Have we flattened the curve? TNT asks University of Washington epidemiologist for answers
Did we flatten the curve on the coronavirus?
It’s too soon to declare victory, but it’s looking that way, says Dr. Stephen Hawes, professor of epidemiology at the University of Washington School of Medicine.
“Most likely we did, compared to the trajectory of other states and other outbreaks,” he said last week.
Even if the curve was flattened, it doesn’t mean the pandemic is over. Nationwide restrictions weren’t meant to reduce the number of cases of COVID-19. It was just to delay and spread them out over time. Rather than a steep peak of cases, a gentle, or flattened hill was the goal.
“It allows health departments and hospitals to be ready and not be overwhelmed with patients with COVID,” Hawes said. “The real worry early in the epidemic was how quickly this would ramp up and overwhelm the hospital staff and resources and ICUs.”
The coronavirus, known as SARS-CoV-2, hasn’t disappeared. Pierce County reported 20 new cases and two deaths on Tuesday. Those numbers are down from their peak in late April.
For people who study disease, the pandemic has been the sum of all fears.
“It speaks to the fragility of society, both economically and health wise,” Hawes said. “I think it’s shocking. It’s really been eye-opening.”
No crystal ball
Much has been made over philanthropist Bill Gates and others who warned of a coming pandemic prior to 2020. Most epidemiologists knew a crisis like COVID-19 was possible. But not all were sure COVID-19 was the one to be worried about, even as it was upon them, Hawes said.
Within two weeks of the first cases appearing in western Washington, the university convened a gathering of infectious disease experts, Hawes said.
“We did a poll in the audience: Who thought this would kind of go away and who thought it would really blow up and over run the health care system,” Hawes recalled.
“People were all over the place,” he said.
The gathered experts had divergent ideas on what would happen, even in the next month or two, he said.
“There’s so much uncertainty, even among experts, that it’s hard to say, ‘I told you so,’” Hawes said.
While the medical system has been able to take advantage of the slowdown in infections, so have other segments of society.
Businesses from restaurants to meat-packing plants are devising and implementing protocols designed to reduce infections between employees and the public.
“Flattening the curve also allows both medical professionals and businesses to learn what’s happening in other places and prepare for the best approach,” Hawes said.
But the cost to businesses and workers has been enormous. Unemployment is the highest its been since the Great Depression. Even the medical industry has laid off and furloughed employees.
“It’s unsatisfactory to everyone,” Hawes said.
Testing
Flattening the curve of an outbreak is achieved on many fronts.
Testing is crucial in determining how widespread the pandemic has become, Hawes said. So far, efforts are falling short.
“It’s certainly not at a magnitude where we’re testing a large proportion of the population,” Hawes said.
The polymerase chain reaction test (PCR) used to detect the live virus is still limited to people with symptoms. A newly approved antigen test which can deliver results in minutes has just been approved by the FDA.
It’s the third type of test, serological, that most interests Hawes.
“It’ll be more about antibody testing to see who in the past has been infected, who might be immune,” Hawes said. “It’ll really inform what happened over the past two months in terms of transmission. What proportion of people were infected but didn’t have symptoms.”
For instance, testing could show how many young people were infected but were asymptomatic.
Different policies could be developed for different demographics beyond the current ones that urge vulnerable groups to be more cautious.
Hawes understands that the public wants answers now. Widespread testing will help, he said.
“It’s frustrating, but we’re bound to learn more,” he said.
Social distancing and masks
Social distancing is not only the most visible weapon in the fight against SARS-CoV-2, Hawes thinks it’s also the most effective.
“The fewer people that are infected who come into contact with uninfected people, the less likely we are to transmit it,” he said.
Some hoped, as with the influenza, that warmer weather would lessen the spread of the virus.
“Since it’s clear that this virus is still around and it’s not dissipating as the weather gets warmer, it’s hard to know what the future will be,“ Hawes said.
Infections among co-workers and at so-called superspreader events like the one that infected members of a Mount Vernon choir illustrate the coronavirus’s effectiveness at transmission.
“It’s very clear that when we have gatherings of a lot of people together there’s more probability that people will get infected,” Hawes said. “The more intermixing of people there is, the more likely we are to have a lot more cases.”
Hawes is aware of the costs of social distancing. Framing the pandemic strictly in terms of health is overly simplistic, he said.
“Certainly, we need to think about the economy and quality of life issues, employment,” he said. “You can’t social distance forever.”
Building the planned development of a vaccine into the relaxation of social distancing guidelines isn’t a good strategy, he said.
Some vaccines have been made quickly. Others, like an HIV vaccine, still don’t exist despite 30 years of trying.
While the news media brings encouraging reports in vaccine developments, they are usually concerning single studies of small groups. Proper scientific study calls for studies that can be reproduced and replicated.
“There’s no evidence we’re going to have a vaccine soon,” Hawes said. “So, that’s not going to solve that.”
Masks are the proverbial two-way street. They can help prevent an infected person from spreading the disease, and they can help prevent an uninfected person from getting it.
If you go out in public, it doesn’t matter which group you fall into.
“It doesn’t take much to wear a mask,” Hawes said. “It doesn’t take much to social distance.”
Contact tracing
Contact tracing, the act of establishing relationships between individuals where an infection may have occurred, is well known in the world of sexually transmitted diseases. But COVID-19 and STDs are spread in different ways.
The goal of contact tracing is not to track down everyone an infected person might have passed by.
“It’s not for who you might have come in contact with at the grocery store,” Hawes said.
Nor is it done in situations where groups of people spend a lot of time with each other, as in a meat-processing plant or at a group care facility.
“Where we know of a sub-population that might be at a great risk, we just test everybody instead of trying to figure out who knows who,” he said.
Instead, contract tracing connects people who spent enough time together for transmission to occur, usually in a casual setting.
“It’s specifically done just for people you’ve spent a considerable amount of time with,” he said.
But contact tracing takes time and resources.
“It’s a daunting task,” he said. “You can only do this when you have a moderate or low number of people infected.”
Where we go from here
COVID-19 has hit some groups, like people of color, in a greater proportion than their representation in the population. The disease has laid bare the high prevalence of underlying conditions many people live with: high blood pressure, diabetes, heart disease, obesity, cancer and more.
“I think we’re gaining a lot of knowledge and understanding that health is not just about a disease and infection,” Hawes said. “It’s about access to care, having quality health care, being screened and just being able to afford to go to the doctor.”
Hawes thinks the impact of the pandemic will be substantial and longstanding in the way that HIV was to the medical field.
“That changed so many things,” he said. “It was very similar (to COVID-19). There was so much uncertainty.”
HIV brought new infection prevention protocols to the medical industry that are now standard practice. COVID-19 has shown the dangers of being too reliant on foreign countries for protective gear and drugs.
COVID-19’s permanent impact on other aspects of society might already be apparent. Virtual doctor appointments and video-linked classrooms are now common place, just a few months into the pandemic.
“That’s a positive. But whether we can, in the future, have big classes where we’ve got 300-400 students in the classroom — I don’t know if we can do that,” Hawes said.
A crowded restaurant might be a place people want to avoid for years to come.
“Restaurants with tables close together, I think people are going to be wondering if that’s the right way to do this,” he said. “Sporting events ... there are some big challenges here.”
Beyond COVID-19
History is replete with pandemics. Hawes thinks we didn’t learn enough lessons from past crises.
“I think infectious diseases and pandemics are a much bigger threat to society than war,” he said.
He hopes this pandemic will prepare us for the next one and bolster funding of public health, research and science.
“I think we’re really susceptible,” he said. “I would bet anything that there will be another one of these that comes down the pipeline even if we solve this one. It’s just bound to happen.”
This story was originally published May 21, 2020 at 5:00 AM.
