While the known Covid-19 infection rate continued to climb this week in the US, efforts to limit further spread are beginning to affect daily life for many Americans. Dr John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at the UC Berkeley School of Public Health, praises the steps government and private companies have taken to limit public gatherings. But he cautioned against letting collective concern turn to toxic fear: “That’s not productive for yourself or for keeping you safe.”
The conversation has been edited for length and clarity.
We’re starting to see a real shift in public life across the US, with the cancellation and in some cases government banning of large public gatherings and events. How effective are those kinds of measures in limiting the spread of infections?
I was publicly vocal that sporting events should shut down weeks ago. I thought it was just irresponsible of [the Bay Area sports teams] the San Jose Sharks and the Golden State Warriors to hold public games with fans. So I think all the advice and now dicta to not have these gatherings is a wise thing to do in the face of a pandemic.
There’s no better way to infect more people rapidly than to take human beings and put them in a confined space for a prolonged period of time. And that’s exactly what gatherings do, bringing people from disparate parts of a community together, crowding them together and leaving them there for a prolonged period of time. Think for a moment that you’re the virus instead of a human, and your role in life is to produce more viral particles. It’s ideal from a virus’s perspective in terms of transmission.
What are some of the most persistent public misconceptions about Covid-19?
I’ve heard some say: look at influenza, that’s already killed between 20 and 30,000 Americans this year, so what’s the big deal about Covid-19? I think that’s a major mis-framing of the situation. There’s no question that influenza is a horrible disease that kills a lot of people every year. On the other hand, we’ve got an infectious agent facing us that we think is around 20 times more contagious than influenza, and carries a mortality rate that is probably 20 to 40 times greater than influenza, and it’s increasing in some parts of the world almost 33% a day over the past two weeks. Where we are now with Covid-19 and where we could be in a few weeks to a few months, we don’t know, but it could be disastrous.
Other places experiencing coronavirus outbreaks have been successful in slowing transmission. What are they doing right that the US isn’t doing?
Everybody’s still struggling with knowing what was effective and what was not effective in China. China has not only blunted the curve, but we’re seeing the number of cases declining. I suspect it was related to the draconian measures of not letting people travel outside of that region. They walled off the Hubei province, as many as 56 million people. It’s hard to imagine something like that here in the US, but if things get worse, we might see that. We need to understand what worked and what didn’t work so we can learn from that and apply those things here. But China is a very different society from ours in terms of how it’s governed.
We may also be seeing a decline in cases in South Korea. They’ve done an enormous amount of testing, so they know where to apply their public health resources.
What are the most challenging unknowns about this coronavirus?
One of the biggest is that we don’t know how many people are infected. We don’t know how many people are currently infected, we don’t know how many people were infected and then got over it, we don’t know how many people were infected and never got sick. Without knowing the denominator, we don’t know what the case fatality rate is. We don’t know any of that because the testing in the US has been woefully inadequate. And that’s been a real black eye for the Food and Drug Administration, the Centers for Disease Control and the national government. It should never have happened in this country.
Without knowing how big a problem this is and where the problem is, how can we make rational public health decisions? It means we have to make blanket decisions for wide swaths of the country when that may not be necessary. We’ve gone from containment to mitigation now, but there may be parts of the country where we should still be putting effort and money into containment.
All of these things are knowable, but they’re unknown now because we’ve completely bungled the testing that we should be doing. Just completely. I’m shocked to be saying this. With more testing, we’d know how to marshal our resources and how best to apply them.
You’ve called for maintaining calm and perspective. In early February, you said this wasn’t something to panic about in the US.
Well, that was a few weeks ago.
Many more people in the US are far more concerned than they were about a month ago. Just how worried should we be now?
People have a difficult time understanding risk. This is not in any way to diminish the impact of this pandemic – we have to do everything we can to stop it or at least blunt it. But we take risks every day that don’t even reach our consciousness, like getting into a car. Let’s do what we can do to prevent getting infected and go on with our lives.
I can speak from the perspective of a physician and a public health professor and I can tell you what is optimal to prevent people from not getting infected. But we have to have a society that functions – if we have a society where everybody is hunkered down and nobody’s making sure the water we drink is safe, or that there’s an adequate food supply, all the public health measures in the world are not going to be of value. These are all things that need to be balanced.
We should be very concerned, and we should act accordingly in a rational way. Fear and anxiety are not productive for yourself or for keeping you safe. We have to find that balance. Don’t drift into fear and anxiety, because that’s destructive to us as individuals and as a community.
So I’m very worried.