• William Miller, MD

Change in Public Health Strategy Needed

Miller Report for the Week of August 10th, 2020; by William Miller, MD.


By many measures, our initial response to this epidemic, which included shutting down “non-essential” aspects of our economy, were successful in thwarting a truly disastrous surge that would have overwhelmed our health care system. As we have loosened those restrictions, cases have been predictably climbing over the past six weeks. This is true across the US, as well as here on the Coast.


This increase has led to an equally predictable increase in the need for testing. Unfortunately, instead of having adequate testing to promptly identify new areas of outbreak and mitigate them with aggressive contact tracing and quarantine measures, we have once again run into a national shortage of testing supplies. This is made worse by laboratories being over whelmed by the volume causing delays in test results, at times over 16 days or more. Clearly, a public health strategy based on early identification of newly infected persons with the subsequent requirement of isolating for 14 days fails miserably when the test result is not even available inside those 14 days.


Medical tests, those that we use in hospitals to identify patients sick due to COVID, are also in short supply.


Public health departments around the State have been unable to keep up with contact tracing as California averages more than 8,000 new positive test results per day. Thus, community surveillance testing followed by contact tracing has failed as a containment strategy. At this point, we need to move on to other approaches.


Politicizing the situation is not helpful. However, to be clear, the problem lies at the highest levels of the federal government that have failed to show needed leadership. The federal response has been uncoordinated and inadequate from the start. Writing to your local county supervisor or even your state representatives will not be helpful either. Pressure needs to be placed at the federal level encouraging a more organized and effective response.


Take heart, there is much that we can still do as a community. Remember, this is a community challenge and we must come together as a community to respond to it. Short of going back to shelter-in-place, or even worse completely shutting down our communities, we need to get very serious about masks and social distancing.


Masks must be worn in all settings outside the home in which you might encounter others. While it is fine to go without a mask while biking along a public trail, it isn’t okay when strolling down the sidewalks in town. And, the mask really needs to cover your nose as well as your mouth. If people can’t seem to find the motivation to do this voluntarily, then law enforcement will need to enforce this mandate, even as unpopular as that may be.


Additionally, our definition about what it means to socially distance needs to be kicked up a couple of notches. Simply standing six feet apart in line at the grocery store is not enough. We need to seriously limit the size of our social gatherings. Please, limit social gatherings to only a few close relatives and friends. Having a big family reunion right now is a bad idea for you, your family and for the rest of us.


Lastly, let’s examine this idea of a social bubble. It is an attempt to recognize that we are social creatures and we need the interaction and support of our friends and loved ones. If we can define our own small group of such cherished persons and agree to only let down our mask and socialize closely with them and only them, then everyone in our social bubble will stay safe. It only works if everyone in that group stays within the group. If social bubbles overlap then it instead becomes a fluid way for the disease to spread from one unmasked group to the next.


In his inaugural address, President John F. Kennedy challenged us to, “Ask not what your country can do for you – ask what you can do for your country.” He meant that we should each, as good citizens, strive to find ways to work for public good. Well, your country is asking you now to each do your part to stop the spread of this disease for the greater good. And if patriotism means making sacrifices for the greater good of the nation, then now is the time… be a patriot and wear the mask.

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