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How Will We Know When to End Social Distancing?

By Dr. Joe Jarvis

By now, most Utahns are staying at home in response to the novel coronavirus. So it’s reasonable to ask how we’ll know when to relax our social isolation. Utah’s state epidemiologist, Dr. Angela Dunn, was recently asked that exact question. She said that it’s too early to project when that time will come, but that certainly the rate of new infections must subside considerably first.

 Experts nationwide have been giving this question serious thought. WHO Director-General Tedros Adhanom Ghebreyesus said during a recent briefing that lockdown measures are meant to enable the use of the more precise public health practices that will be needed to stop transmission after social isolation is discontinued. What are these public health practices, and is Utah ready to deploy them?

Sharon Begley, writing for  Stat, stated:

“The approach getting the most support is one that experts have long doubted could work with a respiratory virus: aggressive case finding, contact tracing, community surveillance, isolation of cases, and quarantining of contacts.” 

Here’s what that would mean in Utah: after the number of new cases has fallen to zero and remained at zero for two weeks, (and assuming Utah could impose restrictions on travel into the state from areas with continued coronavirus transmission) we could implement widespread targeted testing. For each new case we found, we’d follow up with everyone that infected person has been in contact with, and test them. These procedures would be backed up by quarantine when required.

Begley goes on to say:

An analysis of how China, Hong Kong, South Korea, and Singapore controlled the coronavirus outbreak concluded that the strategy with the greatest impact was rapid testing, contact tracing, and quarantining cases and those they might have infected, for two weeks.

blog-feed_joe-jarvis-on-social-distancing.jpgTo be clear: Utah does not currently have the testing capacity or the personnel to carry out this targeted strategy. However, since we are still in a phase of the pandemic when case counts are rising, we are weeks away from the point where that process will work again. If Utah’s leadership uses these coming weeks appropriately, our State can stockpile supplies for testing and personal protective wear, like gloves, gowns, and masks. We can also use this time to retrain public health personnel—perhaps some of those who’ve just had their pay cut by Intermountain can get back their hours this way. Word from the Utah Department of Health has it that state employees have been asked to volunteer for this post-isolation case contacting work, and over 1200 people have offered to help.

It’s not 100 percent certain that these public health procedures will be enough keep coronavirus from spreading while we research and develop a vaccine. We may need to return to social isolation for periods of time to prevent fresh overloads of hospitals. But targeted testing and contact tracing does offer the possibility of returning to a semblance of normalcy for some, if not all, of the time before the vaccine becomes available.

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