COVID 19 Update 4-16-20

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Over the next several weeks, you will see movement towards relaxing the social distancing recommendations. For the moment, Governor Ducey’s stay at home order is in effect through April 30, 2020. It is unclear what will happen after that, as the Governor is wisely waiting to see how case numbers progress before making any future decisions. Predictive modeling now suggests we will hit our peak number of cases in early May 2020. However, just this week we have seen a small decrease in the growth rate of new Covid 19 cases in Arizona. New case numbers were increasing by approximately 10% every day, yet this week that rate is down to about 7% each day. Ideally that number would be zero, yet it is an improvement. Unfortunately, we are still identifying over 300 new cases a day. As of April 16, the total number of cases in Arizona is 4234 with 150 deaths. In Pima County, we have identified 760 cases and had 37 people die from the virus.

Clearly, many businesses and individuals have been severely affected by the abrupt changes put into effect since mid-March. The pressure to resume more business and commerce activity is totally understandable, yet the slowing of the rate of new infections is the benefit of social distancing. Unfortunately, if we relax social distancing too soon, we will most likely undo the gains that are being achieved. Even though the daily number of new cases is starting to reduce, we may see a resurgence of cases, especially if the above-mentioned modelling is accurate. That is why the caution.

As I have shared with some people recently, I view COVID19 as a marathon in which we are only in mile 5 of a 26-mile race. We do not anticipate the virus to suddenly disappear, so concerns about new outbreaks and spread will persist for months to come.

Of note though, a lot of what we think is COVID 19 is not. Numbers from Tucson Medical Center (TMC) indicate that approximately 80% of the 900 plus patients with symptoms suggestive of the virus were NEGATIVE for it. However, we have not been able to widely test the population as a whole, so these numbers do not truly reflect the prevalence of the virus in our community since we are not detecting asymptomatic carriers.

One strategy to reduce future risk will center on testing and contact tracing. In brief, we want to evaluate more people with an antibody test to determine if they have been exposed to the virus. Theoretically, someone with antibodies to the virus should have some immunity. Unfortunately, we do not know if this is true with Covid 19. In addition, we remain limited by the lack of a widely available trustworthy antibody test, although several solutions have been announced recently, including one developed here in Tucson at the University of Arizona.
We will use tracing, in combination with PCR testing for the virus itself, to identify any possible contacts of a newly diagnosed individual. The plan is to quickly identify these contacts and then test and/or quarantine them in order to control the spread of this virus.

There are two main ways this tracing may occur: through old fashioned public health surveillance or electronically.

For decades, public health departments have managed communicable diseases by contacting via phone or in person those individuals who were around a contagious person. This process is labor intensive yet does work.

Electronic surveillance of contacts is relatively new and controversial. It is based on the wide usage of cell phones and the ability to monitor an individual’s movements with cell phone data. Democratic countries such as South Korea and Israel have employed these techniques with good success. Dictatorships such as China have also used these types of surveillance for COVID19 control. While effective, there is concern these electronic techniques could have serious civil liberty issues, as they may continue to be used after the major public health threat is eliminated. This topic will get more attention in the coming weeks, and I want you to at least be aware so you may share any opinions you have on it with your elected representatives.

Finally, I want to again emphasize that the vast majority (90+ percent) of people infected with COVID19 recover from it. News coverage focuses on the sad and tragic cases giving a skewed view. Be aware, COVID 19 is a deadly and unpredictable disease, yet for many Americans now, the fear of the disease may be as debilitating. We must be vigilant and observe the public health guidance, yet please also remain hopeful.

Jeff Mayer, MD