COVID-19: Moving from Failed Containment to Mitigation

Written by WorldClinic

March 11, 2020

Updated: Apr 3, 2020

As you have seen, heard, and read in the media, the number of active cases of COVID-19 is growing every day across the nation. The team at WorldClinic is closely monitoring the COVID-19 pandemic’s ever-changing landscape to ensure our members are kept apprised of the latest developments and guidelines.

Looking into the next couple of months of 2020, field experts believe that COVID-19 will spread successfully into the general population of the United States in numbers similar to prior influenza viruses. Until now, attempts to break the chain of transmission of COVID-19 have centered on keeping the virus contained through quarantine and vigorously investigating every case. That effort will continue though we are challenged by the fact that there are many people who show few/no symptoms yet can still successfully transmit the virus to other people.

As of March 11, 2020, COVID-19 is active in 38 states. Keep in mind that as the disease continues to spread, it will be community-by-community, with differing infection rates influenced by many local factors. There will not be a national “peak virus” moment– for most of us, it will depend entirely on where we live and work. As larger numbers of people are infected in a particular population, that population will develop a degree of immunity to the virus. For the virus, it will become harder and harder to find people who have not yet been infected. This process will ultimately drive down the rate of new cases; fewer new cases mean fewer people transmitting the virus and this cycle will continue until the virus is ultimately ineffective in perpetuating itself in the population.

Many WorldClinic members are affiliated with organizations that are focused on risk management during this turbulent time. While the management of risk in organizational business versus personal health cannot easily be compared, the thought processes and terminology are similar.

Containment Phase

In the initial “containment” phase, the goal is to prevent or eradicate the virus from spreading outside a single location into the broader population. In this phase, the goal is to drive the population risk as close to zero as possible by quarantining those people most likely to transmit the virus outside the original infection location – in the case of COVID-19, the original location was Wuhan, China. Unfortunately, the initial effort at containment failed because the necessary quarantine actions were delayed in execution. By the time quarantines went into effect, COVID-19, assisted by the frequency of international air travel, had already begun its migration across the globe.

Mitigation Phase

Having failed at “containment” we now enter the “mitigation phase” where the underlying assumption is that the virus is already here and is being transmitted through social and physical contact with infected people and contact surfaces (phones, doorknobs, tabletops, etc.). People and organizations must assume that they WILL be affected and take appropriate actions to rationally minimize overall risk while also showing stakeholders that you/your firm are doing your very best to protect everyone.

It is also important to recognize that conventional influenza (i.e.: H1N5) has killed far more people every year than COVID-19 has to date. While the serious illness and death rate does appear to be higher in COVID-19 than in influenza, people and organizations have learned to accept the risks of influenza. Even though influenza affects stakeholders in a very similar way, the COVID-19 virus is a new threat to health whose infective characteristics and transmissibility are not well defined yet.

  • 1 in 200 people who are casually exposed to a COVID-19 positive individual (i.e. working in the same office area for over two hours with someone who is actively spreading the virus), will become COVID-19 positive, a 0.5% transmission rate.
  • This rate can be influenced by both personal and organizational use of infection control strategies such as social distancing, hand washing, frequent wipe down of contact surfaces, and making efforts to screen and keep anyone with cold and flu symptoms out of the workplace.
  • For those who have had close contact with a person who is COVID19 positive (such as living with a person who has tested positive or spending greater than 10 minutes within 6’ of someone who is actively ill), the likelihood of contracting the infection is 10-12%. Individual infection control strategies will greatly influence this rate.

The following rates are characteristics of COVID-19. At present these are relatively uncontrollable, but over the coming months, the development of treatment medications analogous to Tamiflu for flu will likely improve these statistics measurably.

  1. The overall rate of cases requiring some degree of care is reported as 0.7% (75K/11M) in the epicenter of the disease in Wuhan. While we cannot trust this report completely, experts think this is the right order of magnitude.
  2. 80% of those infected and symptomatic will likely experience relatively mild symptoms, such as fever or flu-like symptoms that they treat at home. The number of infected people that display little or no symptoms is a major unknown and may represent a source of infection not fully identified. As testing is more broadly available, we may find that this 80% assessment is a low estimate and many more people may be carriers of the virus that previously recognized.
  3. 15% of those people who are infected and feeling symptomatic will seek medical care, such as visiting an Urgent Care or Emergency Department. 5% of those infected and feeling symptomatic may require advanced care, typically requiring admission to a hospital environment. In China, approximately 1->3% of confirmed cases died. Intensive medical services that are generally more available in countries such as the US will likely drive down this number. As testing is more widely available, the number of confirmed cases will likely go up, which will greatly increase the denominator on this published death rate, thus decreasing the actual observed rate. Disease severity and fatalities are heavily skewed to older age groups, especially those with other diseases.

We are now in the mitigation phase of COVID-19 and there are three key concepts to embrace:

  1. Like the regular seasonal influenza virus we see every year, the risk of contracting COVID-19 is generally pretty low and while no one’s risk of infection or disease will be zero, chances are good that workforce-age people in generally good health will not suffer a life-threatening event.
  2. This is NOT true for those who are older (>75) or those with preexisting lung disease or other serious chronic health conditions (kidney disease, diabetes for example) who are at higher risk for serious life-threatening consequences should take this situation very seriously.
  3. THIS SAME SERIOUS CAUTION APPLIES TO CAREGIVERS who may come in contact with older patients and those with serious pre-existing conditions. These people should also be just as diligent about avoiding virus exposure as they have the potential to transmit the virus to those who can least withstand its attack.

Beyond the Mitigation Phase

Looking into the future, we can anticipate that governments and health care agencies will recognize this dynamic and begin taking appropriate measures to protect the elderly by prohibiting unmonitored access of people from the community into eldercare facilities. Likewise, large-scale close quarter environments, like school dormitories and crowded culture events (concerts and sporting events) may be curtailed or closed. Classes may continue but will occur in an online environment. Likewise, major sporting events may follow a similar path.

In conclusion, COVID-19 is here and everyone should recognize its potential threat to themselves, their co-workers, and their loved ones. The best response is for everyone to take their personal preventive measures seriously and to exercise extra vigilance when visiting those at heightened risk by virtue of age or compromised health.

We will pass along additional updates as they become available.

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