Covid-19 Why are people still getting sick?

Illustration of SARS-CoV-2 from the CDC

After weeks of sheltering in place, as the nation reopens, I would like to know what has been done in the interim to sharpen the understanding of hygiene to contain the virus and allow normal life without fear of making things worse again? Hygiene is not cleaning or killing every germ, it’s what you do to prevent the spread of infection.

The sheltering in place was clearly necessary and saved many lived. But after all these weeks, I am left to wonder why there aren’t more nuanced hygiene instructions? This is not intended as criticism—scientists and doctors working on this problem have been working hard, heroically, really.

But I don’t want to lose sight of the problem solving opportunity here. As public health efforts increase testing, they should also consider taking methodical data on when and how everyone got infected, or likely was infected, down to the nitty gritty details and the spectrum of possibilities, the way the health inspector investigates after food poisoning complaints at restaurants.

Knowing more about exactly why people do get sick from interactions and the kinds of interactions they don’t get sick from—and teasing apart why some people get sick from seemingly similar interactions and others don’t—will make all the difference in whether students can go to school or college in the fall, safely, or people can travel again, or restaurants get customers next month instead of next year. If I were Disneyland or Johns Hopkins University, I would be throwing money at knowing that information.

After all these weeks of lockdown, people are still getting sick. Is it because 6 feet apart isn’t enough? Is it that people aren’t maintaining known recommendations? Are some of those recommendations unnecessary for a lot of circumstances and people? What if we could be resuming, like, 80% of the things we used to do because we understand in better detail how and why people are still getting sick and how to avoid it?

Who is systematically trying to understand human interactions in more detail right now so we understand why infection continues to spread, or when it doesn’t? Contact tracing is necessary, but it’s not the same thing.

The lockdown is like a national allergy elimination diet — you can eliminate everything you eat to stop reacting, but you can’t live like that forever. But you go through the sacrifice because it allows you to track down what causes a reaction so that you can eat almost everything else again and remain healthy.

If you go through the trouble of eliminating everything just to stop reacting, then reintroduce foods simply because you want to get your digestion going again but without truly trying to track down what causes problems at every step, then you lose most of the value of the original sacrifice.

Continuing the lockdown without using it to get a more nuanced understanding of hygiene is like reducing your diet to just toast forever. Reopening the country without understanding the nature of interactions that are still spreading disease and why, is like going to all that trouble to stop eating everything to stop the allergy, only to just start up eating everything willy nilly and losing the advantage of the temporary sacrifice.

Many people and parts of the country are probably safe to resume life. But we don’t know the nuances of the conditions under which those behaviors go from safe to dangerous and vice versa. Just expanding testing isn’t going to tell us that. We need a systematic attempt to understand how this virus is transmitted and how to prevent it, and our current situation where almost everyone is still sheltering in place but the disease continues to be transmitted is the ideal time to do that.

Having that knowledge could allow us to better move forward confidently and safely, and resume more normal life. We need this prevalence testing and contact tracing, but I hope researchers will also start taking detailed data that allows a more nuanced look at when and how infection is being spread, and when and how it is not being spread. Is it really necessary to shut down the beaches, for example? Knowing more detail about the conditions of how the infection is spreading in the world now, and not spread, hand-in-hand with testing, could help make such decisions with confidence.

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