(Author’s Note: This article was published on April 22, 2020. Because of the rapidly evolving nature of this situation, these values and recommendations may have changed.)
It wasn’t long ago that many of us were wrapping up our holiday celebrations and making “new decade, new me” jokes with our friends. A brand-new year always feels like a fresh start, a new foundation upon which to do things differently. Now, four months in, things are certainly different...but not in the ways we expected.
As someone who has worked in public health research, healthcare management, and health education, these last few weeks in particular have felt both fascinating and brutally eerie.
On March 11, the World Health Organization announced that COVID-19, the illness caused by the novel coronavirus (SARS-CoV-2), had become a global pandemic.
By now, most of us know that the novel coronavirus is a highly contagious respiratory virus that is brand-new in the human population. We also know that this disease—the most common visible symptoms of which include a dry cough, fever, and fatigue (and recently, we’ve discovered, potentially gastrointestinal issues)—is rapidly spreading.
On March 23, the director of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, said: “It took 67 days from the first reported case to reach 100,000 cases, 11 days for the second 100,000 cases, and just four days for the third 100,000 cases.” In the first days of April, we reached 1,000,000 confirmed cases globally.
As of April 7, the United States has over one-fourth of the world’s total confirmed cases and the worst outbreak of any country.
The total number of confirmed cases are jumping daily, with various hot spots around the globe whose national rates are accelerating more rapidly than others. Some of the rapid increase is due to actual viral spread, and some of it is the result of increased testing capabilities. It’s also likely that these figures are an underestimate. It’s possible that respiratory illnesses which occurred before testing became available, and thus may have been misdiagnosed, will not be included in the initial round of diagnostic data. Some researchers, however, are working to develop tests that can detect prior infection from the virus.
While it is believed that more than 80 percent of cases are mild, the remainder have the potential to progress to more severe conditions like pneumonia or acute respiratory distress, which often require intensive clinical intervention. And although it is only a small overall percentage of people who require hospitalization, the scale of infection rates makes that “small percentage” an extraordinarily high number.
The necessary intensive care beds, ventilators, and personal protective equipment for medical staff expected to be required for such a caseload are simply not there in most cities and countries—even those with the most advanced healthcare systems. As the epicenter of the disease has shifted from Wuhan, China, to the northern region of Italy, to other European countries such as Spain and France, and now the United States, we already see hospitals reaching capacity, medical professionals overwhelmed, and critical supplies severely limited.
All infectious diseases have an “R0” (pronounced r-naught) value, or basic reproduction ratio, which estimates how quickly the disease spreads within an average population. An R0 value less than 1 indicates that disease transmission is decreasing within a population. An R0 value of 1 indicates that the disease is spreading but at a predictable, stable rate. An R0 higher than 2 indicates exponential growth. While researchers are still trying to figure out a range for the R0 of the novel coronavirus, the most recent data analysis estimates that it is between 2 and 3.5. This means that one person with the novel coronavirus is likely to spread it to, at minimum, two other people. The R0 value isn’t a fixed number and it can be strongly affected by the behavior within a community.
Many experts believe that containment of the virus is no longer possible because such a large percentage of people who contract the disease do not show identifiable symptoms, while still being contagious. Instead, we must turn to mitigation strategies that have been successful in other countries and against other infectious disease pandemics in the past. Personal health practices, such as utilizing proper hand-washing techniques and thoroughly sanitizing communal surfaces and areas, are a critical public health component of disrupting disease transmission within a population, and they can help reduce the R0 value of an infectious agent.
Community-wide behaviors are also critical in decreasing spread.
Social distancing is one measure that can have a major protective impact on a community. Most government officials are now urging people to avoid recreational venues, restaurants, bars, and other areas where groups might gather. However, this recommendation seems to have been widely misunderstood: On social media, we can see that people have still been hanging out in groups at home and heading to public parks and crowded beaches with friends; parents have organized regular playdates for their children; and kids are hanging out together in their neighborhoods.
The idea behind social distancing is to disrupt the chain of infection as early as possible by eliminating new links between people. This allows us to “flatten the curve,” which means that instead of a sharp spike in new infections, the infection rate slows down. It may not reduce the total number of cases over a long period of time, but when implemented properly, it can reduce the number of cases that occur over a short period of time. This gives hospitals a better chance of providing help to all those who need it.
Given the nature of exponential growth, we could otherwise be in for a rough ride. Let’s think about it this way: I invite two friends over to my house for a “girls’ yoga night.” We’ve now created a network of three people who are linked. Now imagine one person from the girls’ night goes home to her family of four. Her whole family is now in our network of people who are linked. Now imagine that she invites two neighborhood kids to play with her kids the next day. Of course, these kids return to their own families after the playdate. Both children and all of their family members have now joined our group.
Now imagine that my other friend from the girls’ night also has a similar experience: She returns to her household of multiple people and then invites one or two new people into her home the next day. How huge the network of linked people has become! Even though we weren’t in a crowded bar or restaurant, we still have connected an enormous number of people over the course of just 24 hours. We began with a total of three people, reaching well into the double digits in a very short time frame.
If I, as the original host, had the coronavirus and showed no symptoms (or only very mild ones), I probably infected both of my friends! Based on current R0 estimates, each of them is likely to spread it to a couple of people, and then each of those people is likely to spread it to a couple of other people.
If just one of those friends had said no to the girls’ night, her entire chain of transmission would have been immediately eliminated from the network. (If that led to the cancelling of the girls’ night, even better! Then I would have kept my germs to myself and both potential chains of transmission would have been prevented.)
All of this is why social distancing is such a powerful way to stop exponential spread of the novel coronavirus—especially because the virus can spread from asymptomatic hosts for up to a period of 14 days, and experts now think (but have not yet confirmed) that anywhere from 25 percent to 50 percent of carriers may not show any symptoms.
At this point, we should all simply act as if we have the virus and are trying to stop the spread to others. Besides, just because I may not experience any symptoms doesn’t mean the people I spread it to won’t have a markedly different experience. While the virus may not affect some of us personally, our communities are an interconnected system. Our actions impact those around us—including vulnerable populations who could rapidly progress to a critical state of health, and the healthcare workers charged with taking care of them.
Yes, social distancing has been detrimental to many of our livelihoods, and the economic impact cannot be discounted. I worry about the health outcomes associated with poverty and other socioeconomic burdens. But the earlier we can successfully and comprehensively implement social distancing to decrease the R0value of the novel coronavirus, the shorter the period of isolation that will be required; the more lives we will save; and the more control we'll have over measures that can potentially help to mitigate the disruption to the economy.
As described in the girls’ night scenario, removing one link in the chain of transmission made a significant impact on the total number of people exposed. The longer we wait to reduce transmission, the more likely it is that we will be mandated to stay at home even longer, thanks to skyrocketing rates of infection and a collapse in the healthcare system. These will pose a far greater long-term threat to people’s ability to work—not to mention that if the healthcare system collapses, we lose our frontline defense to the novel coronavirus (as well as care for other health issues).
What can we do in the meantime?
If you are a yoga teacher and wondering what you can do right now, consider what unique services you can offer that will add value. During a time of high uncertainty such as this one, your services and the ability to foster support and community are surely needed more than ever. Yoga International is offering an online portal for you to use to connect with your students virtually over the next several weeks. Google Classrooms and Zoom are other remote, affordable options that allow you to serve from a distance.
And if the crisis has you struggling financially, remember that communication is vital. Communicate with your landlord, your mortgage company, any lenders you deal with on a regular basis. Many creditors are currently offering grace periods on payments, but not publicly advertising this. Keep up with federal and state policies that have been enacted to provide help for individuals, small businesses (these options may also be supplemented further by your individual state) and student loan relief.
In most communities around the United States, dialing 211 can connect you with personal financial relief resources in your area.
This will pass. Stay present, and look toward the future.
Finally, do not forget to take care of yourself. If you are a yoga teacher, or anyone in a service or care-giving profession right now—healthcare, social services, counseling, newly homeschooling parents, and let’s certainly not forget our grocery store employees!—you are probably someone people look to for comfort at stressful times. However, this situation is unprecedented and monumental for all of us. This is a historic time. Nobody has all the answers, so don’t put pressure on yourself to have the answers, either. Check in with yourself regularly and see what your personal worries may be. Reach out to colleagues, friends, and family, and allow yourself to ask for what you need.
And do spend time alone outside and in nature, especially now that spring has sprung! Social distancing is not the same as quarantine—going outside, at a healthy distance (six feet or more) from other people and avoiding communal surfaces, is encouraged and can support your mental and physical health. In locations that are under “lockdown” or “mandatory shelter-in-place” directives right now, spending time outside for exercise is one of the few things you can do. Just don’t congregate at public recreation areas.
It’s also okay to do nothing for a while as your spirit adjusts to a new routine. Things can feel somber and weird at times. Take breaks from the headlines to focus on all of the things that are going well around you. Maybe you’ve had more time with your family. Maybe you’ve been able to check in with friends you normally don’t talk to. Maybe you’ve had a moment to pause and catch your own breath. Maybe you’re able to support your community now in some unique way. These are ways we can adapt to disruption and build our own resilience.
Additional Resources: If you find yourself interested in the scientific and policy aspects of COVID-19, Johns Hopkins University is offering a free two-week course that explains COVID-19 public health recommendations. Beginner-friendly!