In a time of difficult choices, I’ve had the responsibility to make some especially hard ones as the County Health Officer. I am profoundly grateful for the support I have had from many community members.
Local elected officials and I are under intense pressure to enact further closures to slow COVID-19’s spread. Many are worried about ongoing tourism. Retailers, hairdressers, personal trainers and pretty much anyone exposed to other people in their line of work are also concerned.
As a health care worker, I identify with these concerns. Exposure to more people means more risk.
My job is to think on a community level, and I have been considering the hypothesis that it’s possible to enact too-aggressive measures too early in this outbreak.
Obviously, we know the opposite is also true. We can see where too little social distancing or measures taken too late result in catastrophic spread and overwhelming caseloads in some European countries.
Although it’s not being talked about in the media — perhaps to avoid sending mixed messages — I suspect my hypothesis is on the minds of epidemiologists and being discussed in video-chats among public health workers.
Here’s my reasoning: We are not going to stop SARS-CoV-2, the coronavirus that causes COVID-19, from spreading in our community, no matter how aggressively we act to contain it. Rather, we are trying to slow its spread to “flatten” the outbreak curve. My concern is that being too aggressive too soon will not flatten the curve but rather shift it to the right, delaying but not blunting the surge in cases.
Shelter-in-place comes with an inherent expiration date. There’s a practical limit to how much time we can effectively shut down economic and social activity. I don’t know whether that limit is two weeks, two months or two years, but there will be a point when we can’t force people to stay home. People will resume activity as a matter of need. We rely on our social connections for survival, and our social distancing practices will eventually break down.
Also, we need to ensure that the treatment is not worse than the disease. As Dr. David Katz, founding director of the Yale-Griffin Prevention Research Center, said in The New York Times: “The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.”
Our goal must be to slow SARS-CoV-2 — not stop it entirely.
What measures are sufficient to achieve that goal? Are current closures enough? Unfortunately, we have no way to know for certain. We can look to other communities for guidance.
In early March, Seattle became the first U.S. epicenter of COVID-19 and continues to see increasing cases. But neither Seattle, King County, nor Washington state have implemented shelter-in-place orders. (Everett, Washington, enacted such an order March 20.) Washington has no reports of overwhelmed medical systems, although they are bracing for the worst. Seattle has many more hospital beds than Jackson Hole, but on a per-capita basis I suspect we compare favorably, especially given that our hospital is designed to handle seasonal tourist influxes.
In comparison, several California counties with sustained community transmission, and now the entire state including counties with no confirmed cases, have implemented shelter-in-place orders. This is slowing transmission, but case counts continue to rise.
Rest assured, a countywide shelter-in-place order is on the table for Teton County. (A draft is on my desktop.) If our current strategy does not slow the spread quickly enough, we are prepared to act.
Right now, let’s move to protect the most vulnerable among us. CDC data indicate who should be most concerned about getting infected, who are most likely to need intensive medical care and who should be most empowered to take steps to protect themselves.
Under our current order, there is no doubt certain people are more exposed — hairdressers, retail clerks, hotel housekeepers and others compelled to continue working. Even under a broader shelter-in-place order, grocery clerks, food service workers and health care providers would remain at higher risk. Their employers and the community should channel resources to mitigate exposure through safety training and access to personal protective equipment.
If we are in a situation where we are forced to pick winners and losers, we should do so in a way that protects the most vulnerable. Our next step should be specific protections for defined vulnerable populations.