We are having a COVID-19 communication problem in Nebraska. Everyone seems to be on a different page. First, on the national stage, it is clear that Nebraska has some magical plan that differs from roughly 40 other states (give or take) because . . . ? Fill in the blank. Fill in the blank on the reasoning (there is none) and fill in the blank on the plan. All we know is that our Governor thinks he knows better than every other state. And truly, the answer probably doesn’t matter at this point like it did even 1 week ago. Ricketts has already sealed our collective fate. This is a big experiment, we are working with a lot of unknown variables, and we are two weeks behind this virus on any given day because the people who caught it today won’t have symptoms for 5-14 days (if at all) and then they MIGHT get tested. Without testing, people are shooting in the dark and making decisions with different motives in a political minefield and no matter what, nobody is going to win this battle. Some states and cities will fare better than others. We won’t know until it is all done and number crunchers like us (us non-essential folk) will be doing studies on what transpired where and when and what the result was for the next 50 years. The actions people take today will save lives, and they will cost lives, and if you are a public official, your decisions will affect far more people than the rest of us.
So, as Melody Vaccarro pointed out, we have some amazing heroes out there doing the best they can. They are essential employees, they are epidemiologists and virologists, they are nurses and caregivers, they are public health officials at DHHS and our local health departments, they are our local reporters, they are even politicians. When there are leaders bringing all these people together to pull at the oars at the same moment in the same direction, the ship of state moves swiftly and cleanly and gets where it needs to go. When there are no leaders, it is a total shit show, and usually you can tell because everybody is saying and doing something different. There is no communication. The boat just meanders around randomly in the water until everyone gets tired and grumpy and eventually dies of thirst. Here is an analogy for you football folks: when the coach analyzes the situation and calls a play, and the whole team executes it, things have a shot of going well. When the coach says different things to different players, or just says, “I don’t know, do your own thing”, the result is painful to watch. Then the virus has the ball, and is sprinting down the field before we know it. We are all watching it, and we all know what scenario we are dealing with here in Nebraska.
So while we are not here to point fingers at any one person or player, we are here to say this is the coach’s fault. This is what lack of leadership looks like, and that is on Ricketts. Case in point:
What we have in the paragraph above is failure in communication. When you read this paragraph, it appears as if COVID-19 infections are caused by travel, or worse, by “community-acquired”(sic). Uhhhh, no? Travel does not cause you to become infected with COVID-19. Similarly, COMMUNITY SPREAD IS NOT THE CAUSE OF A VIRUS. This paragraph is a science communication catastrophe. COVID-19 infections are caused by the novel coronavirus. Positive tests are caused by taking a sample way up the nostril of an infected person accurately. Once that test comes back confirmed an investigation happens. THE INVESTIGATION IS NOT TO LOOK FOR THE CAUSE OF THE VIRUS. The investigation is to figure out who infected the person who tested positive so that we can track them down and isolate them and anyone else they might have infected.
A community spread case, by definition, is a case that means, upon investigation, we can’t trace the origins. When you get a community spread case, it means the virus is spreading freely in the community. It is not contained. In a perfect world we would drop everything and test every single person today. We could map pretty accurately every single current case, and future potential cases, and we would quarantine anybody who had contact with those confirmed cases. I mean, this is what we are doing, but we don’t have enough tests. So instead we are playing virus whack-a-mole. Which is fine if you can figure out the source. You identify the case, you figure out who they got it from and work back, and then you look at all their contacts in the two week infection window (give or take), and you quarantine all those people forward for 14 days. Containment is the only way you can stop the spread of a virus without a vaccine or widespread immunity.
So not only was the reporting of this basic science completely bungled somewhere along the way, the lead is completely buried! The lead is that 1) the number of cases in Lancaster county has more than doubled in just a few days, and 2) over HALF the confirmed positive new cases (seven out 11 are still under investigation) are community spread.
Think of community spread cases as the SIDS of infectious disease. Maybe from a science communication standpoint these should be called “IDK” cases? We will take suggestions. But truly that is what community spread means. This person is confirmed positive for COVID-19. They have not travelled to any hotspot and they do not know anyone with a confirmed COVID-19 test they have been in contact with in the last 14 days.
Last week we were shocked that we finally even detected a community spread case. Given the limitations on testing, the cards were stacked against it. As we previously explained, due to a shortage of tests, we were systematically undercounting community spread cases from the get go. This is because with very few tests, we have to be focused on the most at-risk populations (think people who could affect a lot more vulnerable people) and on cases that had a high probability of coming back positive (so we don’t waste tests on negative cases). So at first we were only testing cases of vulnerable populations, and then, only people who had direct contact with a confirmed positive case or someone who had traveled from a hot spot with a lot of confirmed cases. Unfortunately, we know that there are plenty of people with the virus who are totally asymptomatic, and who are potentially walking around spreading it without realizing. Targeting testing in the way we’ve had to do has meant that tons of cases are being missed.
The good news is that we should be relieved that we are finally seeing more of these. Why? Because we are finally testing more people. Most of these came through the drive-thru locations and clearly doctors began loosening standards in recommending the test when there was more capability and wham, we have seven confirmed community spread cases in one day. This was bound to happen, and in some ways, more positive cases is good because it means more testing, and testing is the only thing that will give us the knowledge to stop this thing, or at least slow it down and keep the death toll lower.
That being said, seven community cases in one day is absolutely sobering from a public health standpoint. It is confirming what every public health official knew last week, but most would not say: that COVID-19 is spreading freely in the community here in Lincoln and likely in the rest of the state. It is not contained. We are playing whack-a-mole wearing a blindfold. And that is the story here folks. Investigation of confirmed cases is not looking for the cause of the virus, they are tracing contacts so that we can contain it via quarantine. If we had leadership this would be clear to the general public by now, it would be clear to our public health reporters, and probably most importantly, the whole goddamn state would be on a stay-at-home order which is realistically our own option for flattening the curve.