I am the director of the Center for the Ecology of Infectious Diseases at the University of Georgia. My colleagues and I have been following COVID-19 since the middle of January. Our analysis of the data leads me to believe that serious action now is imperative.
The federal government just passed an $8.3 billion bill to address the epidemic, but additional funding will not be enough to stop it. We must stop transmission, which means prohibiting large gatherings of people, closing schools, and insisting that people who can work from home do so and continue to do so until the epidemic of COVID-19 is over. It is inevitable that such actions will be costly, but not as much as a major epidemic and thousands of lives.
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The outbreak in China is beginning to wane and the U.S. and other countries have the opportunity to learn from China.
Since the epidemic hit different provinces at different times, each was in a different stage when the Wuhan “lockdown” and other interventions occurred around the 23rd of January. This progression allows us to see the benefits of intervening early versus the consequences of delay. There is a very strong correlation — 90% — between the outbreak size in each province and the length of time that elapsed between its first case and the lockdown.
These data show that early action yields critical gains, with every 3.8 days of delay causing every 10 cases to increase to 100.
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Importantly, other than at the epidemic epicenter in Hubei Province (where the city of Wuhan is), no Chinese province had more than 53 cases at the time of the lockdown. Whereas Hubei has now had more than 65,000 cases, the epidemic in other provinces has been limited to a thousand or so infections. Currently, four states (California, Washington, New York and Massachustts) are reporting more than 50 cases, while many states have less than 10. States that wait to act until they have hundreds of cases are more likely to see outbreaks like Hubei.
It is tempting to “wait-and-see” how the epidemic progresses before taking action. These data show that we do not have this luxury. The situation in the U.S. is potentially even worse than it was in China in January. Particularly, data in the U.S. currently provide a poor picture of the actual size of the epidemic. Because our testing has been limited, we likely have many more people unknowingly infected with the virus, increasing the urgency of acting now.
There are two important lessons from China that we should have learned by now.
First, the data from China show that interventions can have significant positive impacts.
Second, the U.S. must act now. The president, CDC, and Congress have regulatory authority to appropriate funds, distribute resources (like test kits), and coordinate the actions of state governments and health departments. State governors may declare states of emergency and take other actions necessary for protection of the people. Local governments can close schools and limit large gatherings. More importantly, through their statements and actions, government bodies and officials everywhere exercise considerable influence over the decisions of private citizens. It is these decisions, primarily, that determine when a susceptible person is exposed to the infection and transmission continues. Officials should be exercising this authority now. For every 3.8 days we wait, every case will turn into 10. The 1,000 cases we have now will turn into 10,000.
Finally, we must cooperate to combat this epidemic. Infectious diseases are hardly bound by quarantines, much less by national boundaries. Biosecurity is a global good and the fates of nations are intertwined. Just as the U.S. must act now, China must not let up its efforts to contain the epidemic or become complacent. The epidemic is not over, and relaxing containment activities now could enable a second wave of transmission. This should not be allowed to happen.
John M. Drake is distinguished research professor and director of the Center for the Ecology of Infectious Diseases at the University of Georgia.
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