The risks of COVID-19 are real, and it’s time to stop downplaying them. Here’s a glimpse at what we’re actually facing — and some ways you can help keep your community safe
Above: A sign for the SoCon basketball tournament, which city government decided to hold last weekend despite the looming spread of COVID-19.
[Asheville’s seen some rapid changes when it comes to COVID-19. Last weekend, the city was hosting a massive basketball tournament. On Tuesday, Asheville’s fire chief declared “the risk is low” for Asheville during a COVID-19 presentation. Just a few days later, both city and county governments were declaring a state of emergency.
The risks are very real. Instead of panic, we need calm and realistic precautions that take the virus seriously. Instead of individual hoarding, we need mutual aid and community support. Survival is a collective act and Ashevillians will get through this. Here, science writer Leigh Cowart draws on her extensive knowledge of infectious disease to let you know what we’re facing and some ways you can help protect your community — David Forbes, editor]
The first thing I want you to know is that COVID-19 is coming, if it isn’t here already. Despite the city’s “the risk is low” statements Tuesday evening. This isn’t going to be a situation where only the high-risk people need to stay home; no one is going to be able to indulge in life as usual when the coronavirus outbreak comes for your community. This isn’t a cold. This isn’t the flu. This isn’t something to brush off. I’m not being hyperbolic. I have roughly a decade of experience reporting on infectious disease, which is enough knowledge to be very alarmed. I want you to know the things that I know, so that you can begin to take action. Because it’s time. It’s been time. We must act.
Some important factors to consider:
Medical Supply Shortage
America does not have the supplies needed to meet patient demand and protect the medical practitioners on the front lines of the outbreak. Period. For example, it is estimated that we will need seven billion respirators over the course of the outbreak. Currently, we have about twelve million. We need to up our supply by nearly 60,000 percent to meet demand. If we do not have adequate medical supplies, people will die.
The shortage is painfully obvious when you consider the face mask. Have you noticed how pictures coming out of other quarantine areas (prior to lockdown) feature civilians wearing face masks, while the CDC recommends that we wear them only if sick? Yes, it is true that surgical face masks do not protect you personally from infectious particles, but that was never the reason we wore them in the first place.
A surgeon doesn’t wear a mask to protect themselves from the wafting debris of a wet, open wound; they wear the mask to protect the wound from the surgeon’s breath. That’s right, face masks are worn to protect the people around you. With a long incubation period (up to two weeks), it’s possible to shed the virus without symptoms, so who is to say how sick one is, really? Check your Rugged American Exceptionalism at the door my friends, the mask has always been about protecting the people around you. So why aren’t we being asked to wear them? Simple: we don’t have enough, and we have to prioritize who gets them. In fact, due to shortages, the CDC has already loosened its respirator recommendations for the medical workers themselves.That means we need to work to keep each other safe in other ways.
Hospital Crowding
This is the scary part, the part where I explain why you must stay home, why this outbreak isn’t just a bad cold with a low death rate. As many as 1 in 5 people who contract COVID-19 will require hospitalization, but the United States only has 2.8 hospital beds per 1000 people. At any point, about 68 percent of those beds are being used, leaving roughly 300,000 free for coronavirus patients. It is estimated that if 10 percent of coronavirus patients in the US require hospitalization, a conservative estimate, every hospital bed in America will be filled by May 10. As Liz Specht calculated for this harrowing look at the math, if only five percent of cases require hospitalization, the beds will be filled by May 16; if one in five people need it, we run out of beds around May 4.
When the beds fill up, that’s it. People are going to die from lack of access to care. Doctors in Italy are already making these life and death decisions, choosing who gets valuable resources and who dies. (As of today, the death rate in Italy is a staggering 1 in 15 cases.) Do not fool yourself into thinking it cannot happen here. Without a dramatic attempt to flatten the curve, hospitals will fill up with cases faster than they can treat them, and more people will die from lack of access to care. Compounding that will be the fact that people will still need non-coronavirus care during the pandemic. Childbirth, appendicitis, chemotherapy, dialysis, none of these things will slow to accommodate the COVID-19 pandemic. Slowing the rate of infections–not IF we get coronavirus, but WHEN–gives hospitals more of a chance to treat more of the people who need care. The way to do this is through social distancing.
Flattening the Curve
The term “flattening” the curve refers to the attempt to reduce the exponential rate of infection, to save lives by reducing the untenable burden of cases on an already strained medical system. And the way to do this is social distancing.
Coronavirus is transmitted through coughing, but there is also evidence for the fecal-oral route. Though we are still learning about it, we know it can persist on surfaces for hours. We know people can infect others with it before they show symptoms. It’s contagious, and we have to stop it.
Regular soap and water is the gold standard. Use hand sanitizer only if this option is unavailable. Coronavirus is contained in a lipid bilayer that can be popped by soap, and too much hand sanitizer will dry out your hands, leaving the skin vulnerable. Yes, wash your hands and wipe down the surfaces in your car and home as much as you can. Use an oven mitt to pump gas. Disinfect your door knobs. Wear gloves. Do not touch your face. Do not apply lip balm with your finger. For fuck’s sake, disinfect your phone! (Please think of your phone as your disgusting unwashed third hand and treat it as such.)
It’s just not enough though. We have to stay home. Every time there is a positive case, you have to think about how long that person was mingling with society before their diagnosis. This isn’t SARS, people don’t just get sick and stay home. This is COVID-19. People get sick and don’t know it yet, spending precious quarantine time breathing on PIN pads, touching door handles, using bank pens, making food for others, mingling in bars, and going to the gym, all the while exposing the other people around them to the virus. By the time a case is confirmed in Asheville, it will have already been here for days, maybe weeks. People will have already, unbeknownst to them, been exposed. People who do not know they have been exposed will continue to act as if they are healthy, potentially bringing the virus into the very homes of those most vulnerable.
To flatten the curve, to save lives, and to stop the outbreak, we must stay home.
Social Distancing: How to do it?
Stay home. Do not go to yoga class, art school, the gun range, your friend’s house, or any gathering that you can miss. Do not go to church, weddings, birthday parties, orgies. Have your groceries delivered and left on the porch if you can. Use a mail-order pharmacy. Cancel everything. Cancel every event you are involved in; decline to attend any event that proceeds as scheduled. See as few people in a day as possible. Stay home. Stay home as much as you can. There is a pandemic, it’s time.
I know this is nearly impossible for the millions of Americans who live paycheck to paycheck, who depend on work for medical care, who rely on schools for childcare and nutrition for their children, who are uninsured and underpaid and overworked and scared. I wish I had a solution, but in the meantime, this piece has more advice on the nuances of social distancing.
For now, know that the federal government has made allowances for states to give unemployment benefits to those quarantined by the virus, or who cannot attend work for fear of catching and spreading it. Also, the city of Asheville has suspended water shut-offs due to non-payment, and Duke’s done the same with electrical power. Currently, locals are also pressing for a moratorium on rents and mortgages, 24/7 access to public restrooms (essential for the homeless population) and for Buncombe County government and the sheriff’s office to suspend enforcing evictions and foreclosures.
Please stay home if you can. Please stay as safe as possible if you cannot.
A Note: Mild vs. Severe vs. Critical
A note on terminology: when the WHO says a case is mild, they mean anything up to hospitalization. Severe means someone needs to be on a ventilator; critical means respiratory or organ failure. This will be a difficult illness for many, under even the best of circumstances. For more on symptoms and what to do if you start coughing, see this piece.
I’ve seen this sentiment echoed a lot in the various chambers of the internet, but it’s a good one, and I want to share it with you all. If we act now, and are able to reduce the impact of the coronavirus pandemic in our community, people will say we overreacted. We have to be willing for people to think that we are being silly. I am asking you to stay home. I am asking you to protect your community. It’s going to suck, but remember: we are all in this together.
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Leigh Cowart is a science reporter in Asheville whose work has appeared in the Washington Post, New York Magazine, Hazlitt, and others. She is the author of Revival of the Sickest and previously used her background in molecular biology to work with pathogenic strains of bacteria in a biomedical research facility
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