"Have a Sense of Optimism. And Wash Your Hands."

A friend wrote to me yesterday, asking for my thoughts and advice on the current crisis, given my (rather limited) education and volunteer work in public and global health. This is an edited version of my reply.

(I want to point out that I'm not an expert in these domains. I'm on academic leave from a master's program in public health, and hold a postgraduate certificate in that domain, but that's not the same as holding a full MPH, nor am I a practicing professional in public health. Everything I write below is evidence-based, but your primary sources of information should always be public health agencies, from the national down to the local levels.)

About COVID-19

We can't "stop" COVID-19. It's loose in the US and, for now, the models suggest that cases are doubling every 5-6 days. We don't know for certain how many cases there are because we're doing an inadequate job of testing, but just assume that whatever the number of cases is today, it'll be 2 times that in less than a week, and 32 times today's number in less than a month.

COVID-19 isn't the flu, not in any sense. It's at least 10x more deadly, and possibly as much as 20-30x more deadly. And with the flu, we have vaccines (imperfect, because influenza evolves, but updated yearly) and we as humans have built up resistance to many of its strains. Neither of these is true with COVID-19. Everyone should take it seriously.

Social distancing

The point of social distancing, handwashing, avoiding-face-touching, and other non-interventional public health measures isn't to "stop" the virus (see above); it's to flatten its growth curve. Why do that? There are a couple of main reasons. First, by reducing the height of the peak (number of cases at a point in time), we can lessen the peak strain on our healthcare system. We're already seeing problems of that sort in Italy where there aren't enough ventilators to go around (to provide limited-time respiratory support to those in critical condition). Second, by flattening out the curve, and pushing more cases farther out in time, we buy researchers more time to work on treatments and vaccines.

People who are young and who aren't otherwise at high risk (due to compromised immune or respiratory systems, or for other reasons) are at low risk from dying from COVID-19. But they have the same risk as anyone of contracting it, and absent social distancing, can spread it, potentially to people who are at high risk. So they need to be just as careful and cautious.

What the future holds

We'll get through this. Our vaccine development technology is far ahead of where it was 20 years ago, even 10 years ago. We should have useful vaccines before the end of next year. And well before then, it's reasonable to expect better treatments to come online—drugs that can lessen the severity of the disease for those afflicted, especially in high-risk categories. Yes, there's going to be a substantial hit to the world economy. Yes, many vulnerable people are going to die—likely hundreds of thousands, possibly millions. And yes, we have yet to appreciate the impact this is going to have on developing nations that are resource-constrained—those nations are going to need all the help we can give them, at a time when our own resources will be stretched. But on the whole, we'll get through it.

What can you do?

So what can any one person do? Follow the recommendations of the CDC and of their state, county, and local public health agencies. Avoid large gatherings. Work from home if possible. Avoid travel unless necessary. Wash your hands. Don't touch your face. Don't shake hands.

You probably have friends or relatives who are alone or who are in high-risk categories. Reach out to them. Ask how they're doing. Offer to help with whatever they need, and mean it. For example, you might have older relatives who aren't comfortable shopping online and who fear going to the grocery store—you could offer to shop for them.

If you're fortunate enough to have a stable job that allows you to work throughout this crisis, consider sharing with those who are in need. To cite just one example, many public school students from low-income homes depend on reduced-cost or free school lunches as their one reliable meal of the day. (The Rotary Club to which I belong sends backpacks full of food home with at-risk children every Friday during the school year because without the backpacks, those children might not eat over the weekend.) If you can afford to help those who are in need, consider doing so.

Finally, have a sense of optimism. It will take time, but we can and will end this pandemic. And I hope and believe that we'll come out the other side with a better sense of the need for investment in and attention to public health, in both good times and bad.

So yes, have a sense of optimism. And wash your hands.