With all the information coming in each day about COVID-19, the College was fortunate enough to have Pia MacDonald, PhD, MPH, CPH, an infectious disease specialist and epidemiologist with RTI International, speak during the 2020 Spring Meeting in Tucson. Her remarks were titled, "COVID-19 Epidemic: The Good, The Bad, The Ugly."


Key Takeaways
Looking closely at the data from China, the WHO-China Joint Mission COVID-19 report indicated that most transmission occurs within households, NOT within the healthcare settings, or in airports, planes, trains or on streets.

In the U.S., to be clear, this is no longer a travel-associated outbreak. COVID-19 is community acquired infection, so the outbreak is domestic and global.

The Good
The China outbreak seems to be waning, meaning that there are fewer cases each day. Of note, China’s response has been the most ambitious, agile, and aggressive disease containment effort in history. It restricted movement of people into and out of Wuhan and 12 other neighboring cities. People were instructed to stay at home for a month, theyimplemented social distancing measures such as closing schools, public transportation, and suspended public gatherings. They had thousands of people tracking sick people and their close contacts to ensure certain they were isolated from other people.

Countries have learned from China. There are more insights on how best to treat the sick so they are less likely to die. There is also a better understanding of who is at highest risk of severe disease. There are identified public health measures that work:case detection, rapid diagnosis,isolation, early treatment,contact tracing, and limiting household transmission.

In the U.S., to be clear, this is no longer a travel associated outbreak. There is community acquired infection, so the outbreak is domestic and global.

The capacity to test for the disease is increasing by the day.There is now testing available in the state laboratories and not just in the CDC in Atlanta. Vaccine development is moving quickly, and it could be available within a year, with additional time to scale.

The Bad
Until a vaccine is available, the public needs to do everything to stall the spread and minimize risk.To date, in China they found that 1 person gives the infection to 2.3 people, so the outbreak can grow quickly, 1 to 2, to 4, to 8, to 16. With a 3.4% case fatality rate, the more people who get infected, the more deaths will occur. While it seems relatively contained within China, it is spreading globally quickly. Meanwhile, major disruptions are taking place with the global supply chain. Eighty percent of active pharmaceutical ingredients manufacturers are located outside of the U.S, the majority located in China and India. This could impact the ability to adequately treat patients.

The Ugly
The public health measures that are known to work will be difficult to achieve in most areas of the world, especially where healthcare and public health systems are weak. Lower- and middle-income countries will be hit far worse than high income countries. Beyond the COVID-19 outbreak, a steady rise has been seen in outbreaks and global epidemics then ever before. What keeps Dr. MacDonald up at night is that only 1/3 of the countries in the world currently have the capacity to quickly detect and report diseases that could pose an international threat. We are not prepared, now or for the future.This is true in the U.S., Canada, and globally. Prevention, detection, and response to disease outbreaks requires an approach and support from each and every person in all sectors. Advocacy is critical for increasing and sustaining public health preparedness and global health security funding. The time is now to decrease present and future risk. Similar to the adage, parents are only as happy as their least happy child, from a global health security perspective,“We are only as safe as our least safe country.”

Ways to Stay Safe

Dr. MacDonald did not wear a mask en route to give the presentation in Tucson. She will continue flying, though she will move if sitting next to someone coughing or sneezing. And, she will want to give them a face mask.