It feels odd isolating with COVID-19 in my child’s old bedroom, surrounded by a giant stuffed fish, band awards and the pile of clothes left in the departure for college. As a public health physician, I knew a bit about this virus. I’m now learning more firsthand. Was I taking precautions? Of course. Am I upset with those I likely caught it from? Certainly not; they were being careful, too. Our actions reduce risk, they don’t eliminate it. Mostly, I worry about others I could have exposed. And it again drives home to me the urgency of addressing our state’s recent surge.
There is much discussion these days about fall colors and the DHHR COVID County Alert Map. While it offers a tool for schools and nursing homes, we can’t stop there. Families, businesses, and communities should absolutely use the map for other purposes — predominantly for driving action. Maps are for going places, in this case to green.
The Alert Map has had some reasonable adaptations, especially early on: better aligning cutoffs with the original Harvard version, wrestling with the issue of small county populations and including full staff in counting nursing home and correctional outbreaks. While pandemic politics (partisan and otherwise) abound, I generally do not subscribe to theories of intentional data manipulation. I do believe models can be overworked in efforts to create precision beyond reality or to meet demands of the moment. No metric is perfect; many are useful. Most important is it be clearly labeled and used to trigger action for change.
School “safety” is not driven by the number of map colors. Beyond in-school prevention measures, our ability to minimize school-related cases is driven by two things. First, how we apply the map. West Virginia has chosen to accept fairly high levels of risk comparing ours to the Centers for Disease Control or other risk scales now emerging. Such a choice could arguably be appropriate for West Virginia given the high benefits of in-person school for so many here. We should be transparent, however, that we are choosing such.
Truly, the most critical factor affecting school and community safety is how we address community spread — what the map measures. Look around. We have unprecedented numbers of people with disease in various locales. Health care providers and facilities are starting to cry out for community action. Transmission rates (Rt) are some of the nation’s highest. Outbreaks are frequent. Deaths and hospitalizations are rising. Many of us now know someone with COVID-19 or have it ourselves.
So, let’s return our focus to the ball. If we want kids in school buildings (70%+ of parents chose this), sports teams playing, facility residents safe, businesses open, health care stable and holidays well-celebrated, then both leadership and we, the state’s citizens, need to seriously address the root issue — virus spread. It will not get better on its own, or by adjusting a map. We have to use the map to guide community action and monitor progress. Timing matters. School has begun and flu season is around the corner — one we will weather better if COVID-19 levels are low and we all get a flu shot. We shouldn’t count on “Hail Marys,” but instead all now drive the ball to the goal — getting to green.
Does this mean a full shutdown? No. Wise implementation of targeted measures? Yes.
Are you in a Red, Orange, Gold or even Yellow County? Individuals, businesses and governments can stand in solidarity with their schools and facilities and take action. Targeted efforts based on local data are best. If it suggests a few primary causes (ask your health department), focus on these. If risks are non-specific, take broader actions. Businesses can expand teleworking; churches celebrate creation outside or go remote; restaurants and bars maximize safer operations (e.g., outdoors, take out, table service only with bars). Organizations and shops can both post and measure proper face covering use, celebrating community and employee safety when targets are met. Develop a funny face covering campaign. Call on a friend. Act on the newly released gathering size (10 or less for gold and above).
And remember masks, distance and ventilation (combined is best), even in your “usual circle.”
We have agency as individuals and communities. Do not wait for those above to fix it. Focus on action together locally and track and celebrate progress: Businesses, proudly share the steps you take in solidarity with your schools and community. State and local officials, recognize, promote and support those doing it right — they are also heroes, like school staff, police, health care and public health workers. Local health agencies and county commissions, create cross-sector task forces to design appropriate actions based on local data and your community’s strengths. Include a plan to sustain low levels once down. Governor’s office, if localities work to enforce and implement the guidelines, or even go beyond when rates are high, support them and have their back. If a county sustains high rates, address the unique issues at hand. For West Virginia to be successful, the map must be about community, not just schools and nursing homes. This virus is here to stay for many, many months — long past delivery and even use of vaccine.
“Running to the fire,” testing and contact tracing alone are not sufficient. We also need jointly-developed fire suppression strategies at state and local levels. We have the tools for such if we organize and use them across sectors. I’ve been intimately reminded that none of us are safe until all of us are safe. The virus is adaptive; we can and must be, too.