What we’ve learned about COVID-19, seven months later

I recently came across COVID-19 statistics that I found startling. Thomas Frieden, former director of the Centers for Disease Control and Prevention, said in August that COVID-19 is now the No. 3 cause of death in the nation. It falls behind heart disease and cancer, but ahead of accidents, injuries, lung disease, diabetes and Alzheimer’s. Deaths from COVID-19 are fourth on the list of U.S. death tolls from major events, behind the 1918 influenza pandemic, the Civil War and World War II.

That these numbers occurred in less than one year is worrisome. Even more worrisome is to consider what the numbers would be had we not implemented intervention measures, such as social distancing, working and learning remotely, and mask-wearing.

Back in March, I discussed the effectiveness of social distancing, and how the 1918 influenza pandemic offered evidence that large-scale interventions do, indeed, work. Seven months later, we can say with confidence that the interventions put in place to combat COVID-19 made a tangible impact. We can also say that there is much we know now about transmission and how to prevent transmission that we did not know then.

What we know about transmission now that we did not know in March:

• The virus is transmitted predominantly by the respiratory route. Contaminated surfaces are not as important as we initially thought they might be. No, this does not mean it is a waste of time and money to wash your hands frequently and load up on hand sanitizer. What it does mean is that respiratory transmission deserves our utmost attention.
• Both asymptomatic and pre-symptomatic individuals can spread COVID-19. In fact, the World Health Organization says the coronavirus can spread one to three days before any symptoms start.
• The risk of transmission is significantly lower outdoors than it is indoors. In addition, ventilation seems to be important. Consider the study by Chinese researchers that showed air currents spread the illness in an enclosed space in a restaurant. (See information from the CDC, as well as a summary in the New York Times.)

What we learned since March about how to prevent transmission:

• Social distancing works. As I wrote in March, “In order for social distancing to be effective in preventing transmission in Western New York, each of us needs to commit to it.” Western New Yorkers did commit to it, and as a result, COVID numbers declined since our peak in April and May.
• Wearing masks is critical. Initially, the CDC stated that masks were only necessary for those who felt sick. Soon, however, recommendations shifted, and masks were seen as a necessity for all of us. Interestingly, in Asian countries where mask-wearing is more widely accepted and implemented, transmission was much better controlled than in the U.S. Mask-wearing was likely a contributing factor.
• Rapid turnaround time in testing is hugely important. The more quickly we can identify people who are positive for SARS CoV-2, the more quickly we can act to ensure that the virus does not spread to others.

With the cold weather approaching, many people are asking me whether I think there will be a second wave. My initial response is that this virus has eluded predictions. However, what we do know is that we are in a much better position to respond than we were in March, when cases were first identified in Western New York.

We have better testing and we have learned how the virus is transmitted. And based on what we have accomplished as a community to keep transmission at a low level thus far, we know how to prevent transmission: avoid large gatherings, practice social distancing, wear masks and wash our hands frequently.

These practices will be especially important in Western New York as cold weather limits our time outdoors, where the risk of transmission is less than occurs indoors.

With that in mind, I’ll say the same thing I said in March: The evidence is clear that a community-wide effort will reduce transmission of coronavirus infection. But, it will only work if we all do it. So, do it for yourself, your family and your community. It will save lives.