HAYDEN HOLLINGSWORTH: Covid-19 Questions That Need Answers

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Hayden Hollingsworth

The confusion about the coronavirus crisis is badly in need of a central agency, one that can be trusted, to supply data that we all need.

The Center for Disease Control and Prevention  and the Surgeon General’s office should be able to act as a national clearing house. Working with the World Health Organization would assure a global synchronization of effort. Without that, the public is left to sort through what we are being told and then decide what response we can make both individually and corporately.

The “alternative facts” that the president regularly delivers have made that clarity impossible. It serves no purpose to point out his shortcomings with which we have had to deal but one would hope that the responsible scientists from the NIH and the CDC have taken the president aside and told him that he continues to erode his credibility which worsens the crisis.  The announcement that “I knew all along it was a pandemic” may signal that he is beginning to listen. That said, there remain central questions that have not been answered.

First, now that testing has picked up momentum and new cases are being reported at an increased rate, does that reflect a true change in the incidence of the disease, or is it just better data gathering?  If the former is true, our need for draconian measures is justified. If the latter, then we may be less at risk than the increased numbers would suggest. That this is a world wide emergency is not in question.

Second, does the number of cases reported represent those with positive tests and a clinical picture of the illness, or do the numbers reported signify all positive tests even in the absence of clinical disease? If the former, the data are more ominous than the latter which include those who, as yet, are not ill and may not become ill.

Third, how lengthy is the period of contagion?  The most alarming answer would be that asymptomatic people could unwittingly transmit the virus for many days which would authenticate the need for quarantine for everyone.  Related to that one should ask in the presence of active disease when does contagion dissipate? Does active disease infer immunity after symptoms have abated and, if so, how long does that last?

Answers to these questions would help set policy that is based on facts not on guessing or supposition.  Additionally, the current crisis is an opportunity for proactive planning, the lack of which has been revealed.  For the epidemiologist this pandemic offers an unparalleled window for retrospective research which can guide policy decisions for the future.  We have had adequate warning from h1n1, ebola, and other communicable diseases that we need to increase our ability to recognize risk and deal proactively with it when infectious diseases grip the world and make it a dangerous place to live.

While anxiety is a normal response to this, there is precedent in which we can take comfort.  Not since the 1917-18 influenza epidemic have we faced such a crisis but we have been able to control the swine flu and the ebola outbreaks in Africa.  We will, in time, be successful in confronting Covid-19. It will require cooperation and compassion, patience and persistence. With leadership from the scientific and governmental agencies it will happen and for that we can be grateful.

Hayden Hollingsworth