David W. Blodgett MD, MPH (SWUPHD Director & Health Officer)
Scientific understanding of the COVID-19 pandemic, along with rapid advancements in medical and public health capacity to deal with patients – and the virus itself – are ongoing.
Our understanding of the disease
Local, state, and federal data has allowed us a clear picture of who is most impacted by this disease, and helps tailor a better approach for prevention and containment. It is evident that those who are over the age of 65 are much more affected. Of those who are tested and are positive for COVID-19, the following is true: 28% of those over age 85 will require hospitalization. 21% of those aged 65-84 will require hospitalization, 7% of those aged 45-65 will require hospitalization, 3% of those aged 25-45, and less than 1% of those under 25 will require hospitalization.
It is equally clear that there are well defined risk factors that influence whether someone will fare poorly with this disease. These factors include obesity, diabetes, hypertension, chronic kidney disease, chronic lung disease (not to include mild or moderate asthma), being immunocompromised, and substance abuse. 94% of those who have passed away from this disease were known to be either in one of the older age groups, had an underlying disease risk factor, or both. Overall, the risk of death from COVID-19 in Utah is .7%, but it is 18% for those over 85 and 5% for those 70-84. It is .6% for those 50-70, and below that it rapidly drops to less than .01%. These numbers only reflect the cases that we are aware of because they were tested. The Centers for Disease Control (CDC) did serology testing in Utah and estimated that there are 11 cases for every case that we detect. This means that the true hospitalization and fatality rates are much lower.
80% of the spread of this disease happens from 10% of the cases. Most infections happen in families or social groups; about 85% of the time an infected person is able to identify who gave it to them. Sometimes people are exposed at work, when they travel, or in other situations – but that is the exception. The vast majority of transmission happens when two people are within 6 feet of each other for more than 15 minutes. This is a disease of close contact. Most cases are infectious for about 5 days starting 5-7 days after they are infected. The ability to rapidly identify those who are infectious, rather than those that are merely infected, is the question most important to public health.
Interventions for COVID-19
Medications and medical interventions: Advancements in the understanding of how to treat this disease (and what to do and not do) in the medical setting have dramatically changed the nature of what it means to have COVID-19. The average COVID-19 stay in the hospital is less than 7 days where it was once more than three weeks.
Vaccine: Progress toward a safe and effective vaccine continues. Over a hundred vaccines are in development. Six are in the final stages of testing, called Phase 3 trials. We are ramping up our efforts to prepare for the delivery of COVID-19 vaccines in our area. It is hoped that the vaccine will be available in large quantities by spring 2021.
Testing: The ability to access rapid, cheap, readily available testing for Sars Cov-2 (the virus that causes COVID-19) will be a game changer in our response to this disease. Identifying infectious cases in real time (within 15 minutes) through frequent testing will overcome most of the challenges we have in halting the spread. Abundant rapid antigen tests would allow us to test everyone going into nursing homes, restaurants, or just making social visits. Numbers of cases in the community would plummet. Unfortunately, these tests are still too expensive and not available in quantities that would ultimately make a difference, but progress is being made. The rationale for this testing approach is addressed well in these two articles. The first is more accessible, the second is a scientific paper.
Priorities for the future
Protecting those most at risk should be our highest priority. Testing sites should allow for rapid testing and easy accessibility that will provide testing before entering a high-risk situation, rather than wondering if you are exposing your co-workers or someone you love to this disease. Until that time, we will prioritize our testing capacity to focus on those who work with both the elderly and people with underlying health conditions.
Personal responsibility must be a cornerstone of how we seek to meet the risks posed by COVID-19. Everyone can spread this disease, so please carefully consider what you can do to protect the high-rick people around you.
Because this is a disease that spreads primarily through close contact with someone that has symptoms of the disease, basic public health measures can go far to help you in your quest to avoid the illness. Staying home when you are sick is critical, keeping physical distancing to at least six feet as much as possible, washing your hands, and wearing masks all add up to reduce the chances of infection.