtailed during the pandemic. “Every extra person who shows up in the hospital puts everyone else at risk,” he said. “I’m in support of limiting those kinds of congregation (meetings) from happening because the ramifications extend well beyond those individuals.”
New recommendations that everyone should wear a face mask to limit the spread of COVID-19 are based on growing evidence suggesting that the disease can be transmitted by people who don’t feel sick, and by tiny droplets that spread when people are speaking. “The number one benefit [of a mask] is that it prevents someone who is sick from infecting others,” said Joseph Allen. He said it can also offer some level of protection to the wearer. “We’ve seen the scale and scope of this virus. It’s unprecedented, and we’re realizing that we have to throw everything we can at it,” he said.
Practices such as deforestation and poaching—which lead to increased contact between wild animals and human populations—are one of the driving forces behind a surge in dangerous new infectious diseases that have made the leap from animals to humans, such as Ebola, SARS, swine flu, and HIV, according to experts. COVID-19 may have originated in bats, scientists believe. “The evidence is clear; we’re driving disease emergence through less sustainable use of nature,” said Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment (C-CHANGE). “It’s happening more often, and it’s mostly happening because of spillover of pathogens from animals to people.”
“It’s only a matter of time before the virus attacks small, often forgotten towns and rural counties. And that’s where this disease will hit hardest,” wrote Dean Michelle Williams, Bizu Gelaye, assistant professor in the Department of Epidemiology, and Emily M. Broad Leib of Harvard Law School in an opinion piece about the spread of COVID-19. They wrote that rural communities could fare worse than urban and suburban areas because they have older populations with poorer overall health; because many rural hospitals have closed and others are in dire financial straits; and rural counties don’t have many intensive care beds and may not have enough health care workers to care for an influx of patients. The authors recommended expanding telemedicine and social safety net programs to alleviate the burden on rural health systems.
Tests that can show if a person has had COVID-19—serologic or antibody tests—will help determine the proportion of the population that was infected and, hopefully, who has developed immunity to the disease. “The key is whether those antibodies actually protect against infection; we still don’t know that,” said epidemiologist Caroline Buckee. Sarah Fortune, John LaPorte Professor of Immunology and Infectious Diseases, said that serologic testing will help determine if there’s enough “herd immunity” in the population—in other words, if enough people are immune so that there wouldn’t be another huge resurgence of disease.
Aggressive social distancing will help ensure that the coronavirus doesn’t overwhelm hospital systems across the U.S., but if we let up, the virus will come “roaring back,” wrote Joseph Allen and Harvard’s Juliette Kayyem, former assistant secretary at the Department of Homeland Security, in this opinion piece. They wrote that a broad consensus has been reached by many experts about what to do over the next two months to keep the virus at bay: keep up with social distancing, produce test kits and medical resources, then manage the virus through a variety of measures until a vaccine is available. They stressed the importance of having a national plan and national mobilization, not state-by-state ad-hoc approaches. “We cannot half-ass it; this is an ‘all-in’ moment in history if there ever was one,” they wrote. “We cannot think about this in terms of weeks; it took two months for each successful country or region to get this under control. We must act now.”
To fight subsequent waves of COVID-19 and future pandemics, there should be a unified and comprehensive health data system that can link information about patients’ risk factors with information about the spread of disease, wrote David Hunter, Richard Doll Professor of Epidemiology and Medicine, University of Oxford, and Vincent L. Gregory Professor in Cancer Prevention, Emeritus at Harvard Chan School.
A new federal tracking system developed by the Centers for Disease Control and Prevention, COVIDView, will track the coronavirus in the U.S. and provide weekly updates. “I think the information will be valuable,” said epidemiologist Marc Lipsitch. But he and others said the CDC should have developed the system much sooner, and that it doesn’t provide everything it should, such as daily instead of weekly updates. “We’re in the middle of the greatest pandemic in a century,” said Ashish Jha. “So I think what they’re doing is fine and it is helpful. But we need something much more than that. The pandemic doesn’t take the weekend off.”
As of April 4, 12 states had not issued stay-at-home orders to stem the spread of the coronavirus, but public health experts said that if social distancing measures are delayed in some parts of the U.S., the nationwide death toll could rise. Immunologist Yonatan Grad said that while isolation may have protected rural areas to some degree so far, that won’t last. “It just takes more time to show up there,” he said. “But it will.” He noted that there’s a lag of several weeks between when cases start to appear and when a surge of disease hits. “The sooner you’re able to slow the spread of the virus, the more you’re able to flatten the curve and mitigate the risk to your health care infrastructure,” he said.
April 3: Mask on? Mask off? (Vox’s “Today, Explained”)
In this podcast, Joseph Allen, assistant professor of exposure assessment science, said it’s important for the general public to wear cloth face masks to help prevent the spread of COVID-19—but to reserve N95 respirator masks for frontline health workers. He also discussed the inconsistent messaging about masks from federal officials, and how even though Americans aren’t used to wearing masks, it can begin to feel more natural over time. “Norms can change pretty quick, and I think that’s what you’re seeing with other countries in terms of mask-wearing,” he said. He added that masks don’t substitute for other important measures to stop the spread of infection, such as washing hands, staying at least six feet away from people, and staying home except to pick up necessities.
With coronavirus deaths in the U.S. estimated at 100,000 to 250,000 and possibly higher, the U.S. faces a large-scale collective trauma. Aside from having to process so much death, social distancing means that our traditional ways of mourning the dead—attending funerals, dropping off meals at loved ones’ homes, or sitting shiva—are not available to us. “Many of the ways we as individuals, and communities and societies, cope with grief, we will not be permitted to do,” said Karestan Koenen, professor of psychiatric epidemiology. Although saying goodbye to loved ones and comforting those in mourning in person is impossible right now, Koenen said it’s important to find alternatives if we’re going to move ahead.
Commenting on U.S. missteps in addressing the threat posed by the coronavirus, epidemiologist Marc Lipsitch said that actions taken in January—screening people coming off of planes from Wuhan and then banning foreigners who’d spent time in China—was a good idea, but “the problem is those measures became the centerpiece rather than a minor aspect of the response. So we wasted a lot of time not getting prepared in those weeks of late January, early February and much of February, in fact.” Lipsitch said that social distancing is showing signs of working in some parts of the country, but warned against lifting those restrictions too soon. “We’ve grabbed a life raft, and we need to climb out of the water and catch our breath and start making plans for how we’re going to solve the problem,” he said. “But how to get to dry land is really unclear this point.”
April 3: Harvard to help track the virus (Harvard Gazette)
Hundreds of students at Harvard Chan School are volunteering to assist with the COVID-19 response. Working with local boards of health across Massachusetts through the Academic Health Department Consortium, they’re helping with case interviewing and contact tracing, communication efforts, and social media. They’re also assisting Harvard University Health Services by fielding questions from the Harvard community, tracking the latest official health recommendations, and helping with health promotion. Dean Michelle Williams called the students’ efforts “an incredible learning opportunity for all of us, in addition to the contribution we want to make.” Lucas Buyon, PhD ’23, president of the Harvard Chan Student Association, said, “There’s suddenly been a burst of activism from the student body as we’ve realized we’re all public health professionals, and we can do something about this, we can use our skills to help everyone.” The article also quoted Eric Coles, DrPH ’20, who is helping coordinate the volunteer workforce.
There is little evidence that the Trump administration’s restrictions on some international travelers have restrained COVID-19, according to experts. They said that such restrictions can work only as part of a more comprehensive response that includes widespread testing, isolating people who may have been exposed to infection, and ramping up emergency preparedness. Epidemiologist William Hanage said that the Trump travel ban was the wrong approach at the wrong time. “When the travel ban was put in place, the risk of importation from China was quite small,” he said.
There aren’t definitive answers on whether there’s risk of spreading COVID-19 through restaurant takeout or food delivery, but experts offered advice on minimizing potential risk for customers, crews who prepare the food, and delivery drivers. This article referenced Joseph Allen, who wrote in a recent Washington Post op-ed that the risk of getting COVID-19 from grocery shopping or food delivery is low. Epidemiologist William Hanage was also quoted on whether or not COVID-19 can be transmitted by people who don’t adequately wash their hands after using the bathroom. “We can reasonably surmise that some transmissible virus happens from a stool, but we have no evidence to suggest that it is a major route of transmission,” he said. “My judgment would be that the role of this in transmission is dwarfed by the contribution that is made by people who don’t even realize they are infected yet.”
Public health experts say it could take many months until life returns to normal in the wake of COVID-19. Although cases are expected to peak in mid-April in many parts of the U.S., lifting social distancing restrictions too soon could lead to a resurgence of the virus, they say. In the meantime, much needs to be done to fight the pandemic, including expanding testing, creating the infrastructure needed to trace contacts of cases and monitor them in quarantine, expanding hospital capacity, and providing more protective equipment for health workers. “We let things get out of hand,” said epidemiologist Michael Mina. “So now the place that we’re left in is we have to absolutely beat this down with a hammer and get to near zero cases.”
After 9/11, the federal government poured money into bolstering the nation’s public health systems. Without that investment, the current problems with the response to COVID-19, such as a lack of tests for the virus and shortages of hospital beds and medical supplies and equipment, might be even worse, according to experts. Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership, said that it’s a mistake to question whether those funds were over-allocated to, for example, bioterrorism preparation, rather than pandemic planning. “One doesn’t want to be a Monday morning quarterback on that,” he said.
Major symptoms of COVID-19 are fever, coughing, and shortness of breath. But some people experience very different symptoms, such as vomiting and loss of taste and smell, and some experience no symptoms. The variation from person to person has “really put us behind in our ability to identify people with COVID infections, and probably resulted in a lot of people walking around with COVID and not knowing it,” said Andrew Chan, professor in the Department of Immunology and Infectious Diseases. Chan is collaborating with colleagues on a COVID Symptom Tracker app that can provide information about the nature of the disease, who’s getting infected, and how best to limit its spread. Chan explained why the app can help: “If it’s just one person that feels this way, we don’t know what to make of that,” he said. “But if many people are feeling the same way with subtle symptoms then that is something that’s really worth sitting up and taking notice about.”
Health researchers from Harvard and other universities are tracking the effectiveness of social distancing policies by using anonymized mobile location data from Facebook. The researchers—part of the COVID-19 Mobility Data Network—have found, for example, that mobility dropped in New York on weekends but rose again during the week, when some people returned to work. Epidemiologist Caroline Buckee said that the data can also show “if at first people stop moving but then begin to travel further once fatigue sets in.” She said that matching changes in mobility with later hospitalizations can help determine when it makes sense to relax social distancing policies.
Although Floridians are now under a stay-at-home order to curb the spread of COVID-19, experts say it might not have been issued soon enough. Epidemiologist William Hanage said he is “very worried” about what might happen in the state. “My concern for Florida is rooted in the fact it has a population that skews old,” he said. “There have been reasonably large opportunities for super spreading events. And I don’t think there is very good evidence that the transmission of covid-19 is slowed in any meaningful way by warmer temperatures.”
Environmental experts are criticizing Trump administration policy changes they say will lead to more air pollution. Under one new policy, environmental monitoring and reporting requirements won’t be enforced during the COVID-19 pandemic; under another, fuel economy and emission standards will be weakened. Critics say the changes will not only increase the greenhouse gas emissions that lead to climate change, but will also put people with lung conditions at higher risk of harm from COVID-19, a respiratory illness. “Burning fossil fuels is killing millions of people around the world every year, through air pollutants,” said C-CHANGE interim director Aaron Bernstein. “Air pollutants can increase the risk of people getting sick from viral infections like COVID, as well as bacterial infections.”
April 2: You need to wear a mask. Here’s how (Washington Post)
In this opinion piece, Joseph Allen recommended that people start wearing masks when they go out. He wrote that masks provide four public health benefits: they help prevent the user from infecting others, they protect the user from others who might be sick, they serve as a reminder not to touch your face, and they serve as a social cue that COVID-19 poses a real threat. Allen explained the right way to use masks. He also cautioned that wearing a mask doesn’t replace other important measures such as hand-washing, social distancing, covering your cough, and cleaning surfaces.
Even the most favorable scenarios suggest that, when COVID-19 hits its peak in the U.S., the nation will have roughly 20,000 intensive-care-unit beds available—but will need nearly twice that many. There won’t be enough ventilators either. In this Perspective piece, Daniel Wikler, Mary B. Saltonstall Professor of Ethics and Population Health, wrote that clinicians, epidemiologists, patient advocates, and ethicists generally agree that if difficult choices must be made about which patients to save, the goal is to save the most lives possible. Often that may mean prioritizing health care workers, police officers and others who help maintain civil order, because they all help save lives. It may also mean prioritizing the young or those who seem likeliest to survive the disease, he wrote.
If we take six steps, we can beat the coronavirus by early June, according to Harvey Fineberg, former dean of Harvard Chan School. In a New England Journal of Medicine editorial, Fineberg, who is helping the federal government with its COVID-19 response, recommended:
  • The president should put one commander in charge of mobilizing all needed assets to fight the pandemic.
  • The country should make millions of tests to use over the next two weeks to determine the scope of the disease.
  • The nation should supply health care workers with all the protective gear, ventilators, and other supplies they need.
  • The population should be separated into five groups—those infected, those presumed to be infected, those exposed, those not known to have been exposed, and those who have recovered from infection—and treated accordingly.
  • The public should be inspired and mobilized to maintain social distancing, help each other, and use their skills to develop solutions to the pandemic.
  • Research about COVID-19 should continue at a fast pace so that the fight against the disease can be guided by science.
In this podcast, Bhargav Krishna, DrPH ’21, talked about the possible outcomes of the COVID-19 pandemic, particularly in India. Discussion topics included the accuracy of pandemic prediction models, the importance of collecting as much data as possible on infections and deaths, the dangers of COVID-19 for those with underlying conditions, the possibility of the virus mutating into a deadlier strain, and when a vaccine might be available.
To model the course of an epidemic, epidemiologists consider information such as how contagious a virus is, how long people are infectious, the number of people currently infected, and the population susceptible to infection. But there’s still much information about the coronavirus that’s unknown to modelers—such as how long asymptomatic people can shed virus, whether the virus is seasonal, and what role children play in transmission. One big question is how long immunity will last for people who recover from COVID-19. “That continues to be an unknown that will really have big implications for what will happen in the longer term with this virus,” said Yonatan Grad.
David Hunter wrote about what’s desperately needed in the battle against COVID-19 in Britain: more protective gear for health workers, more hospital beds, more ventilators, and more testing. He also argued that the fight against the pandemic should be led by someone like an army general or a captain of industry—“someone … whose expertise is commissioning, or commandeering supplies, and delivering … supplies under fire.”
Does the coronavirus travel through the air? If so, how far can it travel? Experts say the answers to these questions are complicated and studies are inconclusive. To find answers, “you’d have to expose animals to different quantities of airborne viruses, see if they get infected, and relate that to measures of the virus [in places] where people are infected,” said epidemiologist William Hanage. “This is the type of stuff people will work on for years, but no one is going to find out for the moment.” As for whether people should be wearing masks, Hanage said they could potentially stop those with COVID-19 from infecting others, but data is limited. “We’re trying to build the plane while we’re flying it,” he said. “We’re having to make decisions with quite massive consequences in the absence of secure data. It’s a nightmare for your average cautious public-health professional.”
If the U.S. had instituted earlier coronavirus testing and lockdowns, “we clearly would have had a very different situation,” said Ashish Jha on April 1. In an appearance on CNN’s “New Day,” he said, “I don’t know any public health expert who does not believe that if we had gotten our testing together, if we had gotten our hospitals ready, if we had communicated and gotten a lot of our lockdown orders going much earlier,” we would have had “a different situation,” he said. “We clearly would have.” He also said that many states across the U.S. are still not doing enough testing.
Nurses on the front lines of the COVID-19 pandemic are in harm’s way because of a shortage of personal protective equipment, according to the Massachusetts Nurses Association. The group called for a statewide inventory. Howard Koh said it’s important to coordinate the distribution of such equipment. “Hospital A could be overwhelmed, but hospital B nearby may not have that level of volume. So if those hospitals can work together and communicate and coordinate, that’s hugely important for a statewide response,” he said. He added, “My concern is we’re going to see more of those front-line people, our nurses, our doctors, our respiratory therapists, the critical team that we need to keep people alive, are the very people who are going to be too sick to give the care that’s needed.”
A backlog of COVID-19 tests in the U.S. has made it difficult to achieve timely quarantining of patients and to gain an accurate picture of how many are infected. Epidemiologist Caroline Buckee said that until the U.S. health care system is able to test patients widely, it will be impossible to understand the full scope of the virus and to effectively address it.
Harvard faculty, students, researchers, and staff are helping with the response to the COVID-19 pandemic in a variety of ways. Dean Michelle Williams discussed Harvard Chan School’s efforts, which include a partnership with Thrive Global and the CAA Foundation to support frontline health care workers; COVID-19 online resources for employers and employees, from the Center for Work, Health, and Well-Being; an online mental health series to help cope with the pandemic; and efforts to get students and alumni involved with the COVID-19 response through the Massachusetts Department of Public Health.
A vaccine is the best hope for bringing the COVID-19 pandemic to a permanent conclusion—but there won’t be one available for at least a year or more. In the meantime, wrote Marc Lipsitch and Yonatan Grad in this opinion piece, “we should be working overtime” on a number of fronts. They stressed the need to control the spread of disease through continued social distancing, massive testing, and ensuring that healthcare workers have personal protective equipment. They also urged support for finding treatments for COVID-19, increasing healthcare capacity, and accelerating work on a vaccine. Comparing the intense measures being used to slow the spread of the virus to a life raft, and dry land to the pandemic’s end, they wrote that “we must think clearly and understand that getting through the first phase of this pandemic only gets us into the life raft, not to dry land.”
To know if it’s wise to pull back on social distancing, it’s crucial to gather data on what works and what doesn’t in slowing the spread of COVID-19, wrote health policy expert Michael Barnett, epidemiologist Caroline Buckee, and Yonatan Grad in this opinion piece. They recommended comparing outcomes from states across the U.S., which implemented social distancing measures at different times. They also recommended studying whether people followed lockdown orders, whether children contribute to transmission of COVID-19, and whether closing bars and restaurants has a big impact on infection rates. With epidemiological models predicting another outbreak in the fall, finding answers to these questions is key to deciding on the best strategies to use in the months ahead. “If we can combine data on covid-19 cases and the effectiveness of specific social distancing policies, we can develop clear guidelines on what and when to lock down, and how and when to emerge again,” they wrote.
A number of factors will influence when various parts of the U.S. will be hit with the coronavirus—and how hard they’ll be hit—such as the age and health of the population, the area’s connection to other regions, and how densely people live. It also matters how aggressively local officials implement physical distancing policies. That’s why experts are urging leaders in areas without much spread of the virus to start physical distancing measures now. “The effects will be seen weeks down the road,” said epidemiologist Caroline Buckee. For those who think their communities don’t need such measures, she said, “that is extremely naïve. Everywhere should be taking social distancing very seriously, because nowhere is immune to this virus.”
In this video conversation with John Whyte, chief medical officer of WebMD, Kasisomayajula “Vish” Viswanath, Lee Kum Kee Professor of Health Communication, discussed the media’s handling of the COVID-19 pandemic, the need for more focus on health equity issues related to the crisis, and steps people can take to manage the deluge of pandemic-related news.
March 31: The Difficulties When Coronavirus Cases Flood U.S. Hospitals (NPR’s “Morning Edition”)
Although massive efforts are underway to ensure that hospitals aren’t overwhelmed with COVID-19 patients—such as a hospital ship opening in New York and automakers making ventilators—it still may not be enough, according to Ashish Jha. “I still don’t think we’re doing [things] as seriously as we need to,” he said. If people think that “this is somehow just going to affect the big cities on the coast, I think a lot of places are going to get into a lot of trouble. And they may not have the resources that New York has to throw at this problem, and that’s what I worry about,” he said. But one silver lining is the fact that the disease will peak at different times in different places. “Because everybody is getting hit at a different time, we can actually expand the set of resources we have by sharing more effectively,” he said.
The next epicenter of COVID-19 could be parts of the Southeast, given that numbers of cases are rising in Georgia, Florida, and Louisiana, according to Ashish Jha. “We are seeing cases rise quickly across all three states [and] other states as well and what that means is their hospitals are days away —or at most weeks away —from getting into the kind of trouble we are seeing in New York,” he said.
March 31: From the lab to COVID front lines (Harvard Gazette)
Technology born in the lab of Harvard AIDS pioneer Max Essex and nurtured by entrepreneurship resources on campus has played an important role in providing the needed reagents and diagnostic kits that are driving a surge in COVID-19 testing. In 2008, then-researchers at Essex’s Botswana Harvard AIDS Institute Partnership developed a platform that provided rapid, low-cost genotyping for HIV. One of the researchers went on to co-found a company in 2016, Aldatu Biosciences, that uses the platform to provide easy-to-use, low-cost diagnostics for resource-poor areas. Now the company is providing test kits for COVID-19 to local hospitals.
Increasing numbers of people in China who recovered from the coronavirus are testing positive for a second time. Virologists are skeptical about the second-time infections, because they’re typically rare. One possibility could be inaccurate testing. “Testing is not always perfectly sensitive,” said epidemiologist William Hanage. “Some of those cases you’re seeing where it looks as if a person was testing positive, negative, then later tested positive again may be likely explained by one of the intermediate tests just not picking it up when it was there. The amount that that’s happening, we don’t really know.”
Better ventilation systems, touchless entry technology, and antimicrobial surfaces are a few of the building design elements that could become more widespread in the wake of the coronavirus pandemic, say design experts. Healthy buildings expert Joseph Allen said that there is now a heightened awareness of how buildings can influence health. “The heightened awareness, I think, is going to come with a demand for better-performing buildings related to our health,” he said.
The science of social distancing was the focus of a March 25 webinar sponsored by the National Academy of Medicine and the American Public Health Association. Webinar panelists, including epidemiologist Marc Lipsitch, spoke about the effectiveness of social distancing as well as its social and economic costs. “Social distancing impacts everyone,” said Lipsitch. “If we don’t do everything we can—ramping up testing, getting more ventilators in hospitals—it will be an even bigger tragedy. We need to use this time wisely.”
A delayed federal response to the coronavirus, the large size of the U.S., and limited ability for a central command unit to pool resources from around the country have contributed to short supplies of personal protective equipment and COVID-19 tests, according to epidemiologist Michael Mina. “We have no way to centralize things in this country short of declaring martial law,” he said.
The U.S. national park system remains open even though some employees have tested positive for COVID-19, and there have been complaints from employees who must still go to work. Epidemiologist William Hanage noted that even though the number of park employees infected isn’t high right now, COVID-19 is extremely infectious. “Whenever you see the virus, it’s moved on already — it will have infected other people by the time you become aware of it,” he said.
A key element to determining whether it’s OK to restart society after coronavirus shutdowns will be to conduct “serology tests”—blood tests that determine whether people who’ve recovered from COVID-19 have developed antibodies that give them some immunity to the virus. If some people were known to have immunity, they could go back to work, and could help others who are sick. But there are many logistical and scientific challenges associated with the tests, say experts. For instance, it’s unclear when and how to roll out such testing. “I think a lot of groups are trying to figure that out right now,” said epidemiologist Marc Lipsitch. “We’ve never had quite this situation.”
Between 100,000 and 200,000 people may die during the COVID-19 pandemic, according to the White House’s coronavirus task force. The number of deaths per day is expected to peak in mid-April. Epidemiologist William Hanage said that 100,000 to 200,000 deaths “certainly seem to be within the reasonable framework.” He said he wouldn’t be surprised if the numbers turned out to be higher or lower. “One of the things that’s difficult for those of us who’ve been involved with modeling this is communicating the amounts of uncertainty that we have.”
As of March 31, Florida Gov. Ron DeSantis had not ordered a statewide stay-at-home order to curb the COVID-19 epidemic, in spite of projections that the disease could kill thousands of Floridians. Said epidemiologist William Hanage, “I would be quite anxious about the potential for rapid spread in Florida.”
Some in the U.S. may be in denial about the seriousnessness of the COVID-19 pandemic—a natural human response to overwhelming emotion and panic, according to experts. But they say it’s important to convince Americans to stay home to curb the spread of the disease and to avoid overwhelming the health care system. Senior research scientist Elena Savoia, deputy director of the Emergency Preparedness, Research, Evaluation & Practice Program (EPREP), said the message needs to focus not on COVID-19’s danger to individuals, but on the fact that if the health system is overwhelmed, patients in need of non-COVID-19 medical treatment may be unable to access it. “We need to make people understand that the behaviors we adopt now will have an impact on our own freedom and health, even if we are lucky and we are not getting COVID-19,” she said.
Two faculty members from Harvard Chan School were among those named to a Cambridge COVID-19 Expert Advisory Panel: Paul Biddinger, EPREP director at Harvard Chan School and vice chairman for emergency preparedness in Mass General’s Emergency Medicine Department; and epidemiologist William Hanage.
March 30: COVID-19 and Public Health Policy (C-SPAN)
In this video interview, Howard Koh, who served as assistant secretary of health under President Obama, discussed public health policy during the COVID-19 pandemic and the need to invest in pandemic preparedness in the future. “In a time where there are so many public health threats with respect to opioids, tobacco, mental health and other issues that make up an average public health day, often we do not spend a moment to prepare for the future, which is desperately needed,” he said.
March 30: Then as now: Pandemic harkens back to 1918 (Eagle Tribune)
The 1918 flu pandemic led to city shutdowns, school closings, bans on public gatherings, and quarantines. Howard Koh said the current coronavirus pandemic underscores the importance of prevention and preparedness. “The lessons we learned from 1918 are ones we are relearning a century later,” he said. He noted that the 1918 experience shows that social distancing saved lives.
The number of COVID-19 infections in Ocean County, New Jersey could top 100,000 by early May if strict physical distancing measures aren’t kept up, according to recent research that estimated the spread of the coronavirus in every county in America. Gov. Phil Murphy has urged people to stay home if possible. But FXB Center director Mary Bassett said that health, economic, and social inequalities in the U.S. make it difficult for many people to stay home—because they can’t afford to miss a day’s pay or take a sick day. “These inequalities … mean that we are both more susceptible and more likely to have people who are not going to follow the public health advice of social distancing, hand-washing and seeking prompt medical care because they risk their livelihood,” she said.
In this opinion piece, David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health, and co-author Anthony Ong of Cornell University wrote about incidents of harassment and violence against Asian Americans that have occurred amid fears over the coronavirus. “Just as mitigating the transmission of pathogens requires a robust immune response, halting the spread of bigotry and fear necessitates mounting a vigorous community response,” they wrote.
Fast and simple tests for COVID-19 that will soon be available could be used in hospital emergency rooms, urgent-care clinics, and doctors’ offices in areas hard hit by the disease. Howard Koh said that the new “point-of-care” tests—which reveal results on site—will greatly improve testing capacity. “Testing had been a challenge initially, but it’s now ramping up,” he said.
March 30: Wither the handshake? (Harvard Gazette)
The handshake has vanished in recent weeks as people limit close contact to curb the spread of the coronavirus. Epidemiologist William Hanage said he hopes the handshake returns at some point, but for now it’s important to hold off. “Because this is a pandemic, because there is virtually no population immunity, and because we know that people can transmit while being either presymptomatic or showing minimal symptoms, every handshake that you have runs the risk of exposing you or the person you are shaking hands with to the virus,” he said.
“I have broken down in tears at various points, especially as I grapple with the weight of the shared fear and isolation of my patients,” wrote Renee Salas, Yerby Fellow at the Center for Climate, Health, and the Global Environment (C-CHANGE), in this commentary about her experience as an emergency room doctor on the COVID-19 front lines. “Yet this underscores why it has never been more critical to respond with selfless, loving service.” She said that the pandemic provides an opportunity for neighbors and communities to work collaboratively to improve the situation—for example, by following quarantine orders and by advocating for the mobilization of sorely needed tests for COVID-19 and medical equipment. “We are all grieving the loss of the world as we knew it,” she wrote. “Yet this also means we have a profound opportunity and responsibility to unite in shared hope as we envision a better world — one that is more loving, just and better prepared for the next emergency.”
“Summer alone is not going to bring transmission to a level where the number of cases shrinks,” said epidemiologist Marc Lipsitch of COVID-19. “It’s really clear that warmer weather does not stop the transmission or growth of the virus.” If social distancing is used as the main way to control the spread of the virus, the best way to do it is on-again, off-again, over months, he said. “With each cycle, we’ll get more time off social distancing, because the buildup of immunity in the population helps to slow the spread.” He added, “I want to be clear: as an epidemiologist, I’m saying what I think existing tools make possible for the purposes of disease control, and not what I think is socially desirable. Multiple rounds of social distancing are not something I look forward to.”
March 30: Facing a pandemic, Broad does a quick pivot (Harvard Gazette)
The Broad Institute of MIT and Harvard, partnering with state officials and local hospitals, converted one of its labs into a COVID-19 testing facility that can process 2,000 or more samples each day. Epidemiologist Michael Mina helped adapt the Center for Disease Control and Prevention’s testing protocol at the lab.
March 30: A multipronged attack against a shared enemy (Harvard Gazette)
Researchers at Harvard are exploring a variety of ways to fight the coronavirus, such as designing new antiviral treatments or repurposing existing ones, or using antibodies from the plasma of recovered patients for treatments. At Harvard Chan School, researchers are modeling how different therapeutics might help curb the pandemic. “The modeling work is actually really important in trying to help us take steps forward and figure out how much we can expect from any one of these drugs [or vaccines],” said Sarah Fortune.
On March 23, the Environmental Protection Agency (EPA) announced that it would relax pollution enforcement during the coronavirus pandemic. But public health experts say that the move by the Trump administration will endanger people with respiratory illnesses, who are particularly susceptible to COVID-19. “EPA’s decision to weaken pollution enforcement could make a bad situation much worse at a time when the demand for medical care is already stressed,” said Kathy Fallon Lambert, a senior adviser with C-CHANGE. “It’s an unconscionable triple whammy that could lead to increased demands for medical care, increased respiratory illness from air pollution and increased COVID-19 cases.” Noted Aaron Bernstein, “Air pollution is strongly associated with people’s risk of getting pneumonia and other respiratory infections and with getting sicker when they do get pneumonia.”
Leaders in several countries, such as the U.S., China, Iran, and Brazil, minimized the coronavirus outbreak at first for political or economic reasons. The result was widespread disease, nationwide lockdowns, and overwhelmed health care systems. Experts say that intervening earlier in an outbreak with strict social distancing measures, even though painful in the short term, is better than waiting. Said Ashish Jha, “But when it gets bad if left unaddressed, it’s really late in the game, and the stuff you have to do is so much worse.”
Some are wondering whether people who’ve recovered from COVID-19 can go back to work to help restart the U.S. economy. But experts say it’s not yet known if those who’ve recovered can be reinfected. If they do gain immunity, it’s not known how long it would last. Previous studies of coronaviruses suggest that while complete immunity “doesn’t last long,” subsequent bouts are less severe and likely less contagious, said Marc Lipsitch. “That should be our guiding hypothesis,” he said.
Recent data suggests that the growth rate of known coronavirus cases in the New Orleans area is slowing. Experts cautioned that it’s too soon to know if the slower growth rate is a long-term trend, but they also said it’s encouraging. Said Marc Lipsitch, “Any reduction even in the rate of increase is an achievement because it flattens the curve.” Flattening the curve refers to slowing the spread of the virus, which is important because it lowers the chance of overwhelming the health system.
Some think the U.S. should focus on those most at risk for complications from the coronavirus—the elderly and people with chronic disease—so that most of the country can return to normal life. But David Ludwig, professor in the Department of Nutrition, and co-author Richard Malley, a physician specializing in infectious diseases, wrote that most Americans are actually at risk for COVID-19 complications—because of obesity. “So with only a small minority of the population that can be confidently considered low risk, relaxing restrictions on them makes no sense,” they wrote. The added that “calls to relax restrictions offer a false choice. Letting the pandemic ravage the population won’t save money — it simply risks even greater economic calamity.”
Gov. Andrew Cuomo has released 1,100 people from New York’s jails and prisons, but he should release many more in order to limit the spread of the coronavirus in those facilities, wrote Mary Bassett, FXB director and former New York City health commissioner, in an op-ed co-authored with Brooklyn District Attorney Eric Gonzalez and Ford Foundation President Darren Walker. They recommended the release of elderly inmates, those in jail because of noncriminal parole violations, and those up to 180 days from parole. They also urged the governor to furlough low-risk inmates. “This is not only an issue about the health of people in prisons, but also a public health crisis that threatens to become a humanitarian disaster,” they wrote.
In spite of White House assurances on March 26 that there were enough ICU beds and ventilators for COVID-19 patients in New York, Ashish Jha said that the situation could change when numbers of patients surge. “When … most health analysts say, ‘We’re going have a shortage and we need to get going on it right now,’ I think that is undoubtedly true. I’m worried about where this is going. I think we have to … level with people that there’s going to be a potential shortage.”
“As the world mobilizes to contain the coronavirus and its fallout, we can’t lose sight of the bigger, equally alarming picture: The next pandemic is only a matter of time,” wrote Jane Kim, dean for academic affairs and professor of health decision science, and Dean Michelle Williams in this commentary. “The U.S. needs to start preparing for it as soon as possible.”
It’s crucial to have an accurate idea of the true number of cases of COVID-19 in order to better understand the disease’s transmission and whether prevention measures are working, wrote David Canning and David Bloom. They argued that, short of testing everyone—impossible because the lack of test kits, other medical supplies, lab capacity, and personnel—testing a representative random sample of 5,000 people in New York state would help pin down the prevalence of COVID-19 infection. “As more test kits become available, setting aside a portion to achieve a basic level of community surveillance is likely to pay tremendous dividends,” they wrote.
Congress should increase Supplemental Nutrition Assistance Program (SNAP) benefits to help low-income households most affected by COVID-19 and to provide a boost to the economy, according to an op-ed co-authored by Sara Bleich, professor of public health policy.
For the most part, experts don’t think it’s necessary for people to spend a lot of extra time washing their clothes to avoid catching COVID-19. “The average person should not worry about their clothing,” said Sarah Fortune. “If you are a health-care provider and potentially subject to a high density of virus, the answer is different. But for most of us, it is all about our hands and face.”
A staggered pattern of social distancing could save lives, avoid overwhelming hospitals, and allow time for the population to build immunity to the coronavirus, according to a new modeling study led by Yonatan Grad and Marc Lipsitch. Grad said he doesn’t know if the political will exists to impose on-again, off-again treatment over many months, but Sarah Fortune said she thinks it is the most realistic strategy. Ashish Jha said that, given the virus’ current spread, the U.S. needs very aggressive social distancing, as well as much more testing, increased production of protective equipment for health care workers, and a coordinated national response.
Dean Michelle Williams and health communications expert Kasisomayajula “Vish” Viswanath argue that misinformation and disinformation about COVID-19 “can be as contagious and more dangerous than the disease itself.” They recommended seeking information about COVID-19 from reputable sources such as the World Health Organization, the Centers for Disease Control and Protection, and Harvard Chan School; verifying the news you hear; maintaining a healthy dose of skepticism; getting used to uncertainty; and not spending too much time checking the news or Twitter. “For now, the best weapon we have against this pandemic is the truth,” they wrote.
Scientists have long known that some people are “super-spreaders” of infectious diseases. As for what’s causing such super-spreading in the COVID-19 pandemic, experts point to a range of circumstantial, biological, and behavioral factors. For example, the disease could spread simply because someone is around a lot of people at a particular time. “If the person becomes highly infectious at the point they go to a bar to celebrate St. Patrick’s, say, then it can transmit to an extremely large number of people,” said epidemiologist William Hanage. He added, though, that the term “super-spreader” can stigmatize people. “You don’t want to be blaming people who have unknowingly done this,” he said.
March 27: What Will It Take to Flatten the Coronavirus Curve? (Wall Street Journal)
“Flattening the curve”—slowing transmissions of COVID-19—is crucial to avoid overloading hospitals, say experts. Suppressing the disease requires population-wide social distancing, home isolation of people with symptoms, and business and school closings, they say. A new study co-authored by Marc Lipsitch found that intermittent social distancing for many months may be necessary to keep numbers of critically ill patients at a manageable level. “The need for intense social distancing is very strong,” he said. “People who get infected today take an average of around three weeks before they are sick enough to need intensive care, if they’re going to get that sick.”
A metric that measures the value of an individual person’s life—the “value of a statistical life,” or VSL—may help in figuring out what society is willing to pay to reduce the risk of mortality from COVID-19, say experts. The VSL sheds light on how much we’re willing to spend to reduce the odds of dying, which economists have estimated at roughly $9.5 million to $10 million per person in the U.S. Those estimates show why spending trillions to fight COVID might be a good investment, they say. “Let’s say one of our worst-case scenarios comes to pass, and 2 million people die,” said risk analysis expert James Hammitt. “Multiply that by $9 million or $10 million and we’re talking about up to $20 trillion as the value of preventing those deaths. That suggests it’s worth expending a fair amount of our resources to mitigate this.”
With American life near a standstill due to stringent measures to curb the spread of the coronavirus, epidemiologists say there are several possible timelines under which people may be able to safely leave their houses to work, go to school, or have fun. Depending on how the pandemic progresses, extreme social distancing could be relaxed in a month or two, in three to four months, in four to 12 months, or in 12 to 18 months. Discussing the four-to-12-month scenario, William Hanage said, “Once the [current] wave is dealt with, then some things might relax—a little.”
India’s stringent lockdown in response to the coronavirus has led people to panic, said Vikram Patel, professor in the Department of Global Health and Population, in this video interview. He said that misinformation about the severity of the disease has sown fear, constantly changing policies have caused stress, and isolation resulting from social distancing could be difficult, particularly for older people. He also expressed concern about people’s loss of livelihood and inability to access health care for chronic diseases. “I think what’s important now is … to make sure this lockdown is as brief as possible, and that during this period all essential services are actually being accessed without any constraints,” he said.
“Relaxing national vigilance and movement restrictions aimed at preventing more novel coronavirus infections [by Easter] would be like throwing a drowning person a life raft and then shooting it full of holes,” wrote William Hanage in this op-ed. “Once the pandemic has peaked in emergency rooms and ICUs, we will enter a new period in which social distancing will not be required to the extent it is now. The goal will be to avoid explosive outbreaks that overwhelm our resources to cope. We don’t yet know exactly when this will be, but we must deal with the initial surge of infections, which we expect over the next month or so.”
March 26: Battling the Pandemic of Fear (Thrive Global)
“As the world struggles with the COVID-19 pandemic, another pandemic has been incubating close behind: a pandemic of fear,” wrote Harvard Chan School’s Karestan Koenen, Jordan Smoller, professor in the Department of Epidemiology, and Alisa Lincoln of Northeastern University. Noting that “fear unchecked is toxic to our mental health,” the authors urged support for preventive and intervention strategies to combat the fear induced by COVID-19.
Intermittent lockdowns, instead of a single prolonged one, may be the best approach to curbing the coronavirus pandemic, according to a March 24 study by Harvard Chan School researchers published on the preprint server medRxiv. An intermittent strategy would give society at large time to build up immunity to COVID-19, while measures like “stay-at-home” orders are imposed periodically to keep the health care system from being overwhelmed. Authors of the article included research fellow Stephen Kissler, research fellow in the Department of Immunology and Infectious Diseases; Christine Tedijanto, a third year PhD student in the Population Health Sciences program; Marc Lipsitch; and Yonatan Grad.
March 26: Public Health Professor Answers Listener Questions About The Coronavirus (NPR’s “All Things Considered”)
Among questions about the coronavirus answered by Ashish Jha: “Is it OK to play frisbee during social distancing?” Jha said it’s safe to toss a frisbee back and forth if you keep 10-12 feet away from your frisbee partner—but because COVID-19 could potentially be spread by the frisbee, make sure to wash your hands before touching your face.
Listening to music, exercising, staying in touch with friends and family, and maintaining a stable routine can boost resilience in the face of stress from COVID-19, said Christy Denckla, research associate in epidemiology, and Karmel Choi, clinical and research fellow in psychology at the Chan School and Massachusetts General Hospital, in a March 25 online forum on the emotional and psychological effects of the pandemic.
March 26: COVID-19: your questions, answered (World Economic Forum)
A panel of medical experts from around the world, including Dean Michelle Williams, answered questions from the World Economic Forum’s Instagram followers about the coronavirus pandemic. In answer to the question “Is it possible that one day this will happen again?” Williams said, “The next pandemic is only a matter of time. And as has become painfully obvious over these past few weeks, we remain dangerously underprepared.”
Worried about getting exposed to COVID-19 from a delivered package, restaurant takeout, or grocers from the market? The risk is low, according to this op-ed from Joseph Allen.
Studies of outbreaks of COVID-19 on cruise ships have provided important information about the virus’ spread, severity, and ability to infect people asymptomatically. The ships are an ideal place to study the outbreak because they are closed systems, where everyone on board can be tested. Studying COVID-19 in the general population is much harder because many cases go undetected. Marc Lipsitch called some of the cruise ship research “an important effort.”
The U.S. is facing serious problems in dealing with the coronavirus pandemic, including a lack of medical supplies and hospital space, and “abysmal” assistance with testing from the federal government, said Ashish Jha. Officials have known since January that the outbreak was coming, and could have used that time to better prepare, he said. “We wasted two months. Two months is a long time to waste in a pandemic. Time is not on our side,” he said.
Experts say that the coronavirus pandemic shows that humanity is placing too many pressures on the natural world. They say that both global warming and the destruction of the natural world for farming, mining, and housing need to stop, because both drive animals that carry pathogens into increasing contact with people. They also urged that wet markets—where live wild animals are butchered and sold—be permanently banned, and that nations crack down on the illegal wildlife trade. “We’ve had SARS, MERS, COVID-19, HIV,” said C-CHANGE interim director Aaron Bernstein. “We need to see what nature is trying to tell us here. We need to recognize that we’re playing with fire.”
Biotechnology companies racing to develop a safe and effective vaccine against COVID-19 face steep challenges, say experts. Barry Bloom, Joan L. and Julius H. Jacobson Research Professor of Public Health, said of the typical vaccine development process, “You have to formulate it. You have to test it in Phase One, Two and Three studies to show in the first two that it’s safe and the third it’s effective. And that takes years.” Sarah Fortune said that there are also “biologic challenges” to developing a safe and effective vaccine, such as the fact that “all immune responses are not the same.” While Fortune said that a vaccine is the “most effective solution” to the coronavirus, Yonatan Grad emphasized the importance of social distancing and widespread testing. The latter, he said, is “the backbone of a response.”
Computer simulations of the spread of the coronavirus are being heavily relied on by cities and countries to decide whether to impose strict lockdowns. But different models can produce very different outcomes. William Hanage said that politicians shouldn’t automatically trust models claiming to show how a little-studied virus can be kept in check. “It’s like, you’ve decided you’ve got to ride a tiger, except you don’t know where the tiger is, how bit it is, or how many tigers there actually are,” he said.
Although the genetic makeup of the coronavirus is changing slightly, experts say that viruses change small parts of their genetic code all the time, and that the changes occurring in the coronavirus won’t necessarily make it more dangerous. “In the literal sense of ‘is it changing genetically,’ the answer is absolutely yes,” said Marc Lipsitch. “What is in question is whether there’s been any change that’s important to the course of disease or the transmissibility or other things that we as humans care about.” So far, he said, “there is no credible evidence of a change in the biology of the virus either for better or for worse.”
In this opinion piece, Thomas Tsai, assistant professor in the Department of Health Policy and Management and a surgeon at Brigham and Women’s Hospital, and co-author Regan Bergmark, also a Brigham and Women’s surgeon, wrote that “health workers are terrified” because they are caring for COVID-19 patients in spite of a critical lack of personal protective equipment such as masks, goggles, and respirators. “Health care workers are an invaluable resource in this pandemic,” they wrote. “We are not expendable.”
What is the best way to begin to relax stay-at-home and other social distancing measures while keeping COVID-19 under control? Strategies that would help ease the transition include aggressive tracing of contacts of sick people, much more widespread testing, targeted quarantines, and tracking technology, say experts. Marc Lipsitch said that if numbers of COVID-19 cases in the U.S. get low enough, “you may be able to get away potentially with less social distancing the second time around, because you’re controlling the individual cases.”
With coronavirus infections multiplying by the thousands in New York, Gov. Andrew Cuomo predicted on March 24 that the rest of the nation will follow suit. William Hanage said, “Some places will be affected more than others and some places will be affected earlier than others. However, everywhere should be preparing for this.”
While more than a dozen governors have ordered the closure of many businesses and have ordered residents to shelter in place to slow the spread of the coronavirus, Florida Gov. Ron DeSantis has refused to do so. But public health experts say that Florida doesn’t have much time to take action before hospitals become overwhelmed. “It is past time to intervene to slow transmission [in Florida],” said Marc Lipsitch.
Emergency preparedness expert Paul Biddinger was among five medical and infectious disease experts named by Massachusetts Gov. Charlie Baker to a new advisory group aimed at helping the state make strategic decisions regarding the COVID-19 pandemic.
A new initiative from Harvard Chan School, the CAA Foundation (the philanthropic arm of Creative Arts Agency), and Thrive Global is aimed at providing health care workers with physical and psychological resources as they battle the COVID-19 pandemic. Said Dean Michelle Williams, “As this crisis continues to unfold, it’s important for those on the frontlines to be fortified with essential equipment while being supported to care for themselves.”
With coronavirus spreading around the U.S., stresses are increasing exponentially for all, especially for millions of parents already struggling with adversities such as low-wage work, unstable housing, and food insecurity, according to Jack Shonkoff, Julius B. Richmond FAMRI Professor of Child Health and director of the Center on the Developing Child at Harvard University. He said that a toxic overload of adversities can lead to substance abuse, family violence, and mental health problems. The Center plans to offer science-based information to support the developmental needs of young children and their families in the context of the coronavirus, he said. “The question is not whether we will get through the ordeal that lies ahead — because we will,” he said in a recent statement.
President Trump said on March 24 that he wants the U.S. “opened up” by Easter, but public health experts say it’s too soon to let up on business closures and social distancing measures in light of expected increases in COVID-19 cases. Thomas Tsai said, “In this time of crisis and uncertainty what we have to rely on are data. We have to let the data and the evidence that we have available to us guide us. … And what the facts are telling us is that the epidemic is real, and it is rapidly growing.”
Effective leadership in a crisis such as the coronavirus pandemic involves guiding people to the best possible outcome over time, according to this article co-authored by Eric McNulty, associate director of the National Preparedness Leadership Initiative (NPLI), and Leonard Marcus, NPLI founding co-director. They wrote that the best leaders take a broad view of the challenges and opportunities presented by a crisis, avoid micro-managing and over-centralizing the response, and unite employees in a shared mission. “The most effective leaders in crises ensure that someone else is managing the present well while focusing their attention on leading beyond the crisis toward a more promising future,” they wrote.
There are steps people can take in their homes to reduce the risk of infection with the coronavirus, such as wiping down delivered packages or the outside of takeout food containers. Preparedness fellow Rachael Piltch-Loeb suggests cleaning the things you tend to touch the most, such as your cellphone, doorknobs, and remote controls. She also emphasized the need for social distancing. “You are less likely to to become infected and pass the virus to others by staying home,” she said.
March 24: How Climate Change Increases Our Risk For Pandemics (Lakeshore Public Radio)
As animals lose their habitats due to climate change, they are coming into contact with humans more often—and transmitting disease. While scientists don’t yet know what caused the novel coronavirus, they suspect it passed from an animal to a human, according to C-CHANGE interim director Aaron Bernstein. “We’re transforming the climate and we can’t pretend that these radical changes to how the Earth works and life on Earth are not going to affect our health,” he said.
With tests for COVID-19 in short supply, and shortages in personal protective gear, it’s important that health care workers and the very ill get priority for testing, according to Ashish Jha. But as soon as more tests are available, testing must become much more widespread, he said—first for close contacts of those who are ill, so they can be quarantined and monitored; then for people who are mildly ill, to determine whether they have COVID-19; then for a random segment of the population, to find asymptomatic cases. “That’s the priority list, I think most experts agree,” he said.
President Trump suggested on March 23 that social distancing restrictions in the U.S., aimed at slowing the spread of the coronavirus, may ease in weeks rather than months. But many epidemiologists say that months of social distancing are just what is needed to prevent millions of deaths from COVID-19. William Hanage noted that in other places that have had outbreaks, like Wuhan, it took roughly four weeks of a lockdown before new infections began to slow, “about how long it takes infected people to become really sick.” That’s why experts say it’s important to keep social distancing measures in place—to see whether they’re paying off.
The COVID-19 outbreak in the U.S. could be the world’s worst because of the country’s longstanding structural inequality, according to Mary Bassett. She noted that the U.S. has the world’s largest prison population, often living in crowded conditions; a low-income population with health conditions that raise the risk of COVID-19 complications; and a thin social safety net. Government action offering financial support to laid-off or idled workers, and policies that ease prison crowding, will be key to lowering the toll of the coronavirus, she said.
Early data suggests that a global clampdown on public life is helping to slow the spread of the coronavirus. But it’s not clear how long the measures will have to remain in place to keep the virus at bay. Marc Lipsitch said that social distancing—keeping people physically distant from each other as much as possible—is like applying the brakes to a car speeding down a hill. “If you let your foot off the brake, which is letting up on interventions, then gravity will start to accelerate the car again,” he said. “As long as there are any cases around, you will start to speed up and get more cases.”
While it’s important to consider the economic pain of measures being taken to prevent the spread of coronavirus, Marc Lipsitch said that without such measures—including social distancing and the closure of businesses and schools—many people will die and the health care system will be overwhelmed. “I think our political leadership has encouraged a feeling of, we should privilege the present over the future,” Lipsitch said. “It’s just not responsible. Leadership means that, when there is a problem, you encourage the people to sacrifice what’s needed to have a better outcome in the future.”
Navigating the COVID-19 crisis requires finding a balance between protecting public health and protecting the economy, say policymakers, ethicists, and religious leaders. Ashish Jha said that people have set up a false dichotomy between the two. “It is possibly the dumbest debate we’re having,” said Jha. “People are being incredibly simplistic and are not thinking through this beyond the next two weeks.”
With hospital beds and ventilators predicted to be in short supply for the expected numbers of COVID-19 patients, experts say that clinicians will be confronted with having to ration care, as doctors in Italy have already had to do. To make such difficult decisions, many ethicists recommend using a utilitarian approach, in which care would be directed toward those most likely to benefit the most from it, according to this article by Austin Frakt, senior research scientist in the Department of Health Policy and Management.
Chances are that if you live with others, you’ll eventually be living with someone who has COVID-19, wrote Joseph Allen and Marc Lipsitch in this op-ed. Among their recommendations: Open the windows, turn on the humidifier, and run the bathroom exhaust fan. These and other steps can minimize risk of coronavirus spreading through your home if family members and roommates fall ill, they wrote.
As people destroy animals’ forest habitats—mostly for agriculture and grazing cattle—animals that carry viruses such as the coronavirus are coming into increasing contact with humans. Climate  change, which leads to some food-growing regions becoming too hot or wet, is one of the drivers forcing agriculture into new areas—and shrinking  animal habitats. “Creatures big and small, on land and in sea, are being pushed to the poles to get out of the heat,” said C-CHANGE interim director Aaron Bernstein. “That makes them come into contact with animals that they wouldn’t otherwise.”
Social distancing to stop the spread of COVID-19 is personally and economically painful, and some are questioning whether it’s worth it. In this article, Ashish Jha and Aaron Carroll of Indiana University School of Medicine wrote that the human cost of stopping social distancing “would be devastating, and the economic toll from that devastation might be even steeper than what we’re seeing right now. More people could die from COVID-19 … in just a few months than have died in every single war this country has fought since its inception.” Jha and Carroll said two things are needed right now: complete cessation of all nonessential activities for at least two weeks, and massive testing of the population.
Public health experts are horrified at the prospect of resuming business across the U.S. before coronavirus is under control. But President Trump is considering pulling back on social distancing. “It is way too early to even consider rolling back any guidelines,” said Howard Koh. “With cases and deaths rising by the day, the country must double down, not lighten up, on social distancing and related measures.”
President Trump said he may soon loosen federal guidelines regarding social distancing and urge now-closed businesses to reopen—even though public health experts say social distancing must continue for many more weeks to stop the spread of COVID-19. Marc Lipsitch said, “Now is the time to tighten restrictions on contacts that could transmit the virus, not loosen them. If we let up now, we can be virtually certain that health care will be overwhelmed in many if not all parts of the country.”
To stop the coronavirus, “We must vastly expand our testing capacity,” wrote Marc Lipsitch. “No country has controlled transmission effectively without massive testing capacity.”
Demand for COVID-19 care is spiking in Massachusetts. But Thomas Tsai said that, “over the last several days, the incredible sense of urgency that has taken place in our hospitals [has] really given us a fighting chance to identify, as well as treat, these patients.”
March 23: Life on Lockdown in China (New Yorker)
China’s strategy for slowing the spread of COVID-19 involved the largest quarantine in history. Some experts wonder if the quarantine will only be a temporary solution—if the virus will come back after people go back to work and school. Marc Lipsitch said that the transition back to normal life would be difficult, like letting the air out of a balloon slowly. “I think it will bounce back,” he said of the virus. “But you will have delayed things, and, if you don’t let it bounce back too much before you put the clamps on again, then you may spare the hospitals from getting overwhelmed. But it’s a really painful process, and people are going to get tired of it.”
Nearly 70% of respondents to an online survey say they don’t trust the ability of their country’s health services and authorities to control the COVID-19 epidemic. But they also say they are confident about the information they’re getting as well as their ability to protect themselves from the pandemic. The survey, developed by Harvard Humanitarian Initiative researchers Phuong Pham and Patrick Vinck, is aimed at tracking, monitoring, and analyzing global socio-behavioral trends to inform the COVID-19 global response.
The increasing frequency of infectious disease outbreaks—including SARS, Ebola, and COVID-19—may have something to do with climate change, say experts. For example, changing climates can spur wild animals to look for new habitats, where they come into increasing contact with humans. “Wild animals have viruses in their bodies all the time, which don’t necessarily make them sick, but when they get into people, they make us sick,” said C-CHANGE interim director Aaron Bernstein. He added that air pollution from fossil fuels can make people more susceptible to respiratory infections like COVID-19.
Chatbots—online symptom checkers—are being used to screen patients for signs of COVID-19. But different chatbots tested by reporters provided conflicting and sometimes confusing information. “These tools generally make me sort of nervous because it’s very hard to validate how accurate they are,” said Andrew Beam, assistant professor of epidemiology. “If you don’t really know how good the tool is, it’s hard to understand if you’re actually helping or hurting from a public health perspective.”
Hospitals, clinics, and doctors are trying to provide care for patients such as pregnant women, people with chronic illnesses, and those with injuries, while minimizing their risk of infection with COVID-19. Surgeries are being postponed, doctors’ offices are closing or only treating emergencies, and routine checkups are being canceled, while telehealth is on the rise. Marc Lipsitch said that COVID-19 patients need to be the focus of medical attention right now, and others should be mindful of the risk of catching the disease. “Obviously sick people come to hospitals,” he said. “The general notion of trying to avoid hospitals is an even better idea than avoiding shopping malls or bars.”
Personal protective equipment—masks, eye protection, gloves, and gowns—is in short supply for healthcare workers on the frontlines of fighting COVID-19. As for when COVID-19 containment and mitigation efforts in the U.S. will have any effect, Eric Feigl-Ding, an epidemiologist and health economist, said that any measurable slowdown of infection will probably take three to four weeks.
Taking extra time and care for ourselves to improve our well-being—to prioritize mental and emotional health—is critical during the coronavirus pandemic, wrote Dean Michelle Williams and Shekhar Saxena, professor of the practice of global mental health. They advised: practice physical distancing, but not social isolation; stay mindful and active; limit news consumption; create a new routine to fit your new normal; and seek help when you need it.
Part of the reason for rapidly increasing case counts of people with COVID-19 is that testing has ramped up, according to health officials. But the available data is incomplete because of the delay in implementing widespread testing, and because many cases have gone unreported. It will also take some time before it’s clear whether measures to contain the spread of disease—such as social distancing, self-quarantining, and the closure of schools, businesses, and public events—is helping tamp down the pandemic. “I think it will also be visible to some extent in what is happening in hospitals, the number of cases being seen, the number of critical care beds beings used,” said Yonatan Grad.
Although testing isn’t the only strategy needed to stem the spread of coronavirus, “without testing, we don’t know who has it, who doesn’t,” said Ashish Jha. “We don’t know who’s spreading it. We don’t know which communities have high disease burden versus low disease burden. We are blindfolded, and I’d like to take the blindfolds off so we can fight this battle with our eyes wide open.”
Drug trials are currently underway to see if the drug hydroxychloroquine, which is used to treat malaria, lupus, and rheumatoid arthritis, might also be safe and effective to use for treating COVID-19. It appears that people—including doctors—are hoarding the drug. Some experts say that if doctors are hoarding it’s unethical. Health policy expert Michael Barnett said that if the drug works, it must be saved for those who need it most.
Harvard researchers from a range of disciplines are working on ways to contain and treat the coronavirus. At Harvard Chan School, the Center for Communicable Disease Dynamics is focused on transmission patterns in the U.S. “We are also working on understanding which populations might be crucial to transmission, and how different policies that are being enacted are impacting the growth of the epidemic,” said epidemiologist Michael Mina. He said the Center is also developing new technologies and efforts to increase testing capacity.
The United Kingdom’s response to the COVID-19 outbreak was marked at first by inaction, then by hesitant and sometimes vague action, wrote David Hunter in this Perspective piece. “Through the past few weeks, the U.K. mantra has been we will act at the appropriate time according to the science,” he wrote. “Many clinicians and scientists have been pushing the panic button, but the alarm, if heard, was not acted on publicly until the third week of March.”
Children of all ages—even infants—could be affected by the coronavirus pandemic, because they can sense when a parent or caregiver is upset or worried, according to Archana Basu, research associate at Harvard Chan School and a psychologist at Massachusetts General Hospital. “The key thing here is that, for each age, the information [about the coronavirus] has to be developmentally sensitive using age-appropriate language that is factual,” she said. She recommended limiting media exposure, engaging children in conversation to clear up misconceptions, and maintaining some familiar routines.
Jane Kim and Karestan Koenen ask that people stop using the term “social distancing” and replace it with the more accurate “physical distancing.” They wrote, “To defeat COVID-19, we need physical distance and social solidarity.”
Fast-tracking vaccines can backfire—because they can make people sicker. And if that happens, it could spur an anti-vaccine backlash. But to fight the coronavirus, the Trump administration has allowed one company to begin testing a potential vaccine on humans before doing the typical animal testing. Experts said that while the vaccines currently being developed for coronavirus may not be dangerous, their effects should still be fully studied. That’s because, “in contrast to drugs, vaccines are given only to healthy people,” said Barry Bloom. “We have to be enormously careful not to harm anyone.”
“Herd immunity” is when enough people become immune to a disease—either through catching it or by being vaccinated—so that they don’t spread contagion, which then leads to a lower infection rate in the community. According to Yonatan Grad, herd immunity can only be reached when a precise proportion of a community becomes resistant to an infectious disease; in the case of COVID-19, experts think that proportion might be around 60%.
March 20: Could a New Test Identify Immunity? (Harvard Gazette)
Marc Lipsitch outlined ways to forge through the COVID-19 pandemic, and maybe get some people back to work. Serological testing, to help identify those who may have developed immunity to COVID-19, would be one important step, he said. “The value would be potentially tremendous if we had a workforce that was growing as the epidemic progressed that could safely go back into various jobs — including health care workers,” he said. Lipsitch’s recommendations were also covered in a Harvard Magazine article.
Virtual visits with your doctor will be the new normal during the coronavirus pandemic, wrote Michael Barnett and Asaf Bitton, executive director of AriadneLabs. They offered advice on how to safely access care in the weeks and months to come.
In this opinion piece, Marc Lipsitch and co-author Richard Danzig, senior fellow at the Johns Hopkins Applied Physics Laboratory, wrote that it will be necessary to “wage a sustained war” against COVID-19. They listed a host of challenges and actions that need to be taken, such as reducing the burden on hospitals by establishing methods for home treatment, or by building temporary hospitals. They called for the production of huge quantities of ventilators and for ramped-up testing. They also said it’s crucial to ensure that other aspects of the U.S. infrastructure—such as food production and delivery, power distribution, telecommunication, drinking water, and transportation—be adequately maintained.
In an opinion piece criticizing President Trump’s leadership regarding the coronavirus, columnist Jennifer Senior recommended that the public turn to other leaders, such as New York Gov. Andrew Cuomo, for facts. She also said they should follow experts like Marc Lipsitch, one of “the many civic-minded epidemiologists and virologists and contagion experts on Twitter.”
March 19: The Truth about COVID-19 and the Next 18 Months (Factually! with Adam Conover)
Ashish Jha answered questions about COVID-19 on this podcast. Asked how long people will have to maintain social distancing in order to slow the spread of the disease, Jha said it’s hard to know, because the dearth of testing in the U.S. means it’s impossible to know how many infections there are. Once testing picks up to where it should be, disease hotspots will become evident and containment will be possible—which would make it safer to start relaxing social distancing, he said. “Until we start getting information about who’s sick and who’s not and how many people are sick, it’s very hard to know what to do next,” he said.
March 19: This Is How We Can Beat the Coronavirus  (The Atlantic)
Maintaining social distancing will buy the U.S. time to beat COVID-19—time to ramp up testing and to strengthen the medical infrastructure—wrote Ashish Jha and co-author Aaron Carroll of the Indiana University School of Medicine, in The Atlantic. “We can make things better; it’s not too late. But we have to be willing to act,” they wrote.
As people avoid hospitals and doctors’ offices to slow the spread of coronavirus, they’re increasingly using telemedicine. Health policy expert Michael Barnett said that while the U.S. has been slow to embrace telemedicine until now, this may change as Americans become more accustomed to the technology.
Research in a tuberculosis lab led by Sarah Fortune has come to stop, part of an effort across Harvard to stop or slow work in labs in order to de-densify the University to lower the risk of infection from coronavirus. In Fortune’s lab, researchers must wear N95 masks and full-body protection suits—and they decided to donate that gear to local health care clinics to use as coronavirus cases continue to mount. “We have this special responsibility to share our personal protective equipment with health care workers,” said Fortune. “We all feel like if we—especially us who understand so clearly what this could be—don’t really fully make hard sacrifices, then how could we ask anybody else in our community to do that?”
March 19: You Can Help Break the Chain of Transmission (New York Times)
Epidemiologists William Hanage and Helen Jenkins of Boston University, who are married, used tree diagrams to explain how limiting contacts with others can help prevent many coronavirus infections. They said that simple interventions, such as working from home, can have an exponential effect and can make a huge difference in slowing the spread of disease.
March 19: Understanding China’s coronavirus numbers (PRI’s “The World”)
It’s good news that China is reporting no new locally-transmitted cases of coronavirus, only new infections that originated outside the country, said Winnie Yip, professor of the practice of international health policy and economics and director of the Harvard China Health Partnership. While China is encouraging people to return to work gradually, “the whole country is still under vigilance” to make sure there’s not a second wave of infection, she said. As for how the coronavirus might spread in the U.S., Yip said that, “at least for some parts of the country … [the U.S.] may be reaching a situation that is similar to the northern parts of Italy in a few weeks’ time.”
March 19: An Epidemiologist Answers Your Coronavirus Questions (WNYC’s Brian Lehrer Show)
In this radio interview, epidemiologist Caroline Buckee answered listeners’ questions about coronavirus.
March 19: How to Keep Your Distance (New York Times)
This article—which outlines the differences between concepts like “social distancing,” “self-monitoring,” and “self-quarantine”—quoted Asaf Bitton, executive director of AriadneLabs, who recently wrote a piece called “Social Distancing: This Is Not a Snow Day.” Bitton said he wrote the article after schools and businesses had shut down to slow the spread of coronavirus—and he looked out of his office window to see a park full of people. “I thought, ‘This is crazy.’ Why did we close the schools if we’re going to shift social contact from the schools to the playground?” he said. In his article, he stressed the importance of “making daily choices to stay away from each other as much as possible.”
In spite of a lack of good data on many aspects of the COVID-19 epidemic, it’s essential to keep up with social distancing, because “waiting and hoping for a miracle as health systems are overrun … is not an option,” wrote Marc Lipsitch. Lipsitch’s op-ed came in response to a recent op-ed by another epidemiologist that seemed to suggest that, until data are more certain, taking drastic actions might not be the wisest course of action to curb the spread of the coronavirus. Lipsitch contended, however, that “we know enough to act; indeed, there is an imperative to act strongly and swiftly.”
With COVID-19 testing still limited in the U.S., “social distancing is absolutely the way that we will control and reduce the transmission of this virus in the population,” said Michael Mina. Mina also discussed topics such as how much to worry about contamination from surfaces, and the challenges with ramping up coronavirus testing.
Experts say that healthy people should stay home as much as possible to slow the spread of coronavirus. Ariadne Labs director Asaf Bitton acknowledged that the emphasis on social distancing is “extreme because what we’re asking [Americans] to do really has never been done at scale across our country, certainly in our lifetimes.” He also said that, to reduce confusion, there should be a coordinated public response at all levels of government.
Demand for coronavirus testing in the U.S. still outstrips availability, say experts. Not knowing who’s infected makes it difficult for health officials to make informed decisions on how best to treat patients, spot new outbreaks early, and decide where to focus resources. Said Michael Mina, “The testing capacity remains extraordinarily limited compared to where we should be. And in many ways we are absolutely flying blind at the moment.”
People who live alone, even if healthy, should take the same precautions against the coronavirus that the CDC recommends for everyone, to minimize their own risk as well as the risk of spreading the virus to others, said Rachael Piltch-Loeb. “The risk or the effect of coronavirus on a generally healthy young adult is pretty low, but the reality is that we come in contact [with]—and we can spread this virus really easily to—plenty of other people,” she said.
People who deliver takeout food may face a high risk of exposure to the coronavirus and need to be careful, said infectious disease expert Thomas Tsai. “If we can minimize unnecessary food delivery, we should,” he said. Tsai’s advice for those who order takeout is to wash their hands before opening containers and to wipe down some of the exterior surfaces on packaging. As for the food itself, he said early evidence suggests the virus is inactivated by heat, so should be safe.
Will the U.S. have enough capacity to care for growing numbers of critically ill coronavirus patients? A Wuhan-like outbreak could overwhelm many American I.C.U.s, according to research by epidemiology doctoral student Ruoran Li, Marc Lipsitch, and colleagues. Also, a recent analysis from the Harvard Global Health Institute, the New York Times, and ProPublica found that, in a “moderate” scenario, hospitals in 40% of American markets wouldn’t have enough room for all patients with COVID-19, even if the beds were emptied of all other patients.
It’s essential right now to decrease the risk of transmission of the coronavirus—to spread out the number of infected individuals over time, according to infectious disease expert Thomas Tsai. “The problem is, if we don’t do that, then there’s an increased demand that is going to outstrip the supply of hospital beds and, most critically, mechanical ventilators and [Intensive Care Unit] beds,” he said. Tsai worked on an analysis by the Harvard Global Health Institute of the availability of hospital beds around the country.
Testing for the coronavirus is still “way behind the curve in terms of where we need to be,” according to Ashish Jha. As of March 17 there were roughly 4,500 confirmed cases of COVID-19 in the U.S., but experts suspect that the actual numbers are in the 30,000 to 40,000 range. “Our hospitals and our emergency rooms are not ready,” Jha said. He outlined two choices: “We can either have a national quarantine now—two weeks—get a grip on where things are and then reassess. Or we can not, wait another week, and when things look really terrible, be forced into it, and that’s going to last much longer. Many more people will die.”
Testing for the coronavirus in the U.S. is still far behind where it should be. Some clinicians and individuals have begun skirting FDA rules regarding testing to fill in the gap. And many health facilities are limiting testing to those with clear symptoms of COVID-19 to conserve limited supplies of test kits and protective gear. “If you get large-scale testing such that everyone could do it, we could have a much better sense of the scale of the problem,” said epidemiologist William Hanage.
The coronavirus crisis has led to “panic buying”—people stockpiling supplies like hand wipes, hand sanitizer, and toilet paper. “When you’re seeing extreme responses, it’s because people feel like their survival is threatened and they need to do something to feel like they’re in control,” said Karestan Koenen, professor of psychiatric epidemiology.
March 17: How To Practice Social Distancing (New Yorker)
Social distancing—avoiding close contact with people outside your immediate family, and also certain public spaces—will help curb the spread of the coronavirus, say experts. In this Q&A, Ariadne Labs director Asaf Bitton offers details about what exactly social distancing means and what it doesn’t mean. He admits, “I get that it is uncomfortable, and I want people to get more comfortable being uncomfortable for a while.”
Experts say everyone should be cautious about non-essential travel right now. People who face higher risk from COVID-19—elderly people, or those with underlying health conditions—should be particularly cautious. But even if you and your family are not in a high-risk category, if you travel you could infect others. “Now is the time where we actually do want to start thinking, ‘Well, do I really need to take that trip to go on vacation?’” said Michael Mina. “If it were me, I think I would probably try to decrease my risk as much as possible, and one way to do that is reducing travel.”
In order to minimize the number of deaths from the coronavirus in the U.S. and to keep health care systems functioning, social distancing will be necessary for the entire population over a long period of time, according to a new analysis from Imperial College. Marc Lipsitch said that the take-home message of the analysis is that “we are going to have to have very tight controls in place on transmission through social distancing. And those controls are going to be so tight that they will be economically and socially very damaging.”
New models developed by researchers at the Harvard Global Health Institute (HGHI) and at Harvard Chan School project that, as the number of coronavirus patients increases in the U.S., the pressure on hospitals across the nation will vary dramatically. Many communities are not prepared for the COVID-19 patients expected to need care, according to Ashish Jha. “If we don’t make substantial changes, both in spreading the disease over time and expanding capacity, we’re going to run out of hospital beds,” he said. “And in that instance, we will not be able to take care of critically ill people, and people will die.”
March 17: Will COVID-19 Supply Telehealth Its Moment? (Managed Healthcare Executive)
Medicare has relaxed rules regarding telehealth because of the coronavirus. The new rules will make it easier for seniors to connect “virtually” with their doctors—thus reducing their risk of contracting the virus outside their homes. Experts say the changes could boost the use of telehealth. Health policy expert Michael Barnett cautioned that handling “edge cases” of COVID-19—when some symptoms suggest the possibility of the disease, but it’s unclear—will be difficult via telehealth. “It is going to be the gray area that is going to be the challenge,” he said.
Experts aren’t sure if the spread of the coronavirus will slow down in warmer weather, even though other respiratory viruses like the flu are seasonal. Marc Lipsitch said there may be “modest declines” of COVID-19 transmission as the weather warms, but not enough “to make a big dent.” He noted that SARS-CoV-2 (the scientific name for the new coronavirus), “as a virus new to humans, will face less immunity and thus transmit more readily even outside of the winter season.”
March 17: Talking To Your Kids About Coronavirus (WBUR’s “Cognoscenti”)
In this commentary, Karestan Koenen and Archana Basu advise parents on how to communicate with children about the coronavirus pandemic: provide factual information use age-appropriate words, validate your children’s concerns, and support positive coping activities.
Optimistically, the coronavirus outbreak could abate in about two months, say experts—if we can double down on social distancing. But many doctors and scientists say the focus shouldn’t be on wondering when the disruption to our lives will end, but on how to support the entire community through the crisis. “We need to change the conversation from: ‘How inconvenient it is to me?’ to ‘Who are the people who are suffering most, and how can we help them?’” said Sarah Fortune. “Think of it as a community service.”
A faulty test for the coronavirus, strict regulations about who could be tested, and an initial unwillingness on the government’s part to seek help from the private sector are all factors that contributed to weeks of delay in implementing a significant level of testing for the virus in the U.S. Now experts think the pathogen could infect at least half of the country’s 329 million people, disrupt economic and personal activity for weeks or months, and cause the economy to go into recession. “This is such a rapidly moving infection that losing a few days is bad, and losing a couple of weeks is terrible,” said Ashish Jha, K.T. Li Professor of Global Health and HGHI director. “Losing two months is close to disastrous, and that’s what we did.” He added, “The only shot we have, I believe, of staving off the worst is going to a national quarantine for 14 days.”
To help slow the spread of coronavirus, many U.S. states are ordering widespread closures of schools, bars, and restaurants, banning large public gatherings, and issuing travel restrictions. In Texas, Gov. Greg Abbott is so far allowing cities, counties, school districts, and universities to develop their own responses to the virus. FXB Director Mary Bassett said this approach “makes people feel that they don’t really know what’s going on and that the people who are in charge don’t really know what’s going on.”
William Hanage says it’s crucial to ‘flatten the curve’ of the coronavirus pandemic—to slow its rate of increase—so that the healthcare system doesn’t become overburdened. “We should be intervening now to try and make [the curve] less steep,” he said.
Megan Murray, professor in the Department of Epidemiology, and other experts offered advice on when to seek medical care and how to protect the people you live with if you get symptoms of COVID-19. Good personal hygiene, especially handwashing, and social distancing are very important for preventing transmission, she said. If you think you have COVID-19, call your doctor, but stay home if you’re not in a high-risk category, to avoid exposing yourself to further risk or possibly infecting others at a hospital or clinic.
It’s unclear how long social distancing will have to continue to curb the spread of the coronavirus. “Unfortunately, the answer is not one most people want to hear: We don’t know,” said William Hanage, associate professor of epidemiology. “We’re not trying to come up with long-term plans to stop the pandemic. What we are doing now is trying to stop it from destroying us.” Yonatan Grad, assistant professor of immunology and infectious diseases, noted that “the goal in social distancing efforts is to ‘flatten the curve’—slow the spread of the virus, decreasing the peak of the epidemic and hopefully thereby limiting the chance of overwhelming the healthcare system. But by slowing the spread of the virus, we extend the amount of time it circulates.”
March 16: How We Can Stop the Next New Virus (Washington Post)
Ending the trade in wild animals would greatly reduce the risk of another pandemic like the coronavirus, according to this op-ed co-authored by virologist Nathan Wolfe, AM ’97, SD ’99, and Jared Diamond, author of “Guns, Germs, and Steel.” That’s because emerging human diseases such as SARS, AIDS, and Ebola are animal diseases (“zoonoses”) that jumped to humans. SARS originated in a wild animal market in China, and it’s suspected that COVID-19 did too. China has now closed these markets, but the trade in live animals continues for the purposes of traditional medicine. Although using wild animal products is an important cultural practice in China, “the global threat from coronaviruses is too great,” the authors wrote. “China and other governments around the world must act quickly and decisively to end the wild animal trade. Unless that happens, we predict with confidence that covid-19 will not be the last viral pandemic.”
To slow the spread of coronavirus, it’s not just the elderly and others at high risk who need to stay away from crowded places and social gatherings—it’s everyone, because anyone can become infected and transmit the virus, wrote Marc Lipsitch and Joseph Allen, assistant professor of exposure assessment science, in an op-ed. They pointed out other myths about social distancing—for example, the idea that doing it for a month or so may be enough to stop the epidemic permanently. “Unfortunately, we are in this for the long haul,” they wrote.
During the COVID-19 pandemic, property owners should take steps such as communicating with tenants on minimizing disease spread, implementing disease control measures, establishing flexible work options, and making sure buildings are as “healthy” as possible. Healthy buildings expert Joseph Allen said that air quality and ventilation are important factors in a building’s health. He recommended lots of fresh air circulation to dilute airborne contaminants — which makes infection less likely — or upgrading or improving air filtration. Higher humidity can also help lessen a virus’s likelihood of spreading, he said.
The latest on the coronavirus The latest on the coronavirus Reviewed by Raj Tech Info on April 16, 2020 Rating: 5

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