Covid-19 is a new coronavirus that was discovered only two months ago. It has since sickened at least 75,000 people around the world, but much about it remains unknown. We are still not certain if the virus can be spread by people who have no symptoms. The incubation period — the time between acquiring the virus and when symptoms begin — is estimated at anywhere between two and 14 days. This is a wide range of time during which someone can feel well but actually be infected and possibly transmitting the disease to others. We don’t yet know if there are many more people infected who have no or mild symptoms and are not being tested. Even the testing is still being refined, with the goal of faster and more accurate diagnoses.
This uncertainty can be unsettling, but it is actually normal and expected. By definition, outbreaks are quickly evolving situations. Outbreaks with novel diseases bring even more unknowns. An effective public-health response requires that those leading the response pivot when new information comes out and change course when unexpected circumstance arise.
The decisions to quarantine returning Americans illustrate the agility of the U.S. government’s response. At the beginning of the outbreak, the exposure was concentrated in Wuhan, China, with no U.S. cases. As Americans started being repatriated from Wuhan, this was the opportunity to stop, or at least significantly slow, the spread of covid-19 to the United States by quarantining those with risks for exposure. Military bases were quickly repurposed for this use, and local health authorities coordinated closely with area hospitals and the Centers for Disease Control and Prevention (CDC) to monitor, test and treat patients.
Initially, those on board the Diamond Princess were undergoing a similar type of quarantine. When it became apparent that disease transmission was happening on the ship, the U.S. government decided to evacuate uninfected passengers. This made sense.
Then, during the process of evacuation, positive tests came back for 14 asymptomatic Americans. This presented a dilemma: Should they be evacuated along with the others? Transmission of the virus appears to require close contact, and it’s not clear whether patients without symptoms can infect others. All of those being evacuated were already going to be quarantined in the United States for two more weeks, so there wouldn’t be additional risk to the American public either way. According to The Post, officials from different agencies disagreed, but it was ultimately decided that they would transport these 14 in a contained area of the plane separate from the other passengers. This, too, was a change from the previous plan, but understandable given the complexities and many unknowns.
All of these decisions needed to be made under extreme time pressure. Leaders must use the best available evidence they have, then course-correct as needed. Constant reevaluation is the bedrock of any emergency response. The CDC has announced plans to test additional patients with flu-like symptoms in five cities, even if they have not traveled to China. This is another example of proactive monitoring that should be commended.
Some have criticized the CDC for missteps, such as when a sample was mislabeled and a patient who tested positive for covid-19 was accidentally released from the hospital. I have a different take. Public health relies on public trust. Admitting mistakes and explaining prompt corrective actions engender that trust. In this case, the CDC announced the mistake publicly and immediately enacted measures to isolate the individual. They worked with partners involved to prevent such errors from happening in the future.
Are there areas for the U.S. government to improve its response? Absolutely. The United States should apply more pressure on China to provide up-to-date information to its own people and to other governments. It needs to adequately fund local public-health departments, which are on the front lines of this and every epidemic. It should do much more to increase capacity in countries with less developed public-health infrastructure, because a global response is only as strong as its weakest link. And it certainly should not be cutting funding to the CDC and other critical agencies.
But we must commend the U.S. government and its public health experts for their transparent and evidence-based response thus far. As covid-19 continues to escalate, I hope more governments, and the public, will see that nimbleness, change and constant improvement are good — and necessary — to combat disease outbreaks.