While Hard, Societal Sacrifices Are Measurably Paying Off

The SARS-COV-2 (COVID-19) pandemic has infiltrated almost all aspects of our lives, bringing much of normal societal flow to a grinding halt. Social distancing has restricted contact with others, business closures have reversed economic growth, and other safety and prevention measures have resulted in an abrupt and dramatic change to daily life. Despite these drastic actions, there are still nearly 13 million confirmed cases worldwide and well over 3 million in the United States (U.S.) alone, at the time of this writing. The vast number of COVID-19 infections and, worse, deaths from the virus, begs the question, have the steps we’ve taken made any difference? Is that measurable and, if so, how? Answers to these questions are crucial for a number of reasons. First, the changes we’ve been collectively making are hard. So, knowing whether these steps are saving lives and reducing infections can be motivating. Similarly, some leaders have sown doubt, causing a certain percentage of citizens to ignore scientific recommendations and raising wonder about whether the collective inconvenience, job loss, diminished learning, and isolation are worthwhile or not?

knowing whether these steps are saving lives and reducing infections can be motivating

To address this concern and curb the public skepticism, researchers from the University of Berkeley recently analyzed data to assess the effectiveness of a variety of protective measures across six major epicenters of COVID-19 including the U.S., Iran, France, China, South Korea, and Italy. Gathering 1,717 points of information from the six countries, the researchers assessed the significance of the effect by comparing the growth rate of COVID-19 just prior to the intervention (or interventions) to the change in growth rate soon after the implementation of one or more policies including, but not limited to:

  • Travel bans or suspensions
  • Religious closure
  • Work from home
  • Cancellation of large gatherings
  • Business closure
  • Home isolation

If Nothing Had Been Done, 530 Million People Infected Worldwide

Without any policy action at all, the researchers estimated that the growth rate of COVID-19 infection would have been 43% higher per day across the six countries studied. This would have translated to 14 times more identified COVID-19 infections (i.e. nearly 5 million more cases) in the US alone as of the first week in April. In total, the study predicted that without intervention, there would have been 62 million more confirmed cases (again, as of early April) in the six countries, corresponding to 530 million total infections across the world.

Fig. 4 | Estimated cumulative confirmed COVID-19 infections with and without anti-contagion policies.

The current total of confirmed cases, close to 13 million, pale in comparison to these predicted values if no measures had been implemented in these 6 countries. It is clear that policy measures “significantly and substantially slowed the pandemic” spread. 

A similar study published in Health Affairs, discovered comparable trends in reduced growth rate of infection in the U.S. after implementation of shelter in place orders (SIPO). Following policies until the end of April, the Health Affairs researchers projected that without SIPO, there would have been 10 million more cases across the U.S. and without additional measures of event bans and closures (discussed below), there would have been 35 million more cases. Since two independent studies produced parallel results, we can feel confident about the accuracy of the estimated number of cases averted and lives saved as predicted by these statistical models. In other words, our collective actions and sacrifices, both as individuals and society at large, have mattered and have saved lives.

our collective actions and sacrifices, both as individuals and society at large, have mattered and have saved lives

If Nothing Had Been Done, 530 Million People Infected Worldwide

Both analyses went even further to try to uncover whether specific policies were most influential in mitigating spread of the disease compared with others. According to UC Berkeley and Health Affairs authors, social distancing has been especially impactful for slowing the spread of the virus; but, perhaps, school closures have not had as large an effect. Home isolation and social distancing, per the UC Berkeley analysis, reduced the growth rate of cases of coronavirus by 

-11.31% and -21.81% respectively. The study in Health Affairs also found that the SIPO provided the largest decrease in growth rate of -8% after only 21 days of implementation and that that result, in scientific terms, was statistically significant (p<0.01) – meaning the decline in spreading COVID-19 was definitely from the changed behavior, and not simply luck or chance. Additional actions that have also been emotionally draining and economically difficult, like business closure and quarantining those who test positive for COVID-19, have also effectively slowed the spread of COVID-19. The UC Berkeley experts report that these two actions resulted in a decrease in the rate of COVID-19 growth in the U.S. by -5.35% and -5.92% respectively, and even more in other countries like Italy (-11.40% and -6.06%, respectively). Neither of these studies examine the economic or psychological impact of these various preventative measures, which should be the subject of future research. However, this data makes it clear that while many of these protective measures are costly, challenging, and often unenjoyable, they have successfully stopped the spread of COVID-19.

What Can We Glean?

Both studies make it clear that their reports cannot determine definitively which protective measures are necessary, and which may be obsolete. Rather, these studies aim to shed light on the success of particular measures to slow the spread of COVID-19 and highlight how, all together, worldwide collective efforts have made a massive difference in combating the virus. These results prove that measures such as social distancing and home isolation have significantly slowed the spread of COVID-19, despite some dissenting opinions. In addition, while school closure and cancellation of large gatherings did not show significance or decreases in growth rate, both studies emphasize that these findings should not be interpreted as being unnecessary, nor does the data claim any stake on whether they be applied or avoided for future disease prevention.

The results of these analyses should be comforting since most of the preventative measures have produced what they intended.

The results of these analyses should be comforting since most of the preventative measures have produced what they intended. Through these measures, nations across the world were able to unite to implement meaningful action to slow the spread of COVID-19 and were able to prevent upwards of 530 million global infections. Dr. Kendon Bell, one of the UC Berkeley researchers, stated that as a global population, “we should be very proud” of our teamwork and collective actions to address the pandemic. 

These studies lay the foundation for effective statistical analysis of virus prevention and provide a template for what actions should be considered when facing the next pandemic. Our collaborative efforts to practice social distancing, in particular, and other measures have paid off. We have successfully cared for and protected one another. Let’s continue.

Written & Reported by Robert Shepard; Edited by Dr. Jacki Hart

Will 21-Year-Olds Learn to Take the Pandemic Seriously?

Doug, a 21-year old college student in Boulder, Colorado (CO), tested positive for COVID-19. Unlike others who have had much more serious cases, Doug was lucky. He only showed symptoms for a single day and, thankfully, never entered a hospital or emergency room. In fact, Doug assumed, at first, that he had the flu. 

Reflecting on his experience, Doug describes his main lessons from his quick brush with coronavirus. Doug learned, in large part, that his peers tend to take COVID-19 for granted. In fact, many in his friend group wound up testing positive, including the person from whom Doug contracted the virus. But few have taken it seriously enough to alter their habits and behaviors. 

Despite having had a smooth, easy course without complications, Doug now recognizes how contagious the virus is and tries to communicate with his friends the importance of wearing masks and taking other precautionary measures. Doug bases his newfound caution on the fact that he was exposed to the virus when in the same room with one or more who later tested positive. In fact, as Doug recounts, he was never in direct contact with an infectious person, just in the general vicinity. 

Even before having any symptoms, Doug sought testing because of this exposure. He found it difficult to locate a site; then, serendipitously, he developed symptoms one day later, which lasted less than 24 hours. Doug was quarantining from the time that he learned of the exposure. Three days after his symptoms began, his test results came back positive. His housemates and several friends, who had also been at that party, all tested positive; but no one had more than short-lived, mild symptoms.

While quarantining with housemates, their community came through with support. Other friends without COVID-19 delivered groceries and other supplies. The day that Doug shared his story with Covid-Recovery.org, he was scheduled to get his follow up test back the next day. He was anxious to know the results because he had stayed out of work for nearly a month. 

few his age seem to be taking the virus seriously enough.

When probed about the opinions of COVID-19 held by his peers, Doug described stories similar to what is shown in popular media: few his age seem to be taking the virus seriously enough. Those in Boulder, CO are still holding house parties, and while they wear masks when entering shops and bars, which are mandated, they’re not participating in strict social distancing. Doug believes that people his age might be convinced to change their behavior if their return to college was in jeopardy. Universities, like all schools throughout the country, are making a range of decisions based on the risks within their regions and many other factors. Part of the problem is that the delay between the risky behaviors that might spread the infection and any rise in rates could preclude students from connecting their actions and the schools’ decisions or altered policies. 

As far as Doug’s own behaviors — even though his case was mild, he carries an important message for people of all ages: listen to your doctors and wear your masks! 

Written & Reported by Robert Shepard
Edited by Dr. Jacki Hart

Katarina’s Choice is Hard but Clear: Protect Her Dad

My Covid Story

Being a 21-year-old college student during a pandemic means, for many, worrying about classes, jobs, and friends. I’m lucky to have access to fast, reliable internet and a quiet, safe place where I took the remainder of my UCLA courses online. For me, the hardest change has been the ongoing worry about ways that I might infect my 74-year-old father since moving back home.

There was little known about the novel COVID-19 virus in the early days, other than the increased risk for serious infection and even death for those older than age 70 or with underlying medical conditions. As I carried those facts in my brain, making my way to LAX on route to live with my parents in Rhode Island, I had a panic attack. Although I was fully covered with latex gloves, an N95 mask, sweatshirt, and sweatpants, and even braided my hair up to be out of the way, the following mantra repeated in mind: “I will never forgive myself if I am the reason my family gets sick.” My plane was crowded, LAX was crowded, and I did not take off my mask for a single second of the 6½ hour flight home. As soon as I got out of the airport I removed all of that disposable PPE (personal protective equipment), threw it into a trash bag, and jumped in the car with my mom.
After two weeks of being home, I was relieved to find that I never showed symptoms nor did anyone in my family. Once those two weeks passed, I still avoided seeing any friends or relatives other than my mom and dad for roughly a month. We all agreed that I would do the food shopping to minimize their potential exposure. Once a week, I put on my mask and gloves armed with hand sanitizer in my pocket and head to the grocery store. I continue to wash everything from the grocery store or leave non-perishable foods outside for a week. My philosophy has been that I can’t be too cautious to protect my parents.
During the lockdown period, the experience was almost easier. There weren’t pressures of choices to make, or friends asking me to go out. The protocol, so-to-speak, was clear cut and unwavering. I recognize, and hope that I don’t take for granted, my privilege of having access to shelter, food, WiFi, privacy, and space. While the stay-at-home order was in place, I didn’t have to worry about going anywhere because there was nowhere to go. The risk of my dad getting infected was minimal as long as I stayed inside. That helped me feel calm and in control.
But now, even with reported cases decreasing in Rhode Island, when I go for a run outside and pass by a biker without a mask, I feel a pang of dread wondering whether there is a chance that I just exposed myself to coronavirus. Sometimes, my anxiety eats at me for hours, admonishing myself for making the choice to go running. I know that the chance of contracting coronavirus outside while exercising with a mask on is very low; but when living with someone who could die if they get infected, worrisome thoughts fly through my head daily. Honestly, I feel exhausted.

I’m a 21-year-old college student; it’s summer, and while all of my friends go to bars and beaches, I stay home.

Now that Rhode Island has opened up its restaurants, bars and beaches, it has been more stressful. I’m a 21-year-old college student; it’s summer, and while all of my friends go to bars and beaches, I stay home. For me, the choice isn’t easy, but it is clear: my dad’s life takes precedence over my ability to socialize and hang out with friends. I think the hardest thing for me has been trying to keep everybody happy. Running or walking outside is essential for my own mental health; but I worry and feel strongly about not doing anything to put my parents at risk. It is challenging to explain to my friends why I don’t feel comfortable going out or spending time with them. People don’t always understand or fully appreciate my concern for my parents’ health.
It hasn’t been the summer I expected; that is true for most people. Removing myself from my usual social life and watching it happen without me can take a toll. It’s difficult to watch my friends having fun as I tune in from a screen. But I feel clear that I would rather miss out on a beach day than cause any harm to my Dad.

Is Self-Administered COVID-19 Testing In Our Near Future?

To curb the COVID-19 pandemic, public health officials strive to recommend the most effective and efficient ways to contain the virus. Arguably, one key method for communities to restrain spread of the infection is to apply widespread testing, followed by contact tracing and selective quarantine. The early medical response in the United States (U.S.) was hampered, in part, by the lack of available materials and infrastructure to perform tests – a problem that is resurging as numbers of cases rise in the U.S. Additionally, collecting swab samples can increase the risk of transmission to health care workers conducting the testing, especially when personal protective equipment (PPE) is in short supply. 

Consistent with the goal of efficiency, recent data supports the validity of self-administered testing that can be performed at home by the patient. The person then submits the sample to a reference laboratory where it is examined for presence of COVID-19. In a study conducted in Puget Sound, Washington State, 530 patients with symptoms of an upper respiratory infection tested themselves. Healthcare workers tested these same patients using a nasopharyngeal (NP) technique so that the results could be compared. 

The researchers found that when patients collected tongue, nose, and mid-turbinate (inside the nasal cavity) samples on themselves, the sensitivities (meaning the likelihood that their tests were comparable to the tests conducted by a healthcare worker) for detecting the virus was 89.8%, 94.0%, and 96.2%, respectively. This suggests that patients are able to collect their own samples and that they may accurately predict COVID-19 infection, especially from nasal and mid-turbinate regions. 

Self-administered sample collection may improve efficiency for testing while also reducing the risk of exposure for the healthcare workforce.

Self-administered sample collection may improve efficiency for testing while also reducing the risk of exposure for the healthcare workforce. The study needs more rigorous evaluation and, ideally, replication; but the concept of widespread self-administered testing in the U.S. may prove to be a possible method to help reduce the spread of COVID-19. In fact, the Food and Drug Association (FDA) has approved a home testing kit via the Emergency Use Act (EUA). 

Already in the United Kingdom (UK), individuals are given the option to order a free home testing kit. Once delivered, patients can test themselves and return the swabs to a lab site for analysis. This process provides several advantages: 

  1. Less discomfort for the patient 
  2. Safer for healthcare workers because of reduced exposure
  3. Diminished use of PPE

The British National Health Service (NHS) has released a tutorial on how to conduct a self-administered test at home. As a result, the UK has recently seen great improvement in the number of people they are able to test. They’ve even been able to extend asymptomatic testing and regular retesting to thousands of workers who may come in contact with people through their daily jobs, including taxi drivers and cleaners. 

As countries like the UK step up testing in order to create a safer environment for its citizens, they may serve as a role model, setting a precedent to apply this approach to help contain the spread of COVID-19. Perhaps the FDAs application of the EUA to approve a home testing kit is a sign that this may be an option coming soon to the US as well. 

Written by Rohan Prabhu; Edited by Dr. Jacki Hart 

Reports Lag Behind Surges of Abuse & Domestic Violence

My Covid Story:

As Law Enforcement Partnership Coordinator at RESPOND, Victoria H has helped 100s of DV survivors from all over the world not only find safety but also success.

Nobody is immune to the impacts of COVID-19 on the way we live, but the consequences can be particularly severe for those suffering from domestic abuse. Numerous studies suggest that levels of violence have increased due to the toxic mix of heightened economic pressures, health-related issues, and “stay at home” rules that increase exposure to tense or already abusive relationships and eliminate a victim’s access to safe spaces during the day. These trends are further complicated by greater difficulties reaching out for help and getting access to the usual support organizations in one’s community.  

Stay-At-Home Rules Leave Jane Trapped

The story of Jane (name changed for privacy), a suburban high school student, begins in a way that is all too common within the foster care system – a teen reaching out to her school for help escaping from an abusive home. From that starting point, Jane faced hurdle after hurdle in her quest for safety because her cry for help took place during the emergence of the COVID-19 pandemic.  

On March 12th, Jane contacted her high school to say that recent “stay at home” rules left her trapped around the clock in an abusive home. Administrators worked diligently to set up a day in court. However, on the day of Jane’s scheduled hearing, courts across her state were shut down indefinitely. In the days that followed, social workers from the Department of Children and Families (DCF) navigated the new rules and managed to find Jane a safe home, only to watch their plans crumble once again – this time because a member of the foster-family tested positive for COVID-19. Luckily, local police worked closely with school administrators and DCF to keep a watchful eye on Jane’s abusive family while the support service agencies searched for another solution.  

Eventually, they found a safe new home for Jane. Nonetheless,

Jane’s harrowing story highlights the range of difficulties faced by those experiencing domestic abuse in the COVID-19 era

Jane’s harrowing story highlights the range of difficulties faced by those experiencing domestic abuse in the COVID-19 era, from the violence and trauma itself to the risk of contracting the virus from a stranger to adjusting to a whole new living circumstance at a time that is already fraught with fear and uncertainty. 

What Do the Experts Say?

Victoria Helberg, an employee at Respond (an organization that works with victims of domestic violence) noted how life during the pandemic makes it hard for those in need to reach out for help or to be identified by the community. Ms. Helberg said that there was a decrease in calls to Respond at the start of the pandemic. This trend may seem counterintuitive. But, as Ms. Helberg explains “people don’t have the opportunity to make calls because they were now at home with their abusive partner.”

people don’t have the opportunity to make calls because they were now at home with their abusive partner.

Ms. Helberg’s experience was echoed by a United Nations (UN) report that there has been a notable decrease in domestic violence reports during lockdown. Confirming Ms. Helberg’s real-life experience, the UN speculates that this is due to the hesitance of women to find help or address these incidents when forced to share their lockdown space with their abusers.

Despite increased difficulties reaching out for help reported by many experts, certain locations have still noted a spike in hotline activity regarding abuse. In Spain, the domestic violence hotline received 18% more calls in the first two weeks of lockdown than in the same period just one month earlier. Similarly, the United States and France reported roughly 30% increases in domestic complaints or occurrences of violence. These numbers are striking; yet, based on Ms. Helberg’s experience and the United Nations report, these statistics likely still underestimate the actual increase in incidents of abuse. For example,

Google noticed a 75% increase in Internet searches regarding support for domestic violence in Australia

Google noticed a 75% increase in Internet searches regarding support for domestic violence in Australia, demonstrating the large sum of victims who have likely been unable to receive help during the pandemic but are scouring the web for help. 

No Safe Space

The surge in cases of domestic abuse is also complicated by a lack of access to safe spaces for victims. Ms. Helberg states that “before, their abusive partner may be off to work, or they would be off to work, and they would have those kinds of moments in between to make [such] calls.” With no access to those private times and spaces today, difficult situations are made worse. Even children witnessing or experiencing abuse would rely more on the safety of schools and other locations for both a break from their homes and a place to get help. 

children witnessing or experiencing abuse would rely more on the safety of schools and other locations for both a break from their homes and a place to get help.

How Nations and Localities are Responding to this Crisis within a Crisis

During this extreme time, nations and local organizations have been taking the issue of abuse and domestic violence seriously. UN Secretary-General Antonio Guterres recently brought to light the importance of countries prioritizing support for those dealing with domestic violence. As a result, in France (for example), grocery stores set up a system using certain signals or code words to let the staff know that they need help. Around the globe, local organizations such as Respond have been helping as well, providing many services 100% virtually, while continuing to keep their shelter program staffed 24/7. 

The COVID-19 pandemic has created numerous additional complications for victims of abuse. At the same time, it is helping to shine a light on the seriousness of the ongoing problem and the need for vigilance. Even post-pandemic, governments and organizations need to continue to uncover the incidents, address the challenges, and create viable solutions to end domestic abuse and temper its devastating impact. 

Written & Reported by Ella Gavin; Edited by Dr. Jacki Hart

Hate and Coronavirus Spread Together

My Covid Story:

In February of 2020, the first signs of coronavirus sounded an alarm to epidemiologists in the United States (U.S.) as they watched China go into full lockdown. By March 2020, the pandemic caused by COVID-19 began to proliferate throughout the U.S. Sadly, along with the spread of the virus came racism directed at Asian Americans. Sinophobia, the dislike or fear towards Chinese people and Chinese culture, heightened as rates of coronavirus began to rise.

Life under quarantine is hard for everyone; but the widespread escalation of Anti-Asian harassment and assault have caused undue fear and anxiety for this community. Reports reveal that incidents occur throughout the country and are not confined to specific locations. The Anti-Defamation League (ADL) and other organizations have been tracking the frequency and details of related occurrences from San Luis Obispo, California to Queens, New York with more than 1,500 reported cases since the start of the pandemic. Keep in mind that these represent only the incidents that are documented, with hundreds, perhaps thousands, of reports not recorded. 

Aileen, an Asian American who lives in Manhattan, experienced racism related to COVID-19 firsthand. One early afternoon, before New York City went into full lockdown, Aileen was hopping onto the subway, heading for an appointment. She recalls that the train was not very crowded; as she got on, a white woman shoved her out of the way, gave her a dirty look and covered her face to signal fear of infection. Aileen, who has been healthy throughout the entire pandemic, was shocked. How could someone treat her like less of a person because of her race? Unfortunately, Aileen’s story is not uncommon. Asian business owners have reported graffiti and hate speech along with vandalism. Slurs such as “Go back to China, you brought the virus here” or “Stop eating bats” have been hurled at countless Asian-Americans. 

A Chinese employee of Women, Infants, and Children (WIC), who helps provide services to low income families with eligibility for the federally funded nutrition support program, recalls her similar pandemic story. In March, this person, who prefers to not be identified, fell ill and thought it was related to allergies. She was sick enough, however, to take time off from work; her children — two in high school and the one in college — took care of her for a week, as she recovered from her symptoms of dry cough, loss of taste and smell (very specific for COVID-19), and low-grade fever. She was worried about her job, but received paid time off and felt grateful since many others have not been as lucky. More than a month after she had properly quarantined and fully recovered,  she was in the grocery store buying flour for her daughter who wanted to bake.

I never thought I would be on the receiving end of racism

she said. But while she was waiting to purchase the flour, she heard a woman behind her say “You brought the coronavirus to New York, you are so disgusting for eating bats!” Stunned and deeply insulted, she did not reply nor did she report the incident. The remarks were painful; she froze in disbelief, wondering how people could be so cruel and uninformed.

Damage from, Causes of, and Response to Sinophobia

During a time where mental health is challenged due to isolation, losing those we love, and facing financial and physical hardships, anti-Asian violence and harassment is emotionally draining and hurtful with serious psychological and physical consequences. Attacks involve verbal abuse, offensive graffiti, spitting, coughing or attacking. There is no evidence of Asian Americans and Pacific Islanders having higher infection rates from COVID-19 than other ethnic groups; in fact, according to the Centers for Disease Control and Prevention (CDC), Asian Americans and Pacific Islanders have the second lowest infection rate of all ethnicities in America.

Factors supporting and spreading racist rhetoric include certain news channels and government officials. These constitute large platforms that deliberately scapegoat Asian Americans by using racist terms like “the Chinese Virus” or “Wuhan Flu.” Speaking with those who have been directly affected by discrimination, they report how disheartening and distressing it is when one hears prominent spokespeople, especially POTUS or surrogates from the administration, use racist terms  which, at the very least, excuse racism towards Asian Americans and, at worst, encourage it. 

In response to anti-Asian violence and harassment, the hashtag #IAmNotAVirus has been created.

This represents a movement among Asian Americans and Pacific Islanders to share their stories and allow their voices to be heard.

Taking active steps against hate and discrimination towards Asian Americans requires vigilance about what businesses you support and holding accountable those who incite racism and use “irresponsible rhetoric.” Facebook has recently come under fire for both disregarding voter suppression and not applying their moderation policies to hate speech and racism on their website. A coalition of anti-hate organizations have collaborated to create an initiative called #StopHateForProfit designed to implore Facebook to change their policies. Four hundred large and small companies, as of this writing, are collectively boycotting advertisement on the social media platform. 

Along with not supporting companies and businesses that encourage, support, or allow racism, speaking out against racism must become common practice. Asian Americans Advancing Justice created a bystander intervention training that can educate people on what to do while witnessing racism. 

There is no doubt that COVID-19 has profoundly impacted everyone’s life. It is imperative to remember that we are all human and should treat one another with respect and equity, no matter your race, ethnicity, age, gender or economic position.

Reported & Written by Katarina Ho; Edited by Dr. Jacki Hart

Regina Adjusts to Life as Nurse, Mom, & Online Student

My Covid Story:

Regina, a 35-year-old nurse, works full time at a New York (NY) city hospital, has a two-and-a-half year old son, and is studying to become a nurse practitioner (NP). Like many of us, Regina’s busy, multilayered life was turned upside down by the COVID-19 pandemic sweeping through the United States (U.S.) Her classes became remote and she picked up additional shifts at the hospital, volunteering on the Covid Surge unit.

Adjusting to remote learning was more complicated than Regina anticipated. Her teachers expressed frustration about trying to convey lessons that “really cannot [be taught] through a computer screen.” The students, too, felt that “expectations were unrealistic,” Regina explained. To add to her stress, Regina’s husband was working half time from home as a physical therapist while she was studying in their small apartment. Hundreds of thousands of students have had to transition to online learning. This poses a specific challenge to a large number of students who lack access to WiFi. Many, too, must share workspaces with family members or don’t have computers with microphones or cameras. Regina feels lucky to have stable WiFi access and while going to school remotely has been difficult, Regina says that it’s not nearly the hardest part of the pandemic for her.

Daycare has been closed for her son; so, he has had to stay with his grandparents. Regina and her son have only been able to see one another on her days off. Even then, she had to get a weekly coronavirus test in advance and let her family know whether it was safe for her to visit. Each week this caused a sense of anxiety about whether she may have contracted the virus from her job, and she was constantly double checking the position and integrity of her personal protective equipment (PPE). “I didn’t want to bring home any of the awfulness,”

Regina only saw her son once or twice a week for 5 weeks.

Regina said; so, for five weeks, she only saw her son once or twice a week. Healthcare workers who have been working on the front lines during this pandemic not only risk getting sick themselves, they also often have to cope with being apart from their family and loved ones. Regina was grateful to have access to testing, which allowed her to see her son at least once a week.

PPE Shortage “Was a Debacle”

While being apart from her son has been super sad, adjusting to online learning very challenging, and risking viral contraction at her job nerve-racking, Regina found the nationwide shortage of PPE to be a particularly infuriating aspect of the COVID-19 pandemic.

It was a debacle. There were days when I would get to our unit and there were no isolation gowns

“It was a debacle. There were days when I would get to our unit and there were no isolation gowns,” Regina described. She felt incredulous that she would need to reuse isolation gowns from the previous night. She wondered how both the federal and state governments could allow this to happen to nurses and other frontline workers. At the start of the pandemic in the U.S., March of 2020, national stockpiles were recorded as roughly 12 million masks  — that represented less than 1% of what the Health and Human Services (HHS) agency predicted would be needed in the U.S. for the duration of the pandemic. The lack of supplies continued and on May 3rd Governor Andrew Cuomo of New York along with six other states entered into a consortium to bid for supplies collectively. While Regina felt fortunate that her hospital did not need to use trash bags for gowns like other hospitals around the country, she reported needing to use one N95 mask for an entire week. “We’re only supposed to wear [one N95 mask] per each patient; I was appalled, but at least I had a mask,” she exclaimed with some exacerbation. N95 masks are also only supposed to be worn up to 8-12 hours. Still, some nurses around the country have reported resorting to makeshift ways to try, without proof, to protect themselves from COVID-19 with items like bandanas without filters as masks and, as Regina noted, trash bags as gowns.

Creative Community Connections: Adopt a Nurse

Although living with Coronavirus has been a struggle, Regina has had some positivity within her community who support her. When she volunteered for the COVID-19 surge unit, there was a listserv she found asking if she wanted to be “adopted.” A nurse from Long Island named Kristen put together a Facebook page matching people who wanted to give back and support frontline workers with nurses in Manhattan. Regina thought “why not.” “Someone adopted me; they sent me masks, toys for my kid, and snacks. [My assigned partner] texted and I was so touched because someone actually wanted to help, not out of recognition, really just altruistically. That really lifted my spirits and made my year,” she said. All you need to do is complete a google doc questionnaire and then wait to be paired up.3 This program is a way for community members to show their support and express gratitude during this trying time. 

Regina continues her work full time at the hospital and is taking summer classes online. Thankfully, she has not fallen sick; we’re grateful that she has graciously shared her story.

Reported & Written by Katarina Ho; Edited by Dr. Jacki Hart

COVID-19 Found in Sewage Might Stop Spread & Save Money

As states and countries begin to reopen and people come in closer contact, public health officials worry about the potential for new COVID-19 outbreaks. Vigilance and infection monitoring can help identify new COVID-19 cases before they spread throughout communities. However, current testing measures have limitations that may preclude early detection and prevention. Many counties in the United States (U.S.), for example, lack testing sites. Similarly, the timing of viral testing can be too late to halt significant spread. Individuals usually get tested for the virus, using a nasopharyngeal swab, only after they have symptoms. Unfortunately, they may have been contagious for up to 3 days before feeling anything. With current testing procedures and timing, people can easily spread the virus to others and a surge in cases may already be underway. 

Rather than waiting for the presence of infection, which signals that others have been exposed to, and possibly contracted, the virus, scientists are exploring a more proactive way to monitor COVID-19 in communities: sewage testing. Researchers take samples of fecal matter (yes, poop!) from sewage treatment plants and measure coronavirus particles. These particles represent small genetic parts of the virus that can indicate whether people from within that sewage plant’s distribution are shedding virus before they develop symptoms. Not only does this have the potential to predict possible hot spots, it also offers convenience and the efficiency of wider spread testing. Fecal sampling (also called wastewater testing) allows experts to monitor viral levels across a large group of people without requiring in-person testing. Researchers quantify the particles detected to estimate how many people in the region may be carrying the coronavirus. This can allow for isolation of specific neighborhoods at high risk for outbreaks before they occur by testing the wastewater of areas upstream of the sewage plant.

Similar testing has been applied globally to test for poliovirus, hepatitis A, and norovirus to predict risk of each of these infections in a given region

Testing Ramp Up

COVID19 can infiltrate cells lining the gut, causing viral particles to shed in the feces up to one to two weeks before symptoms begin.

The idea of sewage testing may seem unpleasant. But, COVID19 can infiltrate cells lining the gut, causing viral particles to shed in the feces up to one to two weeks before symptoms begin. Feasibility simulations, run by Drs. Hart and Halden of Arizona State University, estimate that current methods of testing for COVID-19 particles in the sewage can detect infection of a single person in the fecal matter of between 100 and 2,000,000 people. In France, researchers looked back at fecal samples from the month surrounding the outbreak’s peak; fecal viral levels accurately predicted the rise in COVID-19 cases in Paris. In the U. S., many efforts like the collaboration between Clean Water Services and Oregon State University, the startup company BioBot, and several state-sponsored projects (including, California, Washington, Utah, and others), are already sampling in many cities across the country. Their data seems to accurately predict increases in cases in the affected towns. It’s now a matter of ramping up testing coverage and integrating the insights from the sewage with directed public guidance on protective measures to take. Great Britain and Wales are also exploring ways to apply sewage monitoring of COVID-19 more broadly to know how to interpret the information and prevent second waves of coronavirus infections in those countries. 

Early detection of potential COVID-19 cases from sewage testing will allow public health officials to take early action

 If experts know that a group of people have been infected but have not yet become symptomatic, they can target guidance on quarantine measures, procure increased swab testing, and direct medical personnel and resources (e.g. PPE and mechanical ventilators) to the impacted area. These steps might prevent large-scale infectious spread without disrupting the lives and routines of uninfected areas, protect healthcare providers, and make sure that adequate equipment is available to treat those who become sick. Moreover, according to Drs. Hart and Halden, each fecal test kit costs, on average, only $15. The lower cost and broader sampling measures compared to swab testing could extend the value to larger groups of people and save money.

Downside of Fecal Testing

Sewage testing has its limitations. Infections from homes whose septic systems don’t connect to public sewage plants would be missed. Additionally, transit time within sewage pipes and environmental factors, like hot temperatures, affect how quickly viral particles degrade. This means that the test might be less accurate in detecting infections from buildings farther from the sewage plant and/or during the summer. Also, a critical factor to understand is that sewage testing combines samples from many people all together. This method could not tell an individual person whether they should isolate or quarantine and could not replace traditional swab tests, especially for those who have symptoms. But sewage testing in combination with existing detection methods may provide additional data that can help policy stay ahead of potential outbreaks. It may have application for predicting resurgences and second waves or peaks; as such, communities might be able to shed light on whether measures to reopen are safe, including for schools and businesses. 

Much is still uncertain about how the reopening process will affect the course of coronavirus spread. It’s important to approach these new phases with caution and use social distancing measures wherever possible. But large-scale, careful monitoring of the sewage may help predict where additional precautions should be directed while allowing normal activity in disease-free zones. 

By Arpita Jajoo; Edited by Dr. Jacki Hart