Thursday, August 13, 2020

How To Control A Pandemic

While the numbers are shockingly high — yesterday recorded the largest numbers of deaths from Covid-19 since May — there are places where contact tracing and preventative measures are working to keep infection rates low.  From the New York Times:

The coronavirus is raging through the White Mountain Apache tribe. Spread across a large reservation in eastern Arizona, the Apaches have been infected at more than 10 times the rate of people in the state as a whole.

Yet their death rate from Covid-19 is far lower, just 1.3 percent, as compared with 2.1 percent in Arizona. Epidemiologists have a hopeful theory about what led to this startling result: Intensive contact tracing on the reservation likely enabled teams that included doctors to find and treat gravely ill people before it was too late to save them.

A crucial tool has been a simple, inexpensive medical device: an oximeter that, clipped to a finger, detected dangerously low blood oxygen levels in people who often didn’t even realize they were seriously ill.

Contact tracing is generally used to identify and isolate the infected, and thereby to slow the spread of the coronavirus. Elsewhere in the United States, the strategy mostly is failing; the virus has spread too widely, and tracers are struggling to keep up.

But on the reservation, contact tracers have discovered effective new tactics as they trek from home to faraway home. They may not have been able to stop the virus, but they have managed to prevent it from causing so many deaths.

“This is really not about contact tracing cutting down spread,” said Dr. Arnold Monto, a professor of epidemiology and public health at the University of Michigan who was not involved in the project but reviewed the findings. “Do it right, and the mortality will be lower.”

“This could help with other hard-to-reach communities,” he added. “If we identify cases sooner, they won’t come in half dead with horrible lungs.”

This approach, which doctors at the Indian Health Service laid out recently in the New England Journal of Medicine, may offer a new strategy for reducing Covid-19 deaths in some of the hardest-hit communities, Dr. Monto and other experts suggested — especially among people of color who more often live in housing where multiple generations share space.

Dr. Vincent Marconi, director of infectious diseases research at Emory University in Atlanta, said it was “incredible” that contact tracing could have such an effect on a population so disadvantaged and at such high risk.

If the reservation’s methods have lowered death rates, he added, “then absolutely, without a doubt, this needs to be replicated elsewhere.”

It is indeed a lesson for the rest of us: that in a place where life is hard by any measure during the best of times, intelligent medicine and taking care of others is working. If it works in the IHS, it can work in Florida.