Note: this is a follow-up to an open letter to Iowa Governor
Did experts recommend shelter-in-place without all relevant information?
Short answer: No.
The document indicating when to enact shelter-in-place is inadvisable. We have no certainty that the rubric recommends mitigation in time because it hasn’t been studied. A tool like this, if reliable and valid, is still only as good as the information available.
If studies haven’t assessed its accuracy, then we have an experimental guide dictating state response to a new virus that is more contagious than seasonal flu, entering a completely susceptible population.
Tools like this document have a place when professionals cannot advise. The guidance cannot adapt to new information — something that emerges every day in this crisis —and expert opinion is available to decision-makers at this time.
Importantly, concrete evidence has shown that measures like those in Iowa have failed to halt the spread. Relying on them now is not a recommendable course of action.
Managing COVID-19 will take intentional, coordinated mitigation. Areas that delay or end distancing measures early will likely suffer greater economic losses long term — that’s in addition to suffering more death.
I reached out to Dr. Jennifer Nuzzo, a Senior Scientist at the Johns Hopkins Center for Health Security, with regard to the document. An internationally-respected pandemic expert, she testified before Congress on Feb 5 and advised political figures to prepare for the possibility this could not be contained.
Concerning the document titled Guidance for Implementing Public Health Mitigation Measures, she stated:
People testing positive today were infected a week ago, so we’re always a week behind. Iowa likely has many more cases than recognized. Bias often affects early outbreak testing, and good evidence suggests that’s the case here.
The virus spreads before people know they are sick, so asking people to self-isolate when they feel unwell won’t stop the virus. Testing scarcity can give the appearance of low case numbers.
Rural areas with fewer people are not safer if they have smaller hospitals or fewer medical professionals. Iowa ranks near the bottom in terms of doctors per capita and maintains just 635 critical care beds.
The percentage of COVID-19 cases requiring hospitalization hovers around 18%. Iowa could exceed critical care capacity in 1–2 weeks. Nothing guarantees resources will be distributed fairly, either.
COVID-19 is infecting and killing minority populations, especially African-Americans, at a higher rate. Lower-income New York neighborhoods suffered disproportionately high case numbers, and testing skewed in favor of the wealthy. US COVID-19 studies have already shown that money allows more affluent people to distance sooner.
Without any clear, equally applied order, wealthier demographics enjoy benefits not available to disadvantaged parties who may be forced to wait until September for relief funding.
Again, please, I beg you to act.
With great respect from a fellow Iowan,
E. Rosalie Li Rodenborn | Graduate Student
Public Health Biology
Johns Hopkins Bloomberg School of Public Health
Disclaimer: The views expressed in this letter reflect only me and are not affiliated with any other persons or institution.