Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS-CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
• Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.

As readers of Real Answers know, we have been organizing our updates around two great themes: how is the disease spreading, and how sick is it making people.

But today, now that the spread of this virus is just starting to show that it is slowing, in some parts of the US, it makes sense to take a moment and ask, how do we go back to work and play and not risk another explosion of cases and deaths?

This question gives us the urgency of considering the power of science.

The Power of, and Need for, Science

Science remains a very controversial notion.

Prior to this historic pandemic, science was losing ground, interest, and respect.  The rise of the anti-vax movement and the rise of alternative therapies gave strong evidence that a rather huge number of people had decided that science did not hold all the answers, and worse, maybe could no longer be so deeply trusted.

When science gets sullied with the sense that it is part of yet another marketing scam, or tied up with large corporations driving profits, it seems to be just another suspicious aspect of modern American life.

But at its heart, science is a rather simple activity.  At its heart science is simply trying to see what happens, observing.  And what observing what actually happens can do better than any other thing we humans do, is prove that a particular claim is false.

And so science is not a path to truth.  It is not a repository of certainties.  It is the ability of humanity to test a claim, and see if it can be proven false, by honestly observing what happens.  My favorite example of claim and observation is from Galileo in Renaissance Italy.  People then, and now, were and are convinced that a heavy ball falls faster than a light one (The Claim).  So, we can argue the point back and forth all day, but Galileo simply dropped them from the Tower of Pisa and they landed at the same time (The Observation).  Turns out the claim was proven false.  Here is a modern observation of the same point, made in the world’s largest vacuum chamber, here in Cleveland, broadcast by the BBC- https://www.youtube.com/watch?v=E43-CfukEgs .

Now, it turns out that using actual observations to disprove wrong ideas is necessary for a lot of human activities to succeed.  Think about all the eyeglasses we wear.  Get the optics of lenses wrong, go with hunches rather than observations, and your glasses simply will not work, you won’t be able to see.  The same goes for building bridges, or landing on the moon, these things simply will not work or happen without good science- testing claims and only going with the ones we can’t disprove.

Such claim and observing is not so helpful for much of life, such as matters of love and relationship.  But they are totally necessary for anything that needs to work every time.

I would propose that stopping one of the world’s most dangerous pandemics counts as a time we want technical details to work.

What comes to mind is the experience of San Francisco during one of the most deadly pandemics of all time, the 1918 Spanish influenza pandemic.  Just like this one, San Francisco used a stay at home order to stop the spread of the virus, and it turns out that worked back then for that pandemic too.  And just like now, people were so thrilled the strategy worked, and got almost giddy with the hope the danger had passed.  So they threw away all their masks and flocked backed to work.  How did that abandonment of science turn out?

Within a week or so, 2,000 people caught the Spanish flu and died, just like that.

Six Steps Necessary to Re-Open America

There is only one way to avoid the fate of cities like San Francisco in 1918, and that is to try out claims such as their’s and see which are false.

That is, only by use of science can we find a path that will not lead to the COVID-19 epidemics to rage wildly again soon in the US.  We already know this, because states that used science and did it promptly are able to be confident that the pandemic will not rage in their states during this lockdown time, states like Ohio.

Fortunately for all of us, scientists have been able to determine 6 steps that if followed, will reliably reduce the chance of COVID-19 exploding into new epidemics if we go back to work and play.   These observations, validated by observation, come out of The World Health Organization, a group of scientists devoted to sharing tested and reliable observations, or to put it more bluntly, our only chance of a safe path forward.

Here are the six steps:

1. Control transmission of the SARS-CoV-2 virus.
2. Ensure health systems capacities are in place to:
   1. Detect
   2. Test
   3. Isolate every case and trace every contact
3. Minimize outbreak risks in special setting such as medical facilities, nursing homes, and prisons
4. Put in place preventive measures in places such as workplaces, schools, and other places it is essential for people to go
5. Manage importation risk
6. Ensure communities are fully educated, engaged, and empowered to adjust to the “new norm.”

Here is the point:  while we huddle in our homes, the virus may not be spreading as much, but it has not gone anywhere, it is still all over the nation and planet, and just waiting for us to come out.   And, when we do come out, it is almost certain, that new cases will spread and erupt.

So, the only way to re-open the country is to be sure that when we do, the new cases are identified immediately enough, that as close to all the infected people, and all their contacts, are isolated, to cut off spread before it ignites to a huge hot spot.

This is why the first step is not even think about doing this until we know there isn’t much virus spreading around before we open up the nation.   This will allow new cases to be few enough in number to find and isolate.

Fail to do this and we will have a nation, much like the US today, where big outbreaks continue to explode, surprising all, and nearly impossible to nip in the bud.

Do this, and we will have a quiet background against which new cases can both be identified and isolated.

Also notice this strategy totally relies on essential universal screening for those who could be infected, and testing all of them.  That is, this strategy requires we find as close to all the infected people and finding a place for them to stay until no longer contagious.  And doing so with all their contacts too.  Fail to take this step and COVID-19 epidemics will rise up, flare, and force us back into universal shutdown, all catastrophic events at this time.

The other steps are essential too but self-explanatory.

Here is the bad news, as of today our national, American government has failed to succeed in achieving many of these steps.   Yes, states that chose to lockdown have seen a slowing of the spread of the virus, but is the number of new cases down to a level that we can say with confidence that the numbers are small enough to be considered small campfires easily monitored for spread that we can snuff out if they threaten to re-ignite into wildfires?  Science says no, the facts say no.

Look at the critical 2nd step, that essentially sets the expectation that across the nation, we are in a position to detect risk wherever it appears, test whoever needs a test, isolate everyone infected, and identify everyone each infected person has been within 6 feet of.   Why such a stringent standard?  Because if the nation opens up, it will be a guarantee that more infections will happen, which is only OK if each spark that lights can be quickly snuffed out.   New infections that go undetected, can spread widely.   Think about the town of Albany, Georgia, all it took was two funerals and the whole town was plunged into a vast chamber of infection and death.   Or the South Dakota pork processing plant.   Or various megachurches.   This virus creates hot spots very, very rapidly, and hot spots are hotbeds of infection that plunge areas into tragedy in days.   Either we are prepared to catch a new outbreak when it is affecting only 2-10 people, or we face huge outbreaks that cause tragedy and plunge us all back into 2-3 months of lockdown.   This step #2 is the heart of the ability to be able to do this in 5 steps, all the time:

1. Truly screen the whole population for risk, all the time.  This includes symptoms such as fever and cough, lack of a sense of smell.
2. Test everyone who fails the screen, test everyone concerned they might be infected.
3. Identify as close to everyone with an infection in the country as possible.
4. Place all infected people in actual isolation so they cannot spread the infection.   This is the key.  Stopping infected people from spreading the infection is the only, and best way, to stop the infection from spreading.
5. Have teams across the nation able to trace everyone who was in contact with each infected person.  People in actual contact with verified and proven infected people are who hot spots come from, they need to be monitored tightly, tested, and if infected isolated.

Do these 5 steps and we have, perhaps, a shot at opening back up step-by-step, without a full, catastrophic relapse.  Remember the experience of San Francisco cited above, ignore science, ignore facts, and you can feel good about opening the economy and see 2,000 people dead in a week.

But, respect the facts, pay attention to what science has worked so hard to find out what is not true, and we have a hope, of coming back to work, play, earning, and fun, and not re-ignite the plague.

BOTTOM LINES:

1. The catastrophe of this very real plague gives us a priceless moment to take a moment to think about science.
2.  We need to observe the very real suspicions so many feel about what they think science is.  Worries about that the name of science is being used to market scams.  Or that science is being used as a way to promote the power of corporate interests.
3. The nation, the world, has had its fun pretending that this is what science is.  But the heart of science has nothing to do with marketing scams or corporate power plays.  Science, it turns out, is simply observing what actually happens in the world.  Does the big ball drop faster than the small one?  We can argue this point, or do something rather extraordinary- watch to see what actually happens.  That is all science is.
4. Some issues are not answerable by observation and testing claims.  Much of life with each other cannot be settled by observations and tests.  But many projects cannot be done without observation and testing claims.  You can’t get glasses that work unless someone tests which you see better with, testing dozens of different power and shaped lenses, it simply will not work otherwise.  Same for building bridges, or programming a computer.  Such projects always either work or don’t work.
5. Managing this pandemic to minimize the number of us, the people we know and love, from getting infected, from actually dying will take steps that work.  It simply will not happen if we take steps that do not work.
6. Across the world we have seen over 150 nations take their steps.  Some have worked, some have not worked.  It’s just like seeing which ball drops first, claims that are false are there for all to see.  In East Asia, we see the best performing steps.  Hong Kong, a region of 7 million people has suffered a grand total of FOUR deaths.   In Europe and the US we see the worst performing steps taken, with the US tragically performing the worst of any developed country.
7. Had the United States taken the exact steps Hong Kong chose to take, we would have suffered 180 deaths to date, rather than lost the 26,000 we have lost.  Of course, not every nation can replicate other nation’s exact steps, but other nations did adopt the same strategies as Hong Kong, and all that did have experienced death numbers far closer to Hong Kong than the US.
8. Facts matter, choices matter, we have suffered for ignoring them.  Why not use the observations that science likes to deliver?
9. Now the first surge is passing, the lockdown has slowed the spread in our nation.  Our great and vast nation faces an even greater choice than we did in January. In January, we had to choose which strategy to employ to avoid a catastrophic surge.  Now we will choose which strategy to use to avoid a relapse as we return to work and play.

10. Science has studied all the claims for what will work, it has identified which of these steps will not work, and come up with 6 steps based on solid observation of what has not been proven to fail.   Now we choose, will we follow these 6 steps, or not.

At this grave moment of decision, I hope with my whole heart that our United States chooses the 6-point path, knows that opening the nation will for sure lead to more infections, and takes so seriously the challenge of identifying those new infections early before they become full blown hot spots forcing us all back into lockdown and needless loss of life.

We again wish everyone that they stay safe and well, and that we make science once again a trusted friend, a good way to find out what works and what does not, our best and only hope through this terrible plague,

Dr. Arthur Lavin