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Coronavirus Spread in the U.S.: When, Not If

by Molly Walker, Associate Editor, MedPage Today 

— CDC says preparations for domestic transmission should begin

 

The U.S. should prepare for community transmission of the COVID-19 coronavirus, CDC officials said on Tuesday.

“We expect to see community spread [of COVID-19] in this country. It’s not a question of ‘if’ anymore,” said Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, on a media call.

Currently, the U.S. has 14 COVID-19 cases that are travel-associated or in close contacts of travelers, and 43 cases from citizens brought home from the Diamond Princess cruise ship and Wuhan, China. But she cited the “rapidly evolving and expanding” situation, including the explosion of sustained person-to-person community spread in a variety of countries, including South Korea, Italy, Iran, Japan, Taiwan, Thailand, and Singapore.

As the world inches closer to worldwide spread, and the final criterion of a pandemic, Messonnier acknowledged the previous strategy of containing the disease at the borders may no longer be enough to stop it. The strategy would then shift from a containment strategy to mitigation, she said.

“I had this conversation at the breakfast table,” she said. “I told my children I didn’t think we were at risk right now, but we as a family need to start preparing for significant disruptions to our lives.” Messonnier added that she’d contacted her local school superintendent to ask what they were doing to prepare for potential community spread of COVID-19.

In the vein of “when, not if” the U.S. will experience community spread, she advised people to ask whether their providers have telemedicine capability, and said parents should consider “what to do about childcare” if schools are closed.

Messonnier outlined community mitigation guidelines, based on those outlined for pandemic influenza a decade ago. These non-pharmaceutical interventions include personal practices, including covering coughs and washing hands, as well as community and environmental measures such as surface cleaning.

Community measures are the most dire, and include social distancing, or limiting contact in face-to-face settings, employing such options as closing schools, telework or teleschool for children, and recommending that cities potentially “modify, postpone, or cancel mass gatherings.”

This included a special advisory for the healthcare system: triaging patients, conducting patient visits via telemedicine, and delaying elective surgeries.

Obviously, this would be based on the outbreak’s severity and breadth, but CDC called on a variety of industries, including the healthcare, education, and business sectors, to start preparing now because when the virus hits the community, it hits quite rapidly.

“The disruption to everyday life may be severe, but these are things we need to start thinking about right now,” Messonnier noted.

She added that 12 state and local health departments currently have the diagnostic test for COVID-19, but the tests still come to CDC for confirmation. She anticipated commercial laboratories would be coming online with their own tests, as it becomes “more and more important clinicians have a full toolkit.”

“We are working as fast as we can, and we understand the frustration of our partners within the healthcare sector,” Messonnier said.

While the case definition of COVID-19 is still travel-associated, Messonnier said that may change based on information in other countries and when they had new information about case definitions, they would “publicize it broadly.”

She ended with the caveat that she’s not sure if community spread of COVID-19 will be mild or severe, but told a reporter it was better to be overprepared than underprepared.

“People are concerned about the situation. I would say rightfully so,” Messonnier said. “I’m concerned about the situation. CDC is concerned about the situation.”

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