We have met the enemy, and it is us
When I saw the headline with the lead “There Is No Playbook..”, it was a red flag for me. When I took part in pandemic planning with the NYC Health Department back in 2015, I conducted in-depth research into the impacts of pandemics, their history, and the non-pharmaceutical interventions (NPIs) that are needed to blunt these impacts before a vaccine and antivirals are developed as effective counter-measures to a pandemic. There were playbooks prepared for pandemic (see the link); unfortunately, they were largely ignored, and these plans assumed that public health measures, the NPIs, would be actively put in place in time and adhered to, and they were not. Contingency planning and robust preparedness against a pandemic of this kind would have helped address many issues, including social, psychological, and of course, the epidemiological flattening of the curve.
Human beings are just bad at assessing risks and opportunities on the whole due to our cognitive biases, to name only a few that have affected the way we have responded recently as a society to this pandemic (at least here in the USA due to these underlying biases):
Normalcy bias- the tendency to ignore or downplay disaster events that have never happened before or that we have little experience with.
Status quo bias- a preference that things remain the same.
The Ostrich Effect- burying our heads in the sand when confronted with bad news.
There are many other biases at play, but ultimately, we need to recognize these biases, as well as our emotions in reacting to the situation, and how we are behaving in terms of the risk based on the data, not how we might feel or think how safe it might be. Making decisions based on our feelings is mostly what got us into this current situation.
Continued Threat
The threat from this pathogen remains high. While we know more than we did in the past few months, we are still learning about its effects. It not less dangerous today than it was yesterday. We still do not have proven treatments, effective antiviral medications, or vaccines against it. Just because we think that the mortality curve may have flattened, it can just as quickly go back up through additional outbreaks of COVID-19 in our communities here and regionally. Meanwhile, the infection curve is still rising, and we already see epidemics in different parts of the USA. Each of those outbreaks is multiples of infected cases with many opportunities (vectors) for this to infect us and to return to areas that have managed to reduce the infection level.
What we do know is that the SARS-Cov-2 pathogen which causes COVID-19 is highly transmissible, primarily through airborne person to person contact, saliva, or through surfaces. We have to protect ourselves all the time when faced with potential exposure. The moment we let up our guard, and the pathogen is present, we can quickly get infected. Based on the rate of infection (a reproductive rate of R2.1-2.6), according to leading epidemiologists, in the next year, between 40-70% of the total population will become infected, depending on how effectively we apply NPIs. Doing the math on our population and the range of mortality, an estimated 1-3% of case infections, this would lead to roughly 1.3-4 million people killed by this virus over the next 1-1.5 years in the USA alone.
And one other bit of news for people who are reciting the mantra of the need for testing. While I believe we need to put an effective testing regime in place, testing is still problematic, with limited capacity and accuracy that is questionable. The idea here, to quote Michael Osterholm, who is the Director of Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, “is not to scare the wits ‘out of people’ but to scare the wits ‘into people’”; this pathogen, COVID-19, needs to be taken seriously.
Risky Business
With the beautiful Spring weather in many parts of the US, and people ready to get out, we are witnessing an uneven adherence to physical distancing and mask wearing. People of all ages, elderly, teenagers, young adults, and families, are not wearing masks at all, and there are crowds gathering in public places. This is not too surprising, but very disappointing, as we have made progress in reducing the number of infections and the consequent mortality from COVID-19. These are further worrying signs that COVID-19 will continue to spread with weakening precautions against the pandemic.
We need to continue to follow NPIs and personal and household hygiene, and, above all, physical distancing (formerly known as social distancing). Stores and shops need to follow appropriate public health and safety protocols and develop ways to handle crowds outside their stores. Local public health agencies need to actively support these efforts by providing clear guidance, public health enforcement ordinance, and directions based on current knowledge and better practices, so they can make public establishments safer and encourage the public to patronize them once business resumes.
Out of respect for our families and our fellow citizens, especially healthcare workers, we need to abide by them strictly. This is not the time to go to places where there are large crowds, not the time to travel unnecessarily or relax our hygiene measures. We need to continue to stay healthy, avoid physical contact with those outside our households, and to stop the spread.
Dr. Wilson O. Iyokho, Senior Epidemiology and Infectious Disease Specialist. at Pinnacle Performance Management. Dr. Iyokho is also an Epidemiologist and Research Consultant at Coleman Science and Research Management, LLC and conducts research on coronaviruses, rare diseases, health education,and, risk management planning (RMP).
Andrew Boyarsky is President of Pinnacle Performance Management, a business continuity and disaster recovery consultancy focusing on SME, non-profits, universities. He is also a Clinical Associate Professor in the Management and Systems MS at NYU and in the Emergency Management Graduate Program at the John Jay College of Criminal Justice, a part of the City University of New York. He is also host of the podcast Riding the Wave: Project Management for Emergency Managers.