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Study: 36,000 American Lives Would Have Been Saved if White House Acted One Week Earlier

Research from Columbia University Mailman School of Public Health looks at the timing of the imposition of public health control measures, at the start of the pandemic and in the present if infections increase, to project lives saved or lost.
May 26, 2020, 7am PDT | Irvin Dawid
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Anna Hoychuk

At a White House Coronavirus Task Force press briefing on March 16, President Trump announced "new guidelines for every American to follow over the next 15 days as we combat the virus" and released a two-page advisory document, "The President's Coronavirus Guidelines for America [pdf]" that served as a signal to governors and state and county health officers that they needed to take action to keep their residents safe if they hadn't already done so.

A week later, after 535 Americans had succumbed to COVID-19, the U.S. surgeon general announced during the task force meeting, "I want America to understand this week it's going to get bad." And it did, particularly in places like New York, New Jersey and New Orleans.

As of May 23, the U.S. leads the world in coronavirus cases and deaths, with almost 1.7 million cases and over 98,000 deaths compared with over 5.4 million global cases and nearly 344,000 global deaths. Just over 1,000 Americans died of COVID-19 on May 22.

"If the United States had begun imposing social distancing measures one week earlier than it did in March, about 36,000 fewer people would have died in the coronavirus outbreak, according to new estimates from Columbia University disease modeler," write James Glanz and Campbell Robertson for The New York Times.

“It’s a big, big difference. That small moment in time, catching it in that growth phase, is incredibly critical in reducing the number of deaths,” said Jeffrey Shaman, an epidemiologist at Columbia and the leader of the research team.

The findings are based on infectious disease modeling that gauges how reduced contact between people starting in mid-March slowed transmission of the virus. Dr. Shaman’s team modeled what would have happened if those same changes had taken place one or two weeks earlier and estimated the spread of infections and deaths until May 3.

Looking forwards

However, Columbia's research is not just looking at "what could have been," but also what awaits us. The timing is also applied prospectively to the model.

The results show that as states reopen, outbreaks can easily get out of control unless officials closely monitor infections and immediately clamp down on new flare-ups. And they show that each day that officials waited to impose restrictions in early March came at a great cost.

Pandemic not under control

"Currently, daily confirmed cases are in decline after the easing of social distancing measures, due in large part to the impact of measures in place before May 4," states the write-up of the study by the Mailman School of Public Health.  

This decreasing trend, coupled with the lag between infection and diagnosis, conveys a “false signal” that the pandemic is under control.  This decreasing trend, coupled with the lag between infection and diagnosis, conveys a “false signal” that the pandemic is under control.

Study results indicate that the rapid detection of increasing case numbers and fast re-implementation of control measures are needed to control a rebound of outbreaks of COVID-19.

“Efforts raising public awareness of the ongoing high transmissibility and explosive growth potential of COVID-19 are still needed at this critical time,” says lead researcher Jeffrey Shaman, PhD, professor of environmental health sciences at the Columbia Mailman School of Public Health. “Our results also indicate that without sufficient broader testing and contact tracing capacity, the long lag between infection acquisition and case confirmation will mask the rebound and exponential growth of COVID-19 until it is well underway.”

In response to a question by MSNBC host Rachel Maddow on May 21 to help visualize the "quantitative difference" that acting just a few days earlier makes, Shaman, who directs the Climate and Health Program, uses the example of an invasive lily in a pond.

"When you're dealing with the growth of a virus in a fully susceptible population, it's going through a doubling process – it's growing exponentially...They seem to start very small and insignificant...One of my favorite [examples] is an invasive lily in a pond and every day the number of lilies doubles. By day 30, the entire pond is covered in lilies. The question is, 'on what day was it half-way covered?'

"The answer, day 29, just the day before, because it is a doubling process."

Shaman warns against complacency as we move into summer because the virus may be seasonal and less transmissible during summer. He emphasizes the importance of keeping the infection rate, the number of new cases daily, low, until a vaccine and/or effective therapeutics are developed.

Sen Pei and Sasikiran Kandula, both research scientists at Columbia Mailman School of Public Health, are co-authors of the research which is awaiting peer review.

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Published on Wednesday, May 20, 2020 in The New York Times
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