Conference attendees walk towards their hotel in downtown San Antonio. Photo by Joe Van Wyk.
Epidemiologist Cherise Rohr-Allegrini advises against stockpiling supplies but rather take steps to improve the health of your neighbors and elderly. Credit: Joe Van Wyk for the San Antonio Report

Emptying Store Shelves Won’t Help Stop the Spread of Coronavirus, Social Distancing Will

In the mid-2000s, the US government worried about bioweapons and poured funds into public health emergency preparedness. As avian flu prompted fears of a new flu pandemic, I was appointed Pandemic Flu Coordinator for San Antonio Metro Health. I spent the next year talking to every organization who would listen about how to plan for a pandemic.  

While that disease didn’t manifest into a pandemic, another one did in 2009: H1N1. The first cases were identified through routine surveillance in Guadalupe County.  While it became a pandemic, it didn’t cause the level of illness or fatalities we had predicted. So everyone got complacent and the federal funds for pandemic planning were directed elsewhere. 

Then in January 2020, a new disease started killing people in China. As of March 11, we have a full-fledged pandemic spiraling out of control across the globe. With a case-fatality rate of at least 3.4 percent (seasonal flu is 0.1 percent), this looks like the 1918-1919 flu pandemic. There are over 135,000 cases worldwide and growing. That’s pretty scary. 

Until Friday, San Antonio had no cases of COVID-19.  As tests become available, expect to see an upswing in positive cases in San Antonio and across the country. That’ll send more panic through our streets and shops.  Remember, these positive tests don’t necessarily mean “new” cases. These may be newly identified cases.  They already existed, we’re just looking for them now.

As a public health professional, my role is sometimes to pull the fire alarm. It’s also to make sure no one will run into the fire when that alarm is pulled.

In real life outbreaks, sometimes a response doesn’t follow an orderly fire drill, and panic ensues. If you’ve been to Costco lately, you know what I mean. No soap, toilet paper, or disinfecting wipes to be found. 

Responses to the coronavirus pandemic on social media are either dismissive, likening it to the flu, or alarmist, calling for everything to be canceled. The reality is somewhere in between these extremes.

By now many have heard about “flattening the curve.”  At the beginning of an outbreak, many cases that are very severe can overwhelm the health care system. The health care system depletes its resources and deaths increase. If we plot those cases on a graph, we see a large spike. However, if we can instead spread that same number of cases over a longer period of time, the health care system has time to replenish its resources to continue to respond.

San Antonio has many excellent hospitals. Thanks to the South Texas Area Resource Council (STRAC), the level of coordination amongst the hospitals is among the best in the country. This means that they know who has beds available, who has ICU space, how many vents there are, and assorted other critical items. 

There is a limit, though. Even the best systems can only handle so many patients. By flattening the curve, we decrease the number of critical care patients at any given time. If we don’t, health care providers would be forced to decide which patient will get the critical care and which one will be allowed to die.  When the hospitals worked on their pandemic plans in 2006, this was a scary prospect to even consider. All agreed that no one wanted to ever be placed in that position. Italian physicians are being faced with it now. 

So how do we flatten the curve? Social distancing. What does that really mean? Apart from large scale cancellation of events, we need to understand the epidemiology of the disease. We know that it can affect almost all age groups, but the most severe cases are in those over 60 years old and in people with other health issues. These are the people who will require hospitalized care. Our efforts to decrease infection must be aimed at these populations.

That means imposing strict guidelines on any care facility such as nursing homes or other assisted living centers. That includes limiting or prohibiting visitors and enhanced infection control for staff. It means canceling senior-focused events. It means checking in with your elderly family members and neighbors, making sure they’re healthy and have what they need. 

Same goes for friends and family who are immunocompromised. It also means keeping yourself healthy, even if you’re not in the high-risk group, so you don’t transmit the virus to them. 

Help an elderly neighbor set up Skype or FaceTime, so they can interact with others without the risk of infection. Our elders often already feel isolated, and this pandemic will isolate them more. A friend suggested schools adopt a nursing home and have kids write letters to the residents.

While we have moved into the “cancel everything” phase of this pandemic, as a community, we must take a collective breath. Clearing the shelves at Costco isn’t going to slow this pandemic. If you’re well stocked with soap, wipes, toilet paper and food, share it with your neighbor. Keeping your neighbor healthy keeps you healthy too. 

That fire alarm has already been pulled and the fire is raging. Let’s make sure the firefighters have a functioning water hose.  And when this is done, let’s make sure our public health departments have the resources to plan for the next pandemic.

Cherise Rohr-Allegrini is an infectious disease epidemiologist and consultant. She is currently the San Antonio Program Director for The Immunization Partnership. Dr. Rohr-Allegrini was the Pandemic Flu...