The Public i asked Professor Weissman, in light of his involvement with helping doctors with statistics, for his thoughts on the local response to COVID-19 and any lessons learned from it for the future.
First, I think it’s more important to start with the big lessons for right now.
The spread of the virus depends on both the policies of institutions (the state, the University, the county, and, God help us, the US government) and the choices of individuals. Right now, many of us are exhausted with distancing measures and even with masks, so many are starting to revert to comfortable old habits. This is a terrible idea for two reasons:
- The virus is still very much in circulation, including locally. As of October 8, there are 332 identified active cases in Champaign County. Although on-campus cases are pretty well identified thanks to the massive testing, many off-campus ones are sure to be missed. As a ballpark figure, there are likely to be approximately 1,000 infected people around now. The ones not isolating themselves are precisely the people you’re most likely to run into as you circulate in public, since they probably got it while circulating themselves.
- Help is on the way over the next few months, if we can just hold out. Already thanks to more prompt care—proning, blood thinners, remdesivir, and dexamethasone—the age-adjusted chance of dying or having severe effects if you’re infected appears to be down substantially from what it was a few months ago. Even setting aside the question of when some of the many vaccines under trial will become available, there are a host of very promising new therapies coming. These include monoclonal antibodies, llama-based nanobodies (seriously!), nebulized interferon, new anti-virals (such as EIDD-2801), etc.
In other words, it’s always bad to get sick and now is a worse time than a few months from now. So just hang in and wear the damn masks.
OK, now for the requested retrospective. Overall, the Champaign County Public Health Department has been active and serious in making testing easily available and following up positives to reduce spread. Despite setbacks at a horrendous meat-packing plant and some reckless suburban partying, the infection rate has been kept fairly low. Of the 200,000 county residents, 27 have died.
Meanwhile, universities have been under intense financial pressure to bring students back to campus. Some have done it very irresponsibly (for example, the University of Michigan), with almost no precautions. They test so little that we don’t know how many cases they have. Others (like Harvard) have had few undergrads return or have cracked down hard on social contacts at the first sign of trouble (as did MIT). UIUC stands out for an unusual combination of having most students return but trying to limit the infections by means of a rigorous program of twice-weekly testing followed by isolation for the infected and quarantine for the exposed. The testing was made possible by an efficient, convenient, locally developed saliva test. The testing protocol was adjusted based on mathematical modeling, which showed that once-weekly tests or ones with slowly returned results would not work.
How did that go? Not great. The number of students who showed up initially infected was higher than anticipated. By itself, that’s not a terrible problem, since they might spread COVID less here than they would have back where they got it. The next stage was, however, a big problem. The number of new positive cases shot up after the initial round, meaning that each student was infecting several others. That prompted a look back at the model, which turned out to have omitted the possibility that students would continue to circulate despite having gotten a positive test result. The testing pipeline also got clogged, so that exactly the problem that had been anticipated, returning positive results too late to stop further infections, cropped up.
The University’s response was to suspend a few of the worst offenders and ban most socializing for two weeks. That did a pretty good job of knocking down the infection rate, but it seems still to be running about 20 per day. There have been over 2000 new cases on campus, and it looks like the total for the semester will run over 3000. At this point, no one knows what the long-term consequences of this new disease will be for those thousands of mostly young people.
So, see above about taking precautions!
There’s another side to the University’s response that may not have shown up much yet in the numbers but will have a big human cost. Campus workers have had little chance to avoid exposure to these large numbers of infected students. These workers are typically much more vulnerable to severe consequences (for example, due to age) than are the students. They receive no hazard pay. The next few weeks will indicate whether this will be a major new source of spread into the community. Right now, campus workers need to get better protection and pay.
What could be changed soon or done better the next time? (There will be a next time.) There are some technical fixes that might help some, including easy daily home lower-sensitivity antibody tests to quickly identify contagious cases. Faster PCR test results could also be gotten by batch testing. On policy, the University did not have to bait by advertising a very soft policy, saying they wouldn’t be checking bars, and then switch to crackdowns when that inevitably didn’t work. Campus workers and students need to be in on the modeling and planning from the start, both because they directly suffer the consequences of a bad plan and because they actually know something about how things work around here. Unions rather than administrators should pick the workers’ representatives to avoid an echo chamber.
The big changes needed are at the national and international level. The Trump administration, with its depraved indifference to human life, must be replaced, at least by some ordinary government, like say those of Canada or Germany. Otherwise, most people will have no tests when they need them and will be drowned in lies about what protective measures and treatments work. Even the relatively benign players have not been consistently honest with people in this, such as with the Centers for Disease Control’s initial claims that masks were worthless.
Locally, UIUC’s response has not turned out to be a great example. It has the usual problems of top-down command in a very unequal society; but the idea of trying to decide what to do based on a real estimate of the consequences shouldn’t be abandoned. As for our local health department, the bottom line is that our county’s death rate is roughly one fifth of the national rate, so they’ve done a creditable job. But the job isn’t over.
Michael B. Weissman is a retired physics professor who has intermittently been active in politics. He did time for Vietnam draft resistance and initiated the scientific boycott of President Reagan’s Star Wars program.