by Michael Ainscough, MD, MPH
The best short answer is “When we get a vaccine.”
Avoiding the virus in Washington County got a bit more difficult this week. It is not known how two of the cases last week came in contact with the virus, so they were reported as community acquired. Although the cases are now quarantined, the virus could likely be traced back to public exposure somewhere, either within Washington County or in a neighboring county. Because of patient privacy, data on local travel is not made available. If there was no travel and no known person-to-person contact, then this is community spread. The virus has a foot in the door.
The virus does not move. People move it. Either Washington County residents travel to hot spots and bring it back with them, or delivery people like UPS, FedEx, grocery wholesalers, convenience store deliverers, essential business parts deliverers, USPS deliverers from St Louis, or interstate travelers bring it in. Less likely it comes on the surfaces of packages or mail. Eventually there are obvious cases and asymptomatic carriers in the county resulting in community spread. One person can pick up the virus at work, a social gathering, an errand, a playdate, and then bring it home to their family.
Experts say the virus has likely arrived in most rural communities. However, it can take some time to notice because it may take up to two weeks for cases to require hospital care. Because of a lack of testing available, rural communities also might not realize the scope of the simmering problem.
Through the various means noted above, case counts are now rising in rural areas. As the coronavirus spills beyond St. Louis and St. Clair County, Washington County officials are doing their best to prepare for an influx of cases. It is a good thing to be able to handle a disaster, but it is a wonderful thing not to need to. To use a sports analogy for epidemics, you always want to play away games… prevent the virus from coming to your home county. Public health medics say “Prevent all that you can, treat when you must.” That means if you can prevent the virus from coming to your home area, fewer patients will require treatment.
The residents of Washington County have done an excellent job of preventing disease here. Because it is next to impossible to prevent all cases, it appears likely that we will be treating more. As the number of positive cases grows in our county, we need to continue staying at home, social distancing, hand washing and other preventive measures as much as we can. Don’t cheat. If you are at higher risk (seniors, medical conditions, lower immunity) to have complications from an infection, then heeding the guidance becomes even more important.
The following elements are most important in Washington County going forward: 1) More testing to identify active cases, trace contacts, and use quarantines. 2) Enough capacity of our clinics, Washington County Hospital, and referral centers to handle increasing numbers of patients. 3) The cooperation of citizens to continue some restrictions such as social distancing, stay at home, and no gatherings with people outside your household.
How long will this last? Some medications show promise, but there likely won’t be a miracle pill to take at the first sign of symptoms. Waiting for everyone to get the virus would take too long, and would be too costly in human lives. The definitive end will only come after a vaccine, which may be a year away. The virus will cease being a threat only when 80-95% of the population becomes immune, either by recovering from infection or by a vaccination.
In the general population, the positive test rate for coronavirus is nearing 20%, which is nowhere near what is needed. Until we get to 80-95% herd immunity, there will be regional outbreaks. There will likely be several more months, even a year, of intermittent restrictions. Harvard researchers said last week that we may need some degree of social distancing for two more years if there is no vaccine. Going forward, the restrictions likely won’t be a one-size-fits-all solution for the entire state. They may be tailored in cities and counties, depending on the disease burden.
This is the biggest public health emergency in our lifetimes. But we can’t stay home forever. When restrictions are relaxed and businesses begin to reopen, there will be more opportunities to spread the virus and our risk of infection will be higher. Social distancing and masks are the new normal. We need to be smart, be selfless, be positive, be patient, and do the things necessary to get through it.
Michael Ainscough is a local retired physician who has contributed several articles on the coronavirus pandemic. He can be reached at email@example.com.