Shelter in Place Today-Your Actions Can Save Lives

This article is available in Spanish here.

If you are like me, you have probably received countless COVID-19-related emails, announcements, articles, and social media posts. I have held off adding one more from me because I didn’t think I had anything meaningful to add. That was until today.

This blog reaches around the world and I think the information is globally relevant. I’m especially concerned about the US community because we don’t have a coordinated federal response and the wide variation and staggered implementation in statewide responses puts all of us, and the world, at risk.

It is time for all of us to act to limit the spread of this virus and save lives. There is still something that you can do. Right now.

Shelter in place.

You can save lives by reducing the spread of infection for everyone: you and your family, vulnerable populations like elders, people who are unhoused, in prison, detention or jail, people who have compromised immune systems or work in public safety and health care.

You can decide today.

Shelter in place.

This is one step beyond what has been called “social distancing” (which I will call “physical distancing” and distinguish from “social connecting” because hopefully we will commit to maintain and even deepen social connections at this critical time). Sheltering in place means “finding a safe location indoors and staying there until you are given an ‘all clear’ or told to evacuate. You may be asked to shelter in place because of an active shooter; tornado; or chemical, radiological, or other hazard.” (2) We are in the “other hazard” category now.

None of us probably fully understand the economic and social justice impacts of this decision, myself included. Many people in our communities and families and maybe even us personally rely on volunteers for food, shelter, home care, health care, driving and delivery services, etc. Maybe people in our communities and families and maybe us personally are wage workers in the service industry, live off of tips, were already food insecure, don’t have paid sick leave or childcare, etc. Each of us will need to assess these impacts as we make the decision to shelter in place. Some people cannot (or will not) shelter in place. The rest of us, though, must start today.

We can organize “ virtual tip jars” for wait staff. (3) We can press our government to provide paid sick leave, grants to small businesses, and write personal checks to financially shore up individuals and families. We can create GoFundMe campaigns for artists and performers. (4) But we can’t ignore the math.

You can’t ignore the math

“The nature of an outbreak is that you’re never seeing what’s happening. You are seeing an echo of the past…. The numbers we are seeing today are actually transmission dynamics from a week ago. We need to assume until we have good testing that it could be anywhere and act accordingly.” Jeremy Konyndyk, Senior Fellow, Center for Global Development

Because COVID-19 has an incubation period of 1–2 weeks (unlike the flu, for example, which has a 2–4 day incubation period) you can be shedding and spreading the virus all that time without knowing it. Some as-yet-unknown percentage of us may be “super-shedders.”(6) Some as-yet-unknown percentage of us will have the virus and never show symptoms but are still contagious leaving viral droplets in our wake. It’s still believed that children and younger teenagers are in this last category. Yet we see in Italy that healthy (without other underlying conditions) people in their 20s and 30s are becoming sick with more than “mild” cases of the virus. In the US 20% of patients known to be hospitalized with COVID-19 are in the 20–44 age group, 2% greater than the 45–54 age group which is only 18%. (7)

These are some things we think we know. There is so much we don’t know, so much we are learning every day. If you want to stay up-to-date about the facts and fiction of this virus, I recommend a podcast by Dr. Sanjay Gupta called ”Coronavirus: Fact vs Fiction.”

Another thing we know: this virus is spreading exponentially. Six days ago, Jason Warner posted about this in an opinion piece on Facebook. (8) He makes a compelling mathematical case for how and how fast this virus will spread without sheltering in place. He starts with an acknowledgment that “one of the current problems with addressing the pandemic is the social pressures of taking action today…. This is because our brains tend to think linearly as opposed to logarithmically. It’s the same reason many people don’t save for retirement or understand compound interest.”

He adds, “The nature of exponential math is that the infection rates start slowly, and then goes off like a bomb and overwhelms the hospitals.” This is what we are seeing in Italy now. The US, France, Germany and many other countries which have not put adequate containment procedures in place are headed the way of Italy. The US and most of Europe are 9–10 days behind Italy.

Italy is giving us the best picture of what is to come if we don’t take immediate and drastic measures to shelter in place. Now. Today.

Every day that we continue with “business as usual” we are contributing to an infection rate that doubles every 3 days. If we start with 10 confirmed infections, he explains, “in thirty days there will be 1,024 times the number of infected people in your area as there is today.”

“IF WE START EXTREME SOCIAL DISTANCING+ BY MARCH 23, WE AVOID OVER 1.4 MILLION PEOPLE GETTING CRITICALLY ILL AND OVERWHELMING THE HOSPITALS.” (8)

How many cases are in your community today? We can’t continue to ignore the math.

Containment vs. Mitigation

“The coronavirus is coming to you.
It’s coming at an exponential speed: gradually, and then suddenly.
It’s a matter of days. Maybe a week or two.
When it does, your healthcare system will be overwhelmed.
Your fellow citizens will be treated in the hallways.
Exhausted healthcare workers will break down. Some will die.
They will have to decide which patient gets the oxygen and which one dies.
The only way to prevent this is social distancing today. Not tomorrow. Today.
That means keeping as many people home as possible, starting now.” -Tomas Pueyo (9)

This quote is from an article “ Corona Virus: Why You Must Act Now “ published on Medium last week and translated into 26 languages. It’s worth the 30-minute read.

According to epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health, “It’s clearly too late to contain it in much of the [US].” (10) Too late for containment.

There was a window when accurate, rapid testing and quarantines could have contained this virus. Dr. Eric Feigl-Ding, Senior Fellow with the American Federation of Scientists and epidemiologist and health economist also from the Harvard T.H. Chan School of Public Health describes the effectiveness of testing at the onset of an epidemic: “Testing is the cornerstone of stopping an epidemic at the beginning because testing isolates who someone may have infected and who around them may have been exposed and needed to be quarantined.” (11) Places with the least casualties and slowest rates of infection implemented this strategy. Think: Singapore, Taiwan, Hong Kong, for example, and pretty quickly, South Korea. “South Korea now has 19,000 COVID-19 cases and while new ones are still emerging, the rate of increase has been slowing since February 29. A professor at the Yonsei College of Medicine says that if South Korea been slower to test people, there could be tens or hundreds of thousands of cases and far more deaths. ‘South Korea has a significantly lower mortality rate from COVID-19 than other countries: Italy 6%, China 4%.’ South Korea’s rate is less than 1%. ‘And notably South Korea has managed to do this without locking down entire cities or regions.’” (11)

Places with the highest rates of infection and deaths from COVID-19 did not sufficiently test nor contain the spread of the virus at the beginning. Think: China, Italy, Iran, for example. The US is on track to join this second group.

The long delay in accurate, rapid testing let the virus get a foothold in the US. South Korea, for example, is testing 15,000 people per day (with a maximum capacity of 22, 000 tests per day). That means South Korea’s per capita rate is 3,600 tests per 1 million population. As of this writing, the US’ per capita rate is 5 per 1 million population. Five. The US has roughly tested in total the number of people that South Korea is testing everyday. (11) The US still doesn’t have nearly enough tests available and results have been taking 2–4 days to come in while other countries have results in 2–4 hours or, at most, 1 day. All of this contributes to the exponential spreading of the virus (see math above).

It’s probably already spread much more than we realize. And it’s going to accelerate in the coming weeks.

We can no longer wait for testing to be put in place. The time for effective containment has passed in the US using testing data. (If you are in other countries who have yet to see your first case of community spread-it’s not too late for you: test and quarantine.). Our most effective course of action now is mitigation: keeping people apart to slow the spread of the virus. (10)

Don’t get me wrong: testing is still important. We need accurate numbers. We need information about who’s infected. Testing can answer questions about where and how the virus spread and how to best prepare for how many will be gravely ill…and how many will die. Even with the limited testing we have done, we know that failing to radically slow the spread of this virus, people will die both from the virus and from lack of access to ICU beds and ventilators. In the US, testing now won’t stop the spread of this virus. Sheltering in place will.

Travel restrictions from places like Europe will neither effectively contain nor mitigate for the spread of this virus if we in the US continue to do life as usual. Jeremy Konyndyk cautions, “Limiting travel from other parts of the world is worse than useless. It doesn’t afford us any protections. Once the disease is here, once the disease is spreading in our country, that is the greatest threat. Banning travel, anywhere in the world at this point, is a bit like locking the door after the killer is already in the house.

“The reason it is worse than just useless is that it is a distraction. The people who need to be enforcing and monitoring that travel ban are the kind of public health officials that we would want to be protecting nursing homes, supporting hospitals to get ready. We don’t have an infinite supply of those people; we need to prioritize them where they can do the most good.” (5)

Your Actions Today Can Save Lives Tomorrow and Beyond

“If we don’t do very serious mitigation now, we are going to be weeks behind and the horse is going to be out of the barn.” Dr. Anthony Fauci, Director of National Allergy and Infectious Diseases (10)

If too many people wait too long, it will be too late. Please don’t be that person. Please don’t wait.

1. Identify who you will shelter* in place with. Share this or other information with them to help them understand what is at stake and make a commitment to each other to self-sequester. Don’t wait for your state, county or local government to mandate it.
2. Gather essential supplies for one month.** Don’t hoard. Others also need supplies. Consider donating money or supplies to shelters or families who don’t have as much resources as you do. Ask for help from friends, family or food banks if you don’t have resources. Supplies include food, water, medicine. If you have a vehicle and are financially able: fill your gas tank. If you have access to cash it might be useful to have some on hand.
3. Identify one designated person who will leave as needed. In all likelihood, you will need to replenish supplies.*** Identify one person who will do that. Ideally that person would use gloves (you don’t need medical supply gloves just something to cover your hands and wrists) and would self-quarantine for 2 weeks away from others when returning. Limit how often this person leaves and make sure it is absolutely necessary.
4. Reach out to others. Encourage people in your life to join you in this effort. Our actions today can save lives. The more of us who commit to sheltering in place, the more effective this mitigation will be. Think of ways you can support those who cannot shelter in place, like health care and public safety workers, national guard, service workers, people in detention centers or jails and prisons, and many others! Check out thisarticle to learn about the many creative ways the virus sparked an epidemic of people helping people in Seattle! It’s inspiring! Get involved!
5. Go outside where others are not. If you have a garden, tend to it. If you can access the outdoors where other people are not around and you can maintain a physical distance of at least 6 feet (12, 13) at all times, by all means do! Please do not visit playgrounds or sit on benches since these are surfaces where the virus can live.
6. Listen. There are a lot of feelings coming up right now. For all of us. Me included! If you are feeling panic, overwhelm, pulls to hoard: you can discharge these feelings and not act on them. Telling people to “not panic” or “calm down” isn’t helpful. We have these feelings for a reason and, ideally, we would have someone(s) to listen to us and release these feelings so we don’t act on them. If you aren’t feeling anything, it’s likely patterns like numbness, disconnection or denial have gotten you through hard times in the past.

IT’S TIME TO UNNUMB AND BE PRESENT WITH WHAT IS HAPPENING. YOU CAN FACE THIS. YOU ARE NOT ALONE.

“Everyone must do it today. It’s not hype. It’s exponential math.” Jason Warner (8)

“The coming months will challenge us in ways we have never before imagined. But if we continue, as writer Sonya Renee Taylor said, to “put radical love into practice,” we might emerge stronger than we began.” (4)

Footnotes

+ What Jason Warner calls “extreme social distancing” I call “sheltering in place.” In Spanish-speaking countries, the phrase is “Stay at Home” or “Quédate de Casa.”

*I realize not everyone has shelter or that shelter can look many ways. Some of us will shelter with families. Some of us will shelter with roommates. Try to shelter with someone else, if that’s possible. Isolation is hard on us humans. We are social beings and being with others will provide emotional support for the period ahead. If you know of elders who are alone, consider inviting them to shelter with you.

**If you can only supply for a week, do that. Any amount of self-sequestration makes a difference.

***Current estimates are this could be necessary as long as 3–6 months.

References

(1) OpenCulture.com, “ Quarantined Italians Send a Message to Themselves 10 Days Ago: What They Wish They Knew Then,” March 15, 2020.
(2) Yale University Emergency Management Website, “Shelter In Place”.
(3) Prince of Petworth, “Virtual Tip Jar for Service Industry”, Popville, March 16, 2020.
(4) Naomi Ishisaka, “Coroniavirus Sparks an Epidemic of People Helping People”, Seattle Times, March 13, 2020.
(5) Ari Shapiro, “The Pandemic Response That A Public Health Expert Wants, And The One He Got”, NPR, March 12, 2020 (4'43").
(6) Bailey Adlridge, “‘Super Spreaders’ of Coronavirus May be Among Us, Experts Say. What Does That Mean?”, he News&Observer, March 15, 2020.
(7) United States Centers for Disease Control (CDC), “Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12 — March 16, 2020,” March 18, 2020.
(8) Untitled Facebook Post by Jason Warner, March 12, 2020. You can find his original public post at the link above or by searching his name in Facebook and scrolling in his feed to March 12, 2020.
(9) Tomas Pueyo, “Coronavirus: Why You Must Act Now”, Medium, March 10, 2020.
(10) Rob Stein, “To Slow The Spread of the Coronavirus, Experts Turn to Mitigation”, NPR, March 12, 2020 (4'26").
(11) Anthony Kuhn, “Experts Credit South Korea’s Extensive Testing for Curbing Coronavirus Spread”, NPR, March 12, 2020 (3'38").
(12) Lisa Lockerd Maragakis, M.D., M.P.H., “Coronavirus, Social Distancing and Self Quarantine”, John Hopkins Medicine.
(13) Apoorva Mandavilli, “Wondering About Social Distancing?”, New York Times, March 16, 2020.

Originally published at https://ljist.com on March 18, 2020.