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Mistakes USA Has Made in Its Response to COVID-19.. By Dr. Magdy Badran


Fri 03 Jul 2020 | 10:56 AM
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About 52,898 new infections with the COVID-19 coronavirus have been recorded in the United States within 24 hours, a record since the start of the epidemic, according to a Johns Hopkins University survey Wednesday.

The US has recorded 2.8m confirmed infections and 131,099 deaths. At least 20 million people in the US may already have been infected with COVID-19.The University of Washington predicts 180,000 US deaths by October - or 146,000 if 95% of Americans wear masks. Between 5% and 8% of the population had been exposed to the virus.

A New Surge in Coronavirus Cases in America

America could have prevented another surge in coronavirus cases. It’s now clear it didn’t. The surge - which is occurring particularly strongly in southern and western states - has forced at least 16 states to pause or reverse their reopening plans.

In Texas, the state, which has been at the forefront of moves to end lockdown measures, has seen thousands of new cases, prompting Republican Governor Greg Abbott to call a temporary halt to its reopening. The state has seen a record number of people requiring hospital treatment for 13 days .All but 12 of the state's 254 counties have reported cases.

Other states, including Alabama, Arizona, California, Florida, Idaho, Mississippi, Missouri, Nevada, Oklahoma, South Carolina and Wyoming, have all recorded record daily increases in the number of confirmed cases this week. While some of the increase is down to increased testing, the rate of positive tests in some areas is also increasing.

New York, New Jersey and Connecticut said they would ask people travelling from eight states - Alabama, Arkansas, Arizona, Florida, North Carolina, South Carolina, Texas and Utah - to go into self-isolation for 14 days. The list of states impacted by a quarantine travel order doubled to 16 based on their latest coronavirus infection data as the rate of new coronavirus infections in the US continues to grow.

In California, which reported a record 7,149 new confirmed cases on Wednesday June 25, Walt Disney said it was delaying reopening of its Disneyland Park and Disney California Adventure Park originally set for 17 July. The company said it first needed to receive approval from government officials. The state had carried out more than a million tests over the past two weeks, with about 5% coming back positive.

Top disease researcher Dr Anthony Fauci has told the US Senate that he "would not be surprised" if new virus cases in the country reach 100,000 per day."Clearly we are not in control right now," he testified, warning that not enough Americans are wearing masks.

Superspreaders

The coronavirus has traveled the globe, infecting one person at a time. Some sick people might not spread the virus much further, but some people infected with the COVID-19 are “superspreaders.”

Early in the outbreak, researchers estimated that a person carrying COVID-19 would, on average, infect another two to three people. More recent studies have argued, however, that this number may actually be higher.

Children, who can superspread measles disease, appear not to superspread COVID-19. In fact, some children appear to have a form of immunity from the more recent disease.

As early as January, though, there were reports out of Wuhan, China, of a single patient who infected 14 health care workers. That qualifies him as a super spreader: someone who is responsible for infecting an especially large number of other people.

In South Korea, around 40 people who attended a single church service were infected at the same time. At a choir practice of 61 people in Washington State, 32 attendees contracted confirmed COVID-19 and 20 more came down with probable cases. In Chicago, before social distancing was in place, one person that attended a dinner, a funeral and then a birthday party was responsible for 15 new infections.

Superspreaders can accelerate the rate of new infections or substantially expand the geographic distribution of the disease.

Whether someone is a superspreader or not will depend on some combination of the pathogen, the patient’s biology and their environment or behavior. Some infected inpiduals might shed more viruses into the environment than others if their immune system has trouble subduing the invader.

Additionally, asymptomatic inpiduals – up to 50% of all those who get COVID-19 – will continue their normal activities, inadvertently infecting more people. Even people who ultimately do show symptoms are capable of transmitting the virus during a pre-symptomatic phase.

A person’s behaviors, travel patterns and degree of contact with others can also contribute to superspreading. A sick health care worker might come in contact with large numbers of people who are especially susceptible, given the presence of other underlying illnesses.

Public protests – where it’s challenging to keep social distance and people might be raising their voices or coughing from tear gas – are conducive to superspreading.

Researchers in Hong Kong estimated that only 20% of all those infected with COVID -19 were responsible for 80% of all local transmission. Importantly, they also showed that these transmission events were associated with people who had more social contacts – beyond just family members – highlighting the need to rapidly isolate people as soon as they test positive or show symptoms.

Lack of Herd Immunity

Herd immunity, refers to the indirect protection that immunized community members provide to non-immunized members in preventing the spread of contagious disease. The greater the number of immunized inpiduals, the less likely an outbreak can occur because there are fewer susceptible contacts.

As a pathogen that confers immunity to the survivors moves through a susceptible population, the number of susceptible contacts declines. Even if susceptible inpiduals remain, their contacts are likely to be immunized, preventing any further spread of the infection.

The proportion of immune inpiduals in a population above which a disease may no longer persist is the herd immunity threshold. Its value varies with the virulence of the disease, the efficacy of the vaccine, and the contact parameter for the population.

Medical Supply Shortages in the US

Doctors and hospitals across the United States ,but particularly in areas hardest hit by the pandemic, are scrambling for items ( masks, gloves, gowns and ventilators ) essential to help those stricken by the virus and protect medical professionals. The lack of adequate supplies has forced healthcare workers to reuse existing sanitary garb or create their own makeshift gear.

A shortage of ventilators has state officials worried they will soon be forced into performing medical triage, deciding on the fly who receives the life-sustaining support - and who doesn't.

Testing Delays

Ramping up testing at an early date - as done in nations like South Korea and Singapore - is the key to controlling COVID-19. The inability of the US government to do so was the critical failure from which subsequent complications have cascaded. All of the pandemic response is dependent on situational awareness - knowing what is going on and where it is happening.

Comprehensive testing means infected patients can be identified and isolated, limiting the need for the kind of sweeping state-wide shelter-in-place orders that have frozen the US economy and led to millions of unemployed workers.

The initial tests sent in February to just a handful of US laboratories by the administration were faulty. By mid-March, the administration was promising at least 5 million tests by the end of the month. An independent analysis of totals on 30 March, however, indicate only a million tests have been conducted. That's more than any other country but the US population is roughly 329 million people.

What's more, because of a crush of testing that has followed the initial shortages, the labs that analyze the results have been overwhelmed, leading to delays of a week or more before tested inpiduals can learn if they have the virus.

Political Squabbles

The virus is politically motivated. Following the first few American cases, Trump and other administration officials said the situation was under control and would dissipate in the summer "like a miracle". The president has also feuded with Democratic state governors on Twitter. He said state leaders needed to be "appreciative" of the federal government.

Republican Senator Lamar Alexander, appealed to President Donald Trump to wear a face mask - an act he has yet to do in a public event. Sadly this simple life-saving practice has become part of the political debate.

The lack of clarity in the president's order to halt entry into the US from Europe - which at first seemed to apply to US citizens as well as foreign nationals - led to a crushing crowds at airports where unscreened infected passengers could easily transit the disease to others.

Social-distancing Failures

College students on spring break from classes packed Florida beaches. New York City residents filled subway cars.

A church in Louisiana continues to welcome thousands. There have been numerous examples of Americans failing to heed the calls to avoid close social contact, sometimes abetted by local and state government officials who have been reluctant to order businesses to shutter and citizens to shelter in place.

Curtailing public-transportation services, such as New York's subway, may have led to trains and buses that were more crowded. Universities that sent students home to their families may have contributed to the spread of the virus by returning infected inpiduals to cities, neighborhoods and homes not yet in full lockdown.