We need testing to know how many are at risk
Covid-19 Risks and Risk Management in New York’s Capital Area
By Robert A. Michaels, PhD, CEP
15 March 2020 – In our brave new pandemic world, risks of Covid-19 virus infection have skyrocketed. We missed the opportunity to limit U.S. cases mainly via isolating travelers from China and other hotbeds of infection, and their contacts. Further risk management now is urgent.
The pandemic might end in the U.S. with less impact than flu, but only if we implement effective risk reduction strategies now. It may be calamitous otherwise. In the 2019/’20 flu season, reports the U.S. Centers for Disease Control, we had 13 million cases; 120,000 hospitalizations; and 6,600 to 30,000 flu-related deaths. Manyfold more of each were averted by vaccination. Likewise, personal Covid-19 infection risk estimates have meaning only in a specified risk management context.
Waiting for a vaccine
Until a vaccine becomes available, people must decide how best to reduce their infection risk, and risk of infecting others in their families, households, workplaces, and communities. Young people may be at lowest personal risk but, as potential vectors, they share this onus. Testing and physical distancing are the two most essential, most effective strategies. Walking is safer outdoors, for example, than in an indoor shopping mall, as viruses are likely to be less concentrated. Exposures are more likely to be subclinical, and even might promote immune protection, as was the case with epidemic polio decades ago.
Physical distancing is essential for reducing exposure and preventing infection. Each of us therefore must limit personal contacts at meetings and events, and incidental contacts in public places. Numerous strategies are available depending upon personal circumstances. Most of us, however, must shop at stores, report to workplaces, and pick up mail. Most of us cannot achieve total isolation, or eliminate infection risk.
How tests can help
Testing serves medically by identifying Covid-19 cases, and by enabling treatment and patient isolation. It enables tracking of patient contacts for priority testing and isolation. Thus, testing reduces transmission risks and infection incidence. It enables quantification of the average number of people infected by an infected individual (the ‘R value’). Testing enables comparison of the effectiveness of risk reduction strategies.
Testing is essential for epidemiology and pandemic management, as it quantifies infection incidence and risks geographically, and time trends of infection by location. It also quantifies incidence and severity risks by age category. Is clinical severity increased by age, or only by age-related co-morbidities such as immune system compromise and respiratory and cardiac conditions? What is the benefit, if any, of early diagnosis?
Let’s catch up
In short, testing is essential. Our weeks-late start in testing has come at great cost to life and health. That is being remedied. As Winston Churchill has been credited (possibly inaccurately) with saying: “You can count on the Americans to do the right thing, after they have tried everything else.”
With newly available testing, the number of Covid-19 cases in New York State (as of 12 March) abruptly increased by 96, bringing the total to 421, according to Governor Andrew Cuomo. On 14 March New York had its first Covid-19 death. Cases have begun to appear in the Capital area, including in Saratoga County, SUNY/Albany, and Union College. The data are only qualitative, however, reflecting the new reality of the presence (no longer the absence) of recognized cases locally. They also reveal, independent of possibly varying infection risks, more cases with more testing.
A fuller, quantitative characterization of risks and risk trends is needed. The number of cases presently recognized reflects infections that occurred weeks earlier. The actual number of present infections is unknown. It may be 10s, 100s, maybe even 1000s of times higher than the number of initial infections, and of presently recognized cases. Time and expanded testing will tell.
The small number of recognized cases locally has been accompanied by ominous reports of community transmission. The exposure network has expanded beyond traced contacts with people, and possibly now also involves environmental transmission via breathing and/or hand-to-mouth exposure from contaminated surfaces. Accordingly, many meetings are being canceled, and meeting places closed at least temporarily.
In 1665 the bubonic plague pandemic closed Trinity College in Cambridge, England. Isaac Newton, a young student working from home, (according to legend) sat under an apple tree and got beaned. He thereby discovered that gravity on earth and elsewhere is just one force. Newton appreciated the situation of our gravity; we must appreciate the gravity of our situation.
 Dr. Michaels, president of RAM TRAC Corporation in Schenectady, is a toxicologist specializing in assessment and management of potential risks to environmental and public health.