Normalcy Bias and the Spread of the Novel Coronavirus
On message boards and social media, people across the U.S. often refer to Montana as the place they would want to be if a pandemic or other communicable disaster should effect the country.
But how prepared are we in Montana to address the burgeoning crisis of the novel coronavirus outbreak?
COVID 19 and the resulting respiratory disease, SARS-CoV-2, causes viral pneumonia and, in some, fatal organ and respiratory failure. While the mortality rate of this novel coronavirus is, at present estimation, about 2% or 3% in general, for individuals over 70 and 80 years old, this number increases to over 8%. Most concerning, however, is the the rate at which patients become critically ill and need hospitalization; about 20% of those infected will need access to an ICU facility in order to survive.
This high rate of criticality is what prompted China and now South Korea to construct massive new hospital facilities and bring in additional health care personnel to help with the overwhelming cases in addition to regular medical services. Other countries are simply overwhelmed. In Iran, for example, the death tolls are mounting as the country struggles to address the emergent care needed for its infected citizens.
Is Montana prepared to test all of our citizens so we can make wise public health assessments? Are we prepared for 20% of our population being sick and needing emergency care? Is anywhere in the U.S.?
The lessons from Wuhan, Japan, Italy, France, Germany, South Korea and dozens of other countries now seem worlds way and often may even seem irrelevant to Montanans - but this virus is extremely contagious and has already spread rapidly all over the world.
According to the European Centre for Disease Prevention and Control, the virus seems to be transmitted mainly via respiratory droplets that people sneeze, cough, or exhale. There have been cases of individuals becoming infected simply by standing in line together at the grocery or playing games with friends at home. This level of communicability means the United States needs to take steps to minimize the widespread outbreak in America immediately.
So far, the Federal government’s response has been slow and uncoordinated. While places like Singapore, South Korea and Italy test thousands of individuals per day and issue constant health reminders, warnings and updates, the U.S. tests count under 500 total since January 1, largely because the CDC issued rhetorical rather than clinical guidelines for necessary tests, testing kits were flawed and extensive wait times for test results caused confusion, to say nothing of a Federal leadership undermining the severity of the virus.
States such as Washington, Illinois and Rhode Island have now started using independent diagnostic tools to identify cases as the CDC either refused to test or was so slow in response time that waiting for direction or a result became unsafe for communities attempting to curtail the spread of the virus. Robust, efficient testing is essential to identifying and isolating cases in order to lessen the impact on the population and finite medical services.
Although the CDC is now expanding some testing methods, the new methods will require continuing wait times for FDA-approval for new tests. We have a facility in Montana that is studying the new virus extensively; we should also have a way to test for the virus in the state in under a day to mobilize healthcare units to take appropriate measures.
At present, public health departments across Montana have expressed preparedness levels of varying degrees and the State Department of Health and Human Services (DHHS) has made a few vague and non-specific announcements. While Nancy Messonnier of the National Institutes of Health recommends that citizens prepare for the worsening outbreak by contacting schools for at-home remote learning options, no guidelines on such measures have been addressed by anyone in Montana, much less the nation, beyond her remarks.
Out of five people being monitored in Bozeman last month for the virus, Montana only tested one presumed case of COVID 19 in the Bozeman area, a test conducted by the Centers for Disease Control (CDC) in Atlanta over the course of days. When the test came back negative, people in Montana seemed to collectively relax.
Now we know more about COVID 19. We know it has an extremely long incubation period where an individual can be spreading the disease. Most distressingly, we know now that many of the CDC tests are flawed, faulty and just plain wrong. According to ProPublica, a news division of the Wall Street Journal, “The lack of a reliable test prevented local officials from taking a crucial first step in coping with a possible outbreak — ‘surveillance testing’ of hundreds of people in possible hotspots.”
The CDC test of the Montana individual could also have been a false negative, something not uncommon with this virus. Reports from the BBC and Chinese media suggest that, “Some people test negative up to six times even though they are infected with the virus.
Coupled with the fact that the CDC severely limited testing to specific criteria about travel rather than symptoms or clinical diagnostics, the virus was already spreading via human-to-human in communities across the nation without detection and is now poised to effect people on the same scale as has been seen in over a dozen countries around the world.
We are Not Immune
Regardless of what the CDC is reporting, virtually all other sources outside America indicate the likelihood that the U.S. has widespread human-to-human transmission is high and/or growing.
Montana likely has a handful if not many more cases but due to limited diagnostics and stalled testing from the CDC, these case are unreported. This is no reason to panic but it is an impetus to start putting good procedure in place at medical centers for quick assessment and testing all presumptive patients with symptoms.
We need to alert the public to the risks and limit the spread of the virus now. In order to do this, we will need to first voluntarily adjust social behaviors and prepare for similar quarantines and lock-downs as other countries are currently experiencing.
The viral signature of the first deceased patient in Washington state matches the first known case in America, a 35-year-old man in Everett, Washington who was “cured” weeks ago. Some epidemiologists are saying that cured patients can still spread the disease or the individual in Washington state may have spread the disease before entering treatment, as the incubation and infectious period is prolonged in COVID-19 and can be up to a month before symptoms appear and manifest in a patient.
Many of these cases are mild, about 80% of cases according to collective reports, but much is still not known about the virus such as how exactly it is transmitted person-to-person, how long it stays on surfaces, what causes certain individuals to become infected and what courses of treatment are successful in the large number of critical care cases.
We do have the experience of the Chinese medical establishment in combatting this epidemic to study as a template and now South Korea, Japan, Italy, the Diamond Princess cruise ship and other outbreaks.
Overall, when the epidemic of critically ill persons with the virus appeared in Wuhan in late December 2019, many went to the hospital where they infected hospital patients. 41% of the first round of infected persons were existing hospital patients. When this first wave of individuals overwhelmed the medical services of the hospitals, the Chinese government responded by encouraging self-quarantine and building facilities to house infected persons. Medical professionals worked round-the-clock and some even died of exhaustion.
As the epidemic spread and more people in Wuhan contracted the virus and became critically ill, the leadership attempted to curtail the spread of the disease with forced quarantine and curfews, sometimes through military force. As was obvious from the reports from China, the only way they could get the epidemic under control and have the ability to save the lives of their critically-ill citizens was to bring in the military to close roads, weld people into their homes in quarantine and restrict all travel.
Although many in Montana followed the news of the expanding epidemic in China, then Japan, South Korea, on the Diamond Princess cruise ship, and now to Italy, Germany, France and beyond, few still think this disease will effect them. They are, quite frankly, very wrong.
One of the reasons we tune out what we don’t want to hear is a natural process, normalcy bias, which helps humans continue through tragedy or disaster by basically pretending that everything is “normal” even when it is not. But this is not the time to put our heads in the sand. We need to be prepared, individually and as a state and nation.
What Can We Do?
Panic-buying toilet paper and hand sanitizer will do little to curtail the spread of the virus. As a nation, a global community connected by air and sea travel and as individual states, we can create effective countermeasures to lessen the impact of the virus on our people.
In Montana, we can look back to 1918 and the lessons learned during the last pandemic, the Spanish Flu, which ravaged the world's population. We can look back to this time in history to see what effective measures were taken by the State in order to combat infection and spread. For decades, public health officials have studied responses to pandemics and potential outcomes to make good plans for our future.
Coincidentally, the DPHHS created a full-scale pandemic response exercise, “Oro y Plata Armis” to be run in early January 2020. Notes and procedure from this event indicate the primary goal being stabilizing patients and distributing a vaccine. In the case of COVID 19, there is no vaccine to distribute but there likely already are mounting, unknown cases and a direct probability that our healthcare services, especially in rural areas, will become strained.
Our first priority should be robust and efficient testing. As we have seen across the country, the CDC is not capable of issuing, handling and directing testing procedures in a timely and efficient manner. States such as Washington, Rhode Island and Illinois have developed secondary testing methods which can facilitate immediate quarantine and other safety measures until there is confirmation from the CDC.
For example, the first fatality from this disease in Washington state on Friday, Feb. 28, has still not been tested by the CDC and continues to be, under their guidelines, a presumptive case by the CDC standards (must have had travel or contact with someone infected or from Wuhan/China). When, in fact, the individual had an unknown point of contact but was positively identified to have the disease by an independent lab in Washington and extensive clinical diagnosis.
We cannot wait for the CDC to assess Montana cases. We need to be ahead of the nation in creating similar test criteria as other states have so we can identify, isolate and treat cases of SARS-CoV-2 without having to wait for approval from the Federal government.
The ability to develop independent test methods is paramount to keeping Montanans safe and healthy going forward and we should not delay this action and should begin at once screening for possible virus in individuals.
We all in Montana pay into our tax funds to assure public health and safety and if there were ever a time to allot emergency funds, now, before the crisis across the country explodes, is the time to prepare.
What Can You Do?
Montanans are individualists and most of us are prepared to ride out a winter storm, drought or flood in any season. Protecting ourselves from the exponential spread of COVID 19 is not much more difficult.
We must change our social behaviors, even if only for a short time, in order to prevent unchecked spread of this virus. The need to increase hand-washing and decrease touching others is imperative to stopping the spread of the virus.
Especially for people who are elderly or in poor health with pre-existing conditions, this disease can be fatal. If washing our hands more frequently can help save the lives of our older generations in our communities, we must have the care for our fellow citizens to do so. We must also have the care for our medical professionals who will soon find themselves overwhelmed with critical cases across the nation.
Touching our face, hugging, kissing, shaking hands, these actions are so simple and what we are used to doing with one another. If, for just for a short while, we can work to avoid doing these things and increase our personal hygiene, we can have a real hope of stopping the spread of the virus.
If we are sick, we should isolate at home and employers around the state should be encouraged to allow for time off or telecommuting. Again, this will only be for a short time but it can help stem the coming epidemic of cases which will overwhelm medical systems in our state as is happening in countries around the world.
Our normalcy bias must be short-circuited. We are facing a serious, growing epidemic crisis and preparing with small, simple steps will give us strength to combat this virus.
Our plan for Montana should be underway already and should be issued from the highest offices to be executed by local and regional offices:
1. Creation or facilitation of independent testing criteria immediately along with robust screening for possible cases.
2. Creation of a predetermined plan of action for decreasing spread and quarantining possible contacts taking specific known characteristics of COVID 19 spread and infection into account.
3. State of Montana officials should be sharing accurate information daily, including information about neighboring states and the border with Canada.
4. The State should continually push the message of good hygiene online, in schools, public offices and through statewide alert systems.
5. Montana should provide clear instructions about who is at risk and what they and their caregivers can do to reduce mortality. For those already sick, the Public Health offices in communities across the state should have resources about home care and when and how to contact a medical professional to avoid further spread.
6. Each department should be mandated to have a protocol and a person responsible for the public to contact regarding questions about the virus, from Public Schools to Dept. of Ag., Dept. of Commerce, etc.
Included in this article is a poster from Washington state which outlines basic protective measures everyday citizens can take to limit the spread of the virus.
As may be noted, I have not linked to the American CDC in this article as often their information has been wrong, outdated and anything but informative for the American people. Wanting our economy to be robust and grow exponentially is a solid goal but, in my opinion, public health should come first and, from mis-identifying the first death of a U.S. citizen to stalling on testing procedure in order to limit reports of known cases in the country, to censoring information about patients from the medical establishment, I think current guidance from the CDC is not in keeping with the best interests of the American people.
As this is a world-wide epidemic, hundreds of sources, including sources from states within the U.S., are providing much more comprehensive information than the CDC at this time. Hopefully, as the epidemic grows, the CDC will be unable to stifle cases and will need to address public health over economics.
I still travel the state, my child continues to attend school and my husband continues his work at a public university. We are among the million Montanans putting trust in our public health system to protect our best interests. And, while I wish everything could be as normal as it was just a few months ago, the reality is that it is not. Millions of people are quarantined around the world, thousands are dying and very ill. Medical professionals around the world are succumbing under the strain of this novel virus. We need to get prepared now, without hesitation or waiting for the virus to come to us.
We need leadership right now, in advance of this rapidly-spreading virus, to make solid plans, implement independent testing and diagnosis and share basic public safety information. I hope our leadership in Montana is up to the task.
Reilly Neill is the Publisher and Editor of the Montana Press Monthly, a former Montana State House Representative and a former Candidate for Montana Governor. For further sourcing or any questions, please contact her directly at firstname.lastname@example.org.
Further sources: The European Centre for Disease Prevention and Control (ECDC) is an independent agency of the European Union (EU) whose mission is to strengthen Europe's defenses against infectious diseases. The Centre was established in 2004 and is located in Solna, Sweden. Also, on this website you can find information and guidance from the World Health Organization (WHO) regarding the current outbreak of coronavirus disease (COVID-19) that was first reported from Wuhan, China, on 31 December 2019. The WHO page provides daily updates.