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COVID-19 Public Health Update

by Catherine Colquitt, MD

In December 2019, the world learned of a new Coronavirus called SARS-COV-2, causing the disease COVID-19 in which patients were experiencing respiratory illness and death in Wuhan City, Hubei Province, China.  

Since then, we have been deluged with information about the virus, its epidemiology and transmission, its target populations, and its effects on new human hosts. COVID-19 has captured the attention of most of the world.    

We have learned much in the last few months. The viral genome has been sequenced, permitting development of diagnostic tests and paving the way for development of vaccines and antiviral therapies. Several excellent sources of curated scientific data regarding
COVID-19 became indispensable in our understanding of the rapidly changing guidance regarding how best to respond to challenges posed by the new virus.  

These sources include the Johns Hopkins COVID-19 website, which updates worldwide data on cases and deaths in real time; the World Health Organization (WHO) COVID-19 website, which updates daily and has been prolific in issuing and amending guidance on measures designed to blunt the impact of COVID-19 worldwide; and the Centers for Disease Control (CDC) COVID-19 website, which was for several weeks the only outlet for testing in the U.S., and whose guidance is crafted with U.S. healthcare workers, other affected workers, and the broader public in mind.  

As of April 27, 2020, per the Johns Hopkins COVID-19 site, there were more than 3,000,000 confirmed cases globally, and 208,131 COVID-19 deaths worldwide, with more than 993,103 confirmed U.S. COVID-19 cases and 55,729 COVID-19 U.S. deaths. For reference, on March 25, 2020, Johns Hopkins reported 54,000 U.S. COVID-19 cases and 787 U.S. COVID-19 deaths.    

With no proven effective treatments or vaccines yet available to curb
COVID-19’s worldwide impact, controlling the virus remains focused on time-tested communicable disease control measures. These include social distancing, hand hygiene, respiratory etiquette, staying home if ill, cancellation of mass gatherings, school closures, and the shuttering of nonessential services and retail establishments.  

Against this background, healthcare providers and patients struggle to keep up with voluminous and changing guidance and filter out the cacophony of misinformation which has dominated some corners of the internet and other outlets.  

Testing has been difficult in many places, including the U.S., due to a shortage of test kits (swabs and viral transport media) and reagents required for testing. In the U.S., only the CDC’s Atlanta laboratory could test initially, and results could take several business days. Eventually state labs were authorized to test and the Tarrant County Public Health North Texas Regional Laboratory (a Laboratory Response Network facility) began conducting tests using a two-target real-time polymerase chain reaction assay developed at the CDC. Commercial laboratories are now online with testing as well, facilitated by FDA emergency use authorizations to address scarcity of testing capacity.  

 With schools and many businesses closed, our lives have been altered, and we all know people stressed by the measures implemented to curb the spread of COVID-19 in Tarrant County. Frustration and fear of COVID-19 have been felt throughout our country and across the world. 

We have also watched the devastating effects of COVID-19 on populations and healthcare infrastructure in Washington, California, New York, and elsewhere. Tarrant County Public Health and its partners are assisting with the
COVID-19 response, investigating cases and contacts, in hospitals, long-term care facilities, correctional institutions, and other settings. (COVID-19 is especially threatening to the elderly, and persons with diabetes, heart disease, underlying pulmonary conditions, and immunosuppression).  

Tarrant County Public Health and our neighbors have confirmed community spread of COVID-19 in persons with none of the previously identified COVID-19 risk factors, including travel to endemic areas or contact with a known case.  Tarrant County has recorded 53 COVID-19 deaths so far.  On March 25, 2020, that number was two.  

Many facets of COVID-19 responses have been frustrating, and guidance has changed frequently and materially at times throughout our short history with this virus, but reliable sources of information continue to be the CDC, Johns Hopkins, and the WHO.  

The CDC’s Coronavirus 2019 Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings is a highly readable document which emphasizes three key messages: 

  1. Decreasing traffic throughout healthcare facilities;
  1. Isolating symptomatic patients as soon as they are flagged through screening procedures;
  1. Protecting healthcare workers and other frontline workers by limiting staff caring for COVID-19 patients; prioritizing respirator masks and airborne infection isolation rooms, or negative pressure rooms where possible.

Most of us are old enough to remember at least one recent outbreak, but COVID-19 will be noteworthy in our history for the scale of its disruption of our lives and work, and for the lessons we learned about how to better prepare for the next such crisis.  

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