Most of us have seen this curve by now, which explains in a single diagram why it’s important to practice the public health recommendations of staying away from each other as much as possible, washing our hands frequently and practicing proper cough etiquette.
This picture looks different for different populations right now. Italy, Spain and some regions of the USA (such as New York) seem to be somewhere above the line of healthcare system capacity in the red zone today, with health systems overwhelmed and people dying who might otherwise survive. This contrasts with Australia and Cambodia who appear to (for now at least) have remained below the line and in the blue zone.
For some months China were above the line in the red zone. Their case numbers have apparently since dipped below the line but some of their regions never really entered the blue zone. Instead the pandemic slowed due to the impact of herd immunity before protective measures could have an impact. The diagram below explains how herd immunity, which can come from disease or vaccination, works. In short, when enough people are immune, those who are infectious are less likely to come in contact with (and therefore be able to infect) non-immune, susceptible individuals. This will slow or halt transmission.
I was on a small but overwhelmed team responding to the Swine Flu pandemic in a small Australian town in 2009, when the virus first appeared and before its impact was known. Our experience at that time was one of grappling to understand human psychology which I roughly categorised into the following groups:
- Worried Well – the anxieties and misinformation of this group needed a hotline of its own to be manageable and kept us unnecessarily overwhelmed;
- Unworried Unwell – this group included asymptomatic contacts of sick cases who needed to be isolated and monitored. Many in this category were quite disengaged from the interventions being implemented to protect the general public, requiring intense efforts to convince them to follow recommendations. This included some health care workers who believed they knew better than the public health teams trying to control the outbreak;
- Common Sensicals – those who listened to and followed public health advice with what seemed to be a balanced response, including the flexibility to follow changing advice (as the outbreak and knowledge about the virus’ impact evolved);
- Media – these guys were in charge of the whole show. If the media said “we need to know…”, then the public health team downed-tools to pull our data together on time. Had we not, the potential for tiny but significant misinformation could be crushing (see Worried Well at 1.).
One human behaviour that flourishes in infectious disease outbreaks, particularly in the age of social media, is the viral transmission of fake news. People become fearful and easily misled, creating a perfect backdrop for false ideas and claims to spread like wildfire. Some Coronavirus myths circulating today include:
- Covid19 was created in a laboratory and released as a bioweapon, with different political factions laying the blame on their own targeted adversaries.
Scientific evidence disproves this theory. Scientists are able to “see” viruses in minute detail and develop very sophisticated knowledge of their origins. Covid19 is very clearly an evolved species in the family of other naturally-occurring coronaviruses. Humans could not have made the multiple evolutionary differences between other coronavirus species and this one. If humans had created this virus, it would not have many of the features that it has. More detailed explanation can be found at this LiveScience.com article
- Cambodians have been told by politically motivated Khmer-Americans that “every American” has been tested for Covid19, as a way of highlighting the incompetence of the Cambodian government’s response to the outbreak. Every American has not, and should not, be tested for Covid19. Testing criteria must be followed for two main reasons (that I can think of), being:
a) testing those without symptoms or known contact is a massive waste of time and resources, further overwhelming health services who are needed for a proper response;
b) testing for no reason today leads to multiple negative results, requiring everyone to get re-tested again daily if you want to know who might have contracted the virus. No public health system in existence is resourced for such an intense intervention with no benefit.
Testing criteria (which can change as the outbreak pattern changes) follows a common sense approach to outbreak control.
- In places where health systems are not good or governments are corrupt, people are “dropping like flies” from this virus and it is being hidden from public knowledge. Actually even in the most corrupt and appallingly serviced places, communities know each other. You don’t “drop” with Covid19. Nor do you bleed from your eye sockets, as one meme circulating on social media recently suggests. You develop a known range of symptoms which, when severe enough to cause illness or death, are visible to those around you.
High fever and pneumonia evolve over hours and/or days, not moments. In Cambodia, as under-resourced as they are, families of the sick seek help for their loved ones – via health centers that are found in or near almost every village, or via traditional healers, and often (when symptoms are ongoing and a cure is not forthcoming), via both. Those families who don’t seek official help, certainly tell their neighbours who share the information amongst each other. It is true that people die invisibly in Cambodia – childhood drownings and chronic degenerative diseases are examples of lives lost that go undocumented and unassisted. But assistance is always sought and only denied when resources are unavailable or inaccessible (eg unaffordable payment). If Covid19 was spreading in Cambodia today, it would not be a well maintained or undetected secret.
One of the most useful things any of us can do at this time, in my view, is to halt the spread of coronavirus myths, and only share accurate and fact-checked information. Australians have access to accurate information through the ongoing news briefings appearing on our television screens for hours everyday, with our politicians, public health officials and scientists working as a team to tell us what they are doing and why. Nevertheless, we are seeing plenty of evidence of human behaviours that don’t fit my category 3 of Common Sensicals.
Most of the world don’t have access to such quality information or support and many rely on Facebook or other social media for their “news”. As important as it is to stay home and break the Coronavirus transmission chain, equally we can all be doing our part to break the transmission chain of misinformation. Next time someone sends you a video or article that may or may not seem plausible, don’t think you need to share it immediately. Have a think, ask around, investigate whether it might be untrue or exaggerated first. You could protect a lot of people without the same level of privilege, from a lot of angst.
This post from Harvard Medical School offers some good information and links for fact-checking.