Utah should learn from these places that have beat back huge coronavirus spikes

(Jeremy Harmon | The Salt Lake Tribune) Epidemiologist Angela Dunn talks about what the state is doing in case of a coronavirus outbreak in Utah during a new conference at the State Capitol on Monday, March 3, 2020. Behind her are Governor Gary Herbert, Senate President Stuart Adams and Speaker of the House Brad Wilson.

Dr. Anthony Fauci, the nation’s top infectious disease specialist, was recently asked about the places he was most worried about overstressed hospitals and intensive care units.

Utah was the first state he mentioned.

“Some of the states like Utah, Nevada, South Dakota, North Dakota, where … they never had a pretty good reserve of intensive care beds and things like that,” Fauci told The Washington Post. “I hope they’ll be OK, but it’s still a risk that, as you get more surging, they’re going to run out of capacity."

“All the stars are aligned in the wrong place as you go into the fall and winter season, with people congregating at home indoors," Fauci said. "You could not possibly be positioned more poorly.”

He gave this interview before this devastating week of cases, culminating in Friday and Saturday’s announcement of nearly 3,000 new infections each day. The state reported 17 deaths Friday and another nine on Saturday. In eights weeks, we’ve gone from 117 hospitalized patients to 410.

Some patients are being treated in hallways of Utah hospitals. Others say when they call for a nurse, there’s not one available to assist for a half hour. And while there are still some empty ICU beds, there are so many nurses who can’t work due to their own infection or exposure to COVID-19, further exacerbating the problems.

Utah's growing hospitalizations over the previous 8 weeks. (Coronavirus.Utah.gov)

This is all to say: what we’re doing isn’t working. Hospitals are being overrun. People are dying more than ever before. Something has to change.

So what should we do? First, let’s note that other states are going through a similar spike.

New York Times graphic of each individual U.S. state's coronavirus cases. Utah ranks eighth.

Those who want to make everything political will note that nearly all of these are red states. But to blame this on Republican policies isn’t really looking at the whole picture, either. Look at politically-progressive Europe, where cases are also exploding:

Economist charts of European nations coronavirus deaths and cases (https://www.economist.com/graphic-detail/2020/07/03/tracking-the-coronavirus-across-europe)

Essentially, I don’t find the political blame game particularly beneficial. Instead of focusing on where cases are exponentially rising, let’s flip this around and look at where the runaway freight train was slowed or brought to a halt, and see if we can learn from the actions taken there.

Arizona’s limited closures

Arizona was home to the nation’s worst outbreak in June. Hospitals were overrun. Deaths were rising. Then, their state government took action.

• They closed bars, gyms, water parks, and theaters.

• They reduced restaurant capacity to 50%.

• They didn’t exactly mandate masks, but they allowed cities and counties to implement mask mandates — counties covering 85% of Arizona’s population went ahead with the mandate.

And afterward, Arizona’s coronavirus cases declined quickly. The Centers for Disease Control and Prevention used Arizona’s example as a case study in government intervention gone right.

CDC's chart of coronavirus cases in Arizona, with key dates notated. (https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6940e3-H.pdf)

Utah has similar restrictions on restaurants and masks, but they haven’t gone so far as to close any businesses again, even businesses that have disobeyed the weak regulations already in place.

Quite frankly, the thing that may have worked best in Arizona was that the closure of businesses and overrunning of hospitals was a signal to people to take the issue seriously — mask wearing went up in both mandated and non-mandated counties, and a larger percentage of people stayed home, according to Google’s mobility data.

Here’s how the closures impacted unemployment claims.

Arizona unemployment claims. (https://tracktherecovery.org/)

You can see a small bump around the same time as closures occurred, but interestingly, the filings sharply declined even as the four business types stayed closed and restaurant capacity was cut. It’s hard to tease out correlation and causation with all of this data, of course — was the unemployment bump due to the closures or the high number of cases, or both? But still, it doesn’t appear that closing these high-risk industries wrecked Arizona’s economy.

Belgium’s relaxed lockdown

Belgium was also experiencing a huge spike, with 10,000 or even 20,000 cases a day in a country with 11.5 million inhabitants — on a population basis, about the same as Utah having 2,700 to 5,500 cases per day. It was declared “a state of emergency” for their hospitals.

So Belgium instituted a relaxed lockdown:

• Restaurants, bars, and nonessential stores were limited to takeout and delivery only. Salons, swimming pools, and zoos were told to close, but most businesses were allowed to stay open.

• Teleworking was made compulsory whenever possible. Where teleworking is not possible, face masks and ventilation was made mandatory.

• Schools were kept open for young students, made hybrid for secondary students, and pushed online-only for college students.

• Churches were kept open too, but couldn’t hold services. Funerals were capped at 15 people. People were allowed to hang out outside but in groups of four at most.

These rules are significantly less harsh than what occurred earlier in the pandemic. But it’s exactly what Belgium needed to turn the tide. The coronavirus case chart shows that the modified lockdown is working so far. That country’s cases have plummeted.

Belgium's coronavirus cases. (https://www.worldometers.info/coronavirus/country/belgium/)

Belgium’s approach is pretty data-driven and makes a lot of sense. Transmission rates are different among different age groups, so why are we treating schools the same? If business can occur over the internet, why shouldn’t it? In general, the goal is to avoid groups of people getting together indoors, where the virus can spread easily.

‘Knuffelcontacts’ and support bubbles

I didn’t tell you about my favorite Belgium rule, though:

• Every person can designate one "knuffelcontact” — which literally translates to “cuddle contact.” That person is allowed to come over and knuffel (or not); only one knuffelcontact can be at a family’s home at once. People living alone can designate two knuffelcontacts, but they can’t both come over at the same time.

Look, I get it. The word “knuffelcontact” sounds ridiculous, and the idea may make you feel the same. It’s all too easy to imagine a family debating which knuffelcontact can come over at a given time. But it’s an important consideration to make here: people need social life in order to not be depressed, and we’ve certainly seen depression spike during the pandemic.

As Gov. Gary Herbert noted during his news conference this week, being with non-relatives indoors is where a huge chunk of coronavirus growth is occurring. A knuffelcontact, or similar idea, meets people halfway: yes, stopping the virus is important, but we’re going to allow you this reasonable exception because we care about your well-being, too. Physical contact is important.

The Netherlands suggested that single people find a “seksbuddy” — no translation needed — for the same reason. England, however, called it a “support bubble,” and single-adult households could link up with other households for emotional support. If someone in the support bubble tests positive, everyone is instructed to follow the stay-at-home guidelines.

I understand that Americans aren’t used to this degree of government interference in their social lives — frankly, there would probably be a revolt if this were implemented here. And yet, I want people to understand what effective coronavirus measures look like. Limiting social contacts is perhaps the single most important thing someone can do to prevent the spread.

Other lessons

• Act quickly. Germany’s response was perhaps the best in Europe, with surprisingly small numbers of cases and deaths. Many thanked their expansive contact tracing system. But as German scientist Christian Drosten explained at the World Health Summit, “There are already speeches celebrating German success, but it’s not very clear where that comes from. We have moved with exactly the same measures as others. We didn’t do anything particularly well, we just did it sooner.”

• Personal experience and effective messaging matters. Those with personal experience with a COVID-19 case and those who were concerned about COVID-19 infection were more likely to wash their hands than those who did not, according to a CDC study.

• U.S. counties with a high social vulnerability scores had higher coronavirus cases than those with lower scores, according to a CDC study. In particular, rural counties in which housing was crowded — defined as more people living in a home than the number of rooms — were the worst off. Central and southeastern Utah are the areas of Utah with the highest social vulnerability scores. It is important to keep this in mind when allocating resources.

• Faster testing. Africa is kicking our butts at this. Rwanda pools samples together to more quickly test them, then nails down individuals in followups. Senegal has mobile labs that can return results in as quickly as two hours, and are working on rapid tests that cost less than $1 that would get an answer back in 10 minutes. Last week, over 66% of coronavirus tests in Utah took more than 24 hours to come back with results; there’s no excuse for that in a well-off state in the world’s richest country.

I’m not sure if I’m optimistic that these interventions will occur in Utah — our state politicians acted very promptly in the first weeks of the pandemic, but have honestly lagged at every step of the way since. I’m not sure if this was for political reasons, or because they really believed they were doing the right thing in taking only mild action. Herbert did say he’s planning to try some new things soon, which will include mandatory testing for college students.

Regardless, the proof is in the pudding. The state’s current spike shows that our actions to this point have been insufficient, and the deaths this week are the cost of making poor choices. But there are steps we can take, models to follow. We can rebound.

But we’ll need to act.

Andy Larsen is a data columnist. He is also one of The Salt Lake Tribune’s Utah Jazz beat writers. You can reach him at alarsen@sltrib.com.

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