{"id":161668,"date":"2020-03-13T14:21:56","date_gmt":"2020-03-13T18:21:56","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?p=161668"},"modified":"2020-09-17T10:19:34","modified_gmt":"2020-09-17T14:19:34","slug":"we-want-to-protect-our-community","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2020\/we-want-to-protect-our-community\/","title":{"rendered":"‘We Want to Protect Our Community’"},"content":{"rendered":"\n
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March 13, 2020<\/div>\n\t\t\n\t\t\t\t
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\"\"The School of Public Health convened experts in infectious disease, public policy, and ethics and human rights for the Dean\u2019s Seminar Coronavirus: What Do We Know? What Do We Not Know? What Should We Be Doing?<\/a>\u00a0<\/u>on Thursday, March 12, the day after the World Health Organization declared the novel coronavirus (COVID-19) outbreak a pandemic.<\/p>\n

The seminar\u2014which was streamed online only, to avoid a large gathering in person\u2014focused on facts and science to make sense of this rapidly spreading respiratory virus that has drastically upended life in the United States and around the globe. Total worldwide cases have surpassed 125,000, with more than 4,000 deaths, sparking widespread school closures, major public event cancellations, economic uncertainty, and fear and confusion about how to physically and financially adjust to the threat.<\/p>\n

\u201cWhen such challenges emerge, it\u2019s important to take a measured approach, guided by data, and working with our best scientists and scholars, such as those on today\u2019s panel,\u201d said Sandro Galea<\/a>, SPH dean and Robert A. Knox Professor, who will chair<\/a> the statewide Emergency Task Force on Coronavirus & Equity. \u201cNow is the time for public health to provide leadership and clarity.”<\/p>\n

The panelists included Nahid Bhadelia<\/a>, medical director of the Special Pathogens Unit at Boston Medical Center and associate professor of infectious diseases at the School of Medicine and the National Emerging Infectious Diseases Laboratories (NEIDL); Rita Nieves<\/a>, executive director of the Boston Public Health Commission; Davidson Hamer<\/a>, professor of global health; Wendy Mariner<\/a>, professor of health law, ethics & human rights; and Ronald Corley<\/a>, professor of microbiology and medicine at MED and NEIDL.<\/p>\n

Bhadelia, who specializes in infection control of communicable diseases and treated patients in Sierra Leone during the West African Ebola epidemic, described the inevitable burden that the American healthcare system will grapple with if coronavirus cases continue to increase at exponential rates.<\/p>\n

\u201cIn every epidemic, healthcare workers become the linchpin; they’re the interface between the community and the hospital,\u201d said Bhadelia. \u201cWe\u2019re a population that is existing with everyone else in the community, so we are dually at risk.\u201d When healthcare workers develop disease symptoms and are forced to stay home, the workload worsens for the remaining clinicians and patients, she said.<\/p>\n

\u201cAt any given time in Massachusetts, there are about 3,000 to 4,000 hospital beds open, at most,\u201d said Bhadelia. Citing epidemiologic predictions that 40 to 70 percent of the population could contract the virus, she said, \u201cIf you start doing the numbers, you quickly realize we do not have anywhere near the capacity to take care of tens of thousands of COVID-19 patients who might need hospitalizations at the same time.\u201d<\/p>\n

Furthermore, she said, healthcare workers are facing public health challenges beyond initial care of patients who contract the virus. What happens when high-risk patients don\u2019t have a stable home to return to after they\u2019re discharged? Or if they must return to a household with more vulnerable family members? What is the return-to-work policy for healthcare workers?<\/p>\n

\u201cIn the end, my thoughts are that this illness will be mild,\u201d she said. \u201cBut we want to protect those within our community. And that’s where personal responsibility and preparedness come into play.\u201d<\/p>\n

Corley and Hamer untangled the details on what is known\u2014and not known\u2014about the etiology and epidemiology of the new strain of coronavirus. Data shows that the virus accelerated almost four times as fast as SARS due to the former\u2019s high viral load, said Corley.<\/p>\n

\u201cThere’s a chance that this virus actually is more transmissible early on, even when people are asymptomatic, which is one of the major concerns in trying to identify this virus,\u201d Corley said. He said many questions remain: What are the correlates of immunity following infection? Are there biomarkers to predict disease outcomes early in infections? What are the best models to test candidate therapeutics and vaccines? How can the global community become more proactive in its response to the next virus?<\/p>\n

Hamer also expressed concerns about the unknowns around this virus, including potential asymptomatic transmission.<\/p>\n

\u201cThat’s worrisome,\u201d he said. \u201cIf someone doesn\u2019t have symptoms and they go through airport-based or other forms of public screening, they may not have any symptoms to complain about,\u201d which could lead to asymptomatic transmission. He said most studies suggest the virus is fairly infectious, and warned, \u201cif there aren’t control measures, it could lead to a virus running through a community where as many as half to two-thirds of a population becomes infected in the absence of immunity.\u201d<\/p>\n

Nieves said Boston developed a thorough preparedness plan and statewide testing abilities weeks before the city identified its first confirmed novel coronavirus case at the beginning of February. The city has also identified 18 presumptive coronavirus cases, all linked to a March 6 Biogen conference.<\/p>\n

\u2018We were among the first five cities to get a case,\u201d said Nieves. \u201cSince February 28, the Department of Public Health has began testing for COVID-19 at the state laboratory, and that has really made a difference for us.\u201d While the city of 695,000 residents\u20141.2 million, including commuters and visitors\u2014has not yet observed community spread, she said Boston is developing a \u201ccontinuity of operations planning,\u201d which will ensure that BPHC and other daily city operations would remain in effect should the city experience an influx of cases.<\/p>\n

Mariner focused on the burden that quarantines place on employed patients.<\/p>\n

\u201cPeople need resources that make it possible to comply with reasonable public health recommendations,\u201d she said, explaining that three policy and legal issues need to be addressed: financial protections, health services and health insurance, and community and social services.<\/p>\n

\u201cSocial distancing is a wonderful recommendation, but not everyone can afford to stay home from work, especially those who live at the poverty level or paycheck-to-paycheck,\u201d said Mariner, noting that only 10 states and the District of Columbia require paid leave for workers. Massachusetts allows 40 hours of paid sick leave, but that is not even half of the mandatory 14-day quarantine required for anyone exposed or potentially exposed to the virus. She suggested policy changes that would suspend expenses such as rent or utility payments.<\/p>\n

She also noted the need for greater testing capacity that would clarify quickly whether a patient requires additional medical care or could be sent home.<\/p>\n

\u201cThe FDA does have authority to rapidly approve new tests that are developed by state and private entities and they can do that fairly quickly,\u201d Mariner said. \u201cAlthough they did not do so originally, they are working on it now.\u201d She also said that Medicaid eligibility requirements should be waived to ensure that the most vulnerable populations have access to preventive care.<\/p>\n

Also,\u00a0community programs should provide child care services or meals for children during school closings, she said.<\/span><\/p>\n

\u201c<\/strong>Some schools are providing students with computers to take home so they can do distance learning, but what about kids that don’t have Wi-Fi at home? What about kids that don’t have a home?\u201d<\/p>\n

The seminar ended with a brief Q&A session led by Patricia Hibberd<\/a>, chair and professor of global health, in which the panelists reiterated the critical need to expand testing capabilities.<\/p>\n

\u201cWhen we look back and write the history of COVID-19, the testing is going to be one of the biggest disasters that we write about,\u201d said Bhadelia. \u201cIf we had scaled this up to thousands of tests the way other countries did, we could have isolated COVID-19 in particular geographic areas and put all our public health resources there to ensure those areas had the capacity and ability to do what they needed to do.\u201d<\/p>\n

\u2014Jillian McKoy<\/em><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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