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By Dr. Darrell Dantzler, faculty member, Emergency and Disaster Management at American Military University
On February 1, when the U.S. only had one case of coronavirus and zero deaths, I authored an article addressing coronavirus preparedness and mitigation, which included information about social-distancing strategies.
Nearly six months later, the U.S. has experienced more than 4.6 million COVID-19 cases and 155,000 deaths (check that latest statistics). Following a total shutdown of businesses, schools, and government agencies in many states, some states have recently started a phased, or in some cases, a total reopening strategy.
However, many of these reopening efforts have led to skyrocketing infection rates, and 22 states have paused or rolled back reopening efforts. The inability to control the spread of coronavirus is due, in part, to the lack of a comprehensive and multi-layered reopening strategy.
Relying on Temperature Checks Creates a False Sense of Security
During my review of mass gathering and business reopening protocols, I found that many organizations are relying on temperature checks as the sole strategy to prevent or mitigate the virus spread. Taking the temperature of individuals entering a business or large-gathering event to identify those who have a fever should only be one component of an organization’s strategy.
In my opinion, temperature scanning as a sole prevention strategy creates the “levee effect.” The levee effect refers to a mindset where individuals, businesses, or other entities develop a false sense of security based on a mitigation strategy.
A reopening strategy solely based on mandatory temperature checks fosters a false sense of security. This is why other methods of COVID-19 detection are needed to effectively identify people who may be infected with coronavirus and prevent its spread.
Necessary Components of a Comprehensive Strategy to Detect and Prevent the Spread of COVID-19
Developing a comprehensive reopening plan to help mitigate the spread of the virus requires a multi-layer approach that includes a temperature-scanning protocol and various types of testing. This approach should also have awareness campaigns about how the virus spreads, enforcing the use of face coverings, frequent handwashing, and other protective measures.
Temperature Checks Don’t Identify Asymptomatic or Pre-Symptomatic People
Temperature checks administered correctly with a reliable thermometer are a valuable part of an overall strategy to protect the population from spreading or contracting the coronavirus. For example, temperature checks may flag potentially sick employees who have a fever and may be infected with coronavirus.
However, temperature checking will not detect all COVID-related fevers. Temperature checks cannot identify people with the coronavirus who have no fever or have taken fever-lowering medications like acetaminophen or ibuprofen.
More importantly, individuals may be asymptomatic or pre-symptomatic. Asymptomatic and pre-symptomatic spread of the virus is known as the silent spread or the silent transmission, because both types of carriers look and feel normal.
Studies Show Silent Transmission of COVID-19 Is a Reality
Several studies have found the silent transmission of COVID-19 is a stark reality. In studying 712 personnel abroad Diamond Princess cruise ship, the CDC maintained that nearly half of the population that tested positive were asymptomatic or pre-symptomatic. Additionally, a study in Iceland showed 50% of those who tested positive had no symptoms at the time of testing.
Asymptomatic personnel have COVID-19, but do not have symptoms and will never get symptoms from their infection. However, they can infect others. Pre-symptomatic personnel with COVID-19 don’t look or feel sick, but will eventually develop symptoms and can infect others without knowing it.
Research from the Harvard Medical School indicates coronavirus symptoms typically appear within four or five days after exposure, but virus carriers may be contagious as early as 48 to 72 hours before they experience symptoms. Emerging research consistently suggest that people are most likely to spread the virus during the 48 hours before they start to experience symptoms.
Additionally, the CDC estimates 40% of coronavirus transmission happens before people feel sick. In a study published in Science, about four in five people with confirmed coronavirus in China were infected by silent transmission, which explains the rapid geographic spread and containment challenges.
Although there have been several studies confirming silent transmission of COVID-19, the long-term facts about the virus are still emerging and there is still a lot to learn. It is evident that silent transmission is a reality, but the bigger questions are how contagious are silent carriers and what is the rate of transmission?
Organizations working to reopen their facilities must understand that temperature scanning will not flag a contagious silent carrier of COVID-19. The best method to determine a positive COVID-19 case is through testing.
COVID-19 Tests Are Critical to Identifying Infected People
A rigorous test, re-test program is the most effective way to confirm current COVID-19 status as part of a reopening strategy. This strategy has proven effective in the political arena, as well as professional sports including NASCAR, National League Baseball, the NBA, boxing, MLS and MMA fighting.
Two types of tests are available for COVID-19: viral tests and antibody tests. Recently, an asymptomatic test has been approved by the FDA.
A viral test identifies people who are currently infected. Viral tests check samples from the respiratory system, such as a swab from the inside of the nose, to see if a person is currently infected with SARS-CoV-2, the virus that causes COVID-19.
Results may be obtained on-site in less than an hour, while other viral tests must be sent to a laboratory for analysis, a process that can take a few days. It’s important to note that if a person tests negative for COVID-19, that only means the person was not infected at the time the sample was collected.
That person could have been exposed to COVID-19 after the test, become infected, and is potentially spreading the virus to others. This scenario is why the test, re-test strategy is so important.
An antibody test indicates whether a person has had a past infection. Antibody tests check a person’s blood by looking for antibodies, which are proteins that help fight off infections.
The presence of antibodies indicates that the person was once infected with the virus. Having antibodies might also provide protection, or immunity, from infection from the virus again.
However, scientists do not know how much protection the antibodies might provide or how long this protection might last. Therefore, people receiving a positive antibody test should continue to protect themselves.
It’s important to note that individuals may test positive for antibodies even if they never experienced COVID-19 symptoms, which indicates an asymptomatic infection. Also, an antibody test might not show if a person is currently infected, because it can take one to three weeks after infection for antibodies to be present.
As of July 24, the FDA authorized the first diagnostic test for asymptomatic people. This type of test can be for anyone, even those without COVID-19 symptoms or other exposure risk factors. This test is a step toward the type of broad screening that may help enable the reopening of schools and workplaces.
The FDA recognizes that organizations want to conduct screening of asymptomatic people as part of a broader strategy to help ensure the safety of their employees, patients, students, and other people. Last month, the FDA posted updated templates with recommendations for test developers to demonstrate validation for a test that screens asymptomatic people.
Testing Pooled Samples
The FDA has also authorized the first COVID-19 test that uses pooled samples. Sample pooling tests multiple people – in this case four individuals – to be tested together.
The samples collected from these four individuals are tested in a pool or “batch” using one test, rather than running each individual sample on its own test. If the pool is positive, it means that one or more of the individuals tested in that pool may be infected, so each of the samples in that pool are tested again individually.
Because the samples are pooled, it is expected that fewer tests will be run overall, meaning fewer testing supplies will be used and more tests can be run at the same time. That will allow patients to receive results more quickly, in most cases. This testing strategy is most efficient in areas with low prevalence, meaning most results are expected to be negative.
Face Masks: A Critical Strategy to Mitigate the Spread of COVID-19
Although only 31 states require face coverings, the CDC indicated that Americans are increasingly adopting the use of cloth face masks to slow the spread of COVID-19. The latest science may convince even more people to do so.
CDC Director Dr. Robert R. Redfield stated that cloth face coverings are one of the most powerful weapons to slow and stop the spread of the virus. He cited two studies: a Journal of the American Medical Association study that showed universal masking policies reduced SARS-CoV-2 transmission in a Boston hospital system; and a CDC Morbidity and Mortality Weekly Report case study showing that wearing a mask prevented the spread of infection in a Springfield, Missouri, hair salon.
Educating People about How Coronavirus Spreads
COVID-19 spreads mainly through close contact with other people, even with people who have no visible symptoms. There is still a lot to learn regarding how the virus spreads, but it is known that the virus can be transmitted person-to-person, object-to-person, and animal-to-person.
Person-to-person transmission occurs among people in close contact with one another through respiratory droplets produced when an infected person coughs, sneezes, or talks. Droplets may be ingested through the mouth or nose of people who are within six feet of an infected person.
Object-to-person spread happens when a person touches a surface or object that has the virus on it. That person becomes infected with the virus if they then touch their own mouth, nose, or possibly their eyes. This is why it’s so important for people to wash their hands frequently and for organizations to make sure frequently touched surfaces are regularly cleaned and disinfected.
Animal-to-people spread is considered to be low, but the CDC is aware of a small number of cases where infected cats and dogs transmitted the virus after close contact with a person. Again, it’s important for people to regularly wash their hands.
Face Masks Must Be Worn, Especially When Social Distancing Is Not Possible
To reduce the spread of COVID-19, CDC recommends that people wear cloth face masks in public settings when around people outside of their household, especially when other social distancing measures are difficult to maintain.
Cloth face masks may not protect the wearer, but it may keep the wearer from spreading the virus to others. This strategy is especially important for workers who frequently come into close contact with other people.
Cloth face coverings are most likely to reduce the spread of COVID-19 when they are widely used by people in public settings. For more information, read the CDC’s specific guidance for face coverings.
Implementing a Comprehensive Reopening Strategy Will Be Difficult
Unfortunately, for most businesses and schools, a rigorous testing, re-testing program may not be realistic due to a lack of funds. While great progress is being made to offer asymptomatic tests and test in sample pools, the cost may continue to be restrictive.
Therefore, it’s critical that organizations develop a multi-layered reopening strategy to prevent the spread of the virus. This includes temperature scanning, cloth face masks, social distancing, remote working, frequent handwashing, and frequent cleaning and disinfecting of touched surfaces. Implementing these measures can help identify people infected with coronavirus and help reduce the spread of the virus.
About the Author: Dr. Darrell Dantzler is a faculty member at American Military University, teaching courses in Emergency & Disaster Management. He is also the Director of the Fire Protection Analysis and Field Engineering Division within the Office of Fire Protection in the Bureau of Overseas Buildings Operations at the US Department of State. Darrell brings more than 36 years of experience in Disaster and Emergency Management Planning and Response. He is a 20-year United States Air Force Veteran and a 16-year public servant with the Department of State. At State, he conducted fire assessments, fire investigations, and special emergency management assessments in over 70 countries. Darrell graduated from the National Preparedness on Leadership Initiative, Executive Education Leadership Program at Harvard University’s T.H. Chan School of Public Health and Harvard’s Kennedy School of Government. He is a Certified Emergency Manager through the International Association of Emergency Managers. Darrell holds a Ph.D. in Public Safety Leadership with a specialization in Disaster and Emergency Management.