Three D.C. COVID-19 Case Studies

They show what is and isn’t working in D.C. (and possibly nationally).

There is some good news about testing and tracing in D.C.: we’re actually doing enough tests (though the turn around time isn’t great). But three recently released case studies of spread in D.C. illustrate what is and isn’t working with our overall infection control strategy.

Case #1 (slide 9 in pdf):
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This is a failure to convince people that if they have symptoms–and we need to be clearer about the range of symptoms–they need to stay home. And “stay home” means don’t socialize with others. The guidance needs to be clear and unequivocal: if you feel ill, stay home except to get tested (and in my perfect world, if you like, you should be able to call someone and they come to you and test you at your home). No wiggle room–if you feel ‘bad’, assume you have COVID-19 until cleared.

Case #2 (slide 10 in pdf):
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This is clearly an infection acquired before flying, though at least one of them could have exposed other passengers (it’s possible the others were exposed in flight, but the initial case clearly happened in D.C. before leaving). In a sense, they behaved responsibly (if flying for non-essential reasons can be deemed responsible), but communicable diseases are communicable, and socializing leads to spread. This is why we need to crush the curve and massively lower prevalence. As long as people will socialize, and they will, we need to lower the prevalence to the point where encountering an infected person is unlikely.

Case #3 (slide 11 in pdf):

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Sweet Baby Intelligent Designer. First, people who work in the healthcare system have to consider themselves at elevated risk and need to avoid elderly people whenever possible–and the virus doesn’t care about birthdays, only available lungs. Second, kids are a vector, though if the mother was too sick to take care of the kids, there really wasn’t much of an alternative. To protect people in this situation, until prevalence is lower (and this is one more reason why that needs to happen), we have to dramatically lower physical interactions with other people, especially if you are more likely to be exposed or others are in high risk groups.

In short, we still need to crush the curve. It won’t completely stop these transmission events, but it will make them less likely, and when they do happen, we’ll have more resources to flood the zone quickly. We also need to ‘move testing to the patient.’ Somehow, D.C. needs to get testing to people–and adopting saliva-based testing would help greatly.

Barring a miracle, we need to roll back.

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