Three public health experts, including a former member of the National Security Council treating 15 coronavirus patients in Nebraska, have called the outbreak a “pandemic” — suggesting hospitals across the US must prepare for a surge of patients.
A pandemic is defined as the worldwide spread of a disease. The warning came as the US reported its first death from the virus.
“We are clearly in a pandemic. The only reason we’re not saying it is because of politics,” said James Lawler, a professor of infectious disease at the University of Nebraska Medical Center. “It’s about time somebody said it.”
A federal government public health official who was not authorised to speak on the record said: “It’s a pandemic if you can no longer keep it to a specific geographic area.”
“Now we have multiple cases of person to person transmission in the US. It’s no longer just people flying in with the illness, it’s just transmitted within the country. As we’ve seen in other developed nations with advanced biocontainment systems, efforts to contain the virus were marginally successful.”
Mr Lawler was a member of the Homeland Security Council under president Bush and the National Security Council under president Obama, and part of the group that carried out the NSC’s 2005 National Strategy for Pandemic Influenza. He is treating patients infected with the coronavirus who have been evacuated from China and the Diamond Princess cruise liner. Mr Lawler serves as a medical director for the “biocontainment unit” at the University of Nebraska Medical Center, a facility for quarantining and treating patients of highly infectious diseases.
On Friday, an 18-year-old in Snohomish County, Washington, with no history of international travel was diagnosed with Covid-19, pending confirmation by the CDC. “We don’t know how or where the new Snohomish County case was infected,” said the Washington State Department of Health in an announcement. This is an example of what public health experts call “community spread” — infection from within the same community.
On Saturday, health officials confirmed that a patient had died in Washington State, the first fatality from the virus in the US.
The Centers for Disease Control in the US and the World Health Organization have not used the word “pandemic” to describe the spread of coronavirus. “Using the word pandemic carelessly has no tangible benefit,” said the director-general of the World Health Organization on Wednesday. “It may also signal that we can no longer contain the virus, which is not true . . . of course, we will not hesitate to use the word pandemic if it is an accurate description of the situation.”
“I think calling it a pandemic is reasonable,” said Neil Ferguson, a professor on the Faculty of Medicine in the School of Public Health of Imperial College London. Mr Ferguson is an author of a study on the severity of the coronavirus by the WHO’s Collaborating Centre for Infectious Disease Modelling.
The distinction between “outbreak” and “pandemic” determines the response. According to the NSC’s 2005 strategy for pandemics, the first response to an outbreak is to contain it locally. If it cannot be contained, then the public health response shifts to “mitigation” — a national mobilisation to protect hospitals and critical infrastructure.
According to the strategy, “Rather than generating a focal point of casualties, the medical burden of a pandemic is likely to be distributed in communities across the nation for an extended period of time.”
Mr Lawler and the public health official both believe that, while the federal government has taken steps in the past several days to increase commercial production of testing kits, it has been reluctant to commit to the national operational consequences of a pandemic — informing and equipping local governments, hospitals and populations for rolling outbreaks.
“We need a mobilisation,” the official said. “We aren’t seeing it.”
On Saturday, public health officials held a press conference with President Donald Trump at the White House to announce international travel bans and efforts to develop vaccines and produce protective gear, such as masks. Both Health and Human Services Secretary Alex Azar and Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases, cautioned that they expected to see more cases in the US.
Mr Fauci also noted cases of community spread, and said that local health authorities would need to “identify, isolate and contact trace” after discovering new cases. “From within, we will very aggressively do the kind of public health measures that will hopefully contain this,” he said.
Mr Lawler said: “It seems like they’re still thinking in terms of containment. Containment is pointless now.”
Based on his belief that the outbreak was a pandemic, Mr Lawler expected that 30 to 40 per cent of the US population would be infected.
Public health officials have few precedents for a pandemic in the US. According to the non-partisan Congressional Budget Office, a mild flu epidemic like the one in 1957 could infect 75 million people and cause 100,000 deaths today, with a fatality rate of .1 per cent. A severe one, such as the Spanish Flu of 1918, could infect 90m people, and with a fatality rate of 2.5 per cent, could cause 2m deaths.
Mr Lawler estimates that the US will see an outbreak somewhere between the one in 1957 and the one in 1918. “We’re at moderate to severe level if I had to predict where we’re going to end up,” he said. On February 18, the Institute for Disease Modeling wrote that the virus has the potential to be “comparable to the most severe respiratory pandemic in the last century in the absence of effective control measures.”
“We need to invest in vaccines and therapeutics,” said Mr Lawler, “but we have to understand that we’re not going to have them for this first major wave.” Most immediately, he said, the US needed to improve hospital surge capacity, and to protect and train healthcare workers and those who run critical infrastructure, as called for in the 2005 NSC strategy.
He also says local communities need to prepare for “non-pharmaceutical interventions” — closing schools, cancelling public events, encouraging telework, and specific protections for the most vulnerable populations, such as the elderly.
“We need to harden infrastructure,” said the federal public health official. “We need to be providing the equipment to enable local hospitals to contain patients who are infected.” As part of the National Ebola Training and Education Center, an initiative developed after the Ebola outbreak of 2014, major metropolitan hospitals in the US have been trained to isolate patients, but need the equipment to do so.
“We’re not ramping up the deployment of protective equipment and patient isolation systems,” said the official. “As patient numbers rise, they need diagnostic capacity. We’re not increasing it.”
The Department of Health and Human Services did not immediately respond to a request for comment on Saturday.