The COVID-19 Pandemic: "If I Ran the Circus"Nov 16, 2020
Many of us are imprinted by the words of Dr. Seuss. They were read to us as children and we read them to our children. “If I Ran the Circus” remains my favorite for its underlying theme of phantasmagoria. Unfortunately, a set of mystical and competent creatures will not be arriving to end the pandemic. No one is running the circus as every metric for the COVID-19 pandemic soars in most states and in Europe. In a vacuum of national coordination, state and local governments and their public health agencies are imposing ever more drastic measures and some Republican governors are now mandating mask use, even though reluctant to do so before. I summarize as follows: the virus has a plan, but we do not (with apologies to humankind for anthropomorphizing the virus).
Greater coordination and planning around the epidemic are anticipated with the Biden-Harris Administration. It will be needed to quell the epidemic and to organize and implement mass vaccination against SARS-CoV-2. Last week, there was positive news with the announcement of the high efficacy of the Pfizer vaccine and the possibility of its use beginning by year’s end. But the apparatus for doing so needs to be assembled, even as the pandemic surges. Per the New York Times, the states are not yet ready and maintaining the cold chain for the Pfizer vaccine is an additional complexity.
The next few months will be tough in Colorado and elsewhere. The effective reproductive number (RE), which should remain below one for epidemic control, has risen steadily over the last two months in Colorado, reaching 1.7 last week. At this level, the epidemic curve is rising steeply with exponential growth. As I write this commentary on November 16, there are 1,278 Coloradans hospitalized with COVID-19, alarmingly higher than the April peak of 901. The latest modeling predicts a further rise that could be accelerated by a drop in transmission control over the holidays.
The messages from the Governor and the Colorado Department of Public Health and Environment (CDPHE) reflect the gravity of what could happen. Messaging by the CDPHE calls for Coloradans to adhere to the behaviors that reduce transmission. And, the Governor has cautioned Colorado about the dangers of Thanksgiving gatherings and suggested quarantining in advance: "The more family members that make that decision to self-quarantine, the more likely it is that you're not really bringing a loaded pistol for grandma's head," he said. On the COVID-19 dial dashboard, most of the larger counties are now at “Level Orange Safer at Home—High Risk” and moving towards meeting metrics for “Level Red—Stay at Home.”
These reminders to COVID-19 fatigued Coloradans on the importance of their behavior are needed, as the remaining policy measure that could bend the epidemic curve is a return to “Stay at Home” with its serious economic and other consequences. Curfews and earlier closing times for restaurants will help, but are not sufficient by themselves. And, the modeling results show that steps taken in the coming week will not have full impact until the end of the month.
The news on vaccines is promising, but challenging months remain until vaccination is sufficient to achieve herd immunity. That goal is pending, demanding that we continue to protect ourselves and others.
Back to Dr. Seuss. I don’t run the circus, but for controlling the pandemic some of my performers would be a truth-telling ringmaster and the right mix of scientists, clinicians, and practitioners performing within a circus tent held up by evidence. And we, the mask-wearing audience, would respond to what we see and what we are told.
As a reminder, Christl Donnelly from Oxford and Imperial College will be speaking in the Dean’s Speaker Series on November 18. Her topic is timely: Real-time Analysis of COVID-19—Epidemiology, Statistics and Modeling in Action.
Stay well and hang in,