October 6, 2020

public health works

The CDC’s MMWR is a weekly report that is the epidemiological lifeblood of the US public health system. I have written about it’s importance before. This week it published two reports that I find interesting. One showcases the results seen in Arizona. After the initial shutdown of the state with the first outbreak, the stay at home order ended May 15. Soon the number of cases increased with a big jump of 151% between June 1st and June 15th, with hospitals at capacity. After June 17th, mask wearing was mandated by local governments, enhanced sanitations practices begun and other methods to cut down close contact were initiated: limiting size of events, closing gyms, bars, movie theaters and water parks. They also limited restaurants to <50 % capacity with diners 6 feet apart. Cases peaked and then decreased within a month by 75% and were sustained at least through August. This data reinforces that mask wearing is a key factor in cutting down transmissions, supporting the widespread use of masks to help reopen the economy. Yay, masks!

The other report is another cautionary tale of an extended family experiencing an outbreak. A 13 year old had a known exposure to SARS-CoV-2, but she had a negative test 4 days after exposure when she had no symptoms. The family left for vacation and she developed some nasal congestion, but otherwise felt well. The family traveled to meet extended family from other states and spent 3 weeks together in the same house. 14 relatives shared the house during that time, including the 13 year old. 6 other relatives visited but only outside at a 6 foot distance. One visit lasted 10 hours and the other was 3 hours. None wore masks. By the end of the stay, 12 of the relatives who had stayed in the house tested positive for Covid, including the 13 year old who tested positive for antibodies. Of the 6 relatives who visited outside, none developed Covid-19.

This illustrates a few things, including that children and teens can transmit the virus and physical distancing outdoors works. It also demonstrates the cooperation between 4 different states’ health departments: Illinois, Georgia, Massachusetts, and Rhode Island. We need more data like this to help us better understand how to stay safe.

But we also need more contact tracing and better testing to help us get that data. Contact tracing with follow up testing can help contacts know to stay in quarantine to prevent the spread to others. If done in a timely fashion, it can contain an outbreak. For many reasons, the US is failing in this aspect. Contact tracing would be very helpful in preventing further spread related to the White House’s outbreak and has been frustrating to local health officials who worry about the spread outside of the White House.

Wash your hands, cover your nose, keep safe six, and support your local health department.