As we complete our first full week of ‘shelter in place’, now would be a good time to take stock in where we stand nationally and locally. As I have pointed out in previous posts (and have been hearing more and more from patients), the lack of consistent messaging from the CDC has made it difficult to understand the contours of this outbreak. Part of the reason that we are hearing mixed messaging is because, currently, #COVID-19 is highly regional, with some areas being heavily impacted (NYC Metro area), others about to be impacted (New Orleans, Los Angeles, Chicago, Detroit) and some areas with less burden of disease (North Dakota, USVI, Hawaii).

This regionality has led President Trump and Dr. Deborah Birx to begin a discussion of high, medium and low risk areas. Such would “help states make decisions about relaxing or enhancing the measures they have put in place to stop the spread of the coronavirus.” This is faulty thinking and stems from Dr. Birx’s HIV experience, which she has attempted to shoehorn into our response to coronavirus. This is classic ‘to a person with a hammer, everything looks like a nail.’ In HIV, early work focused on a small number of risk groups which, although oversimplifications, were effective in communicating risk reduction techniques intended to slow its spread.

Unlike HIV, coronavirus is spread primarily through respiratory droplets and is incredibly infectious. This makes the entire population is susceptible, unless actively infected, hospitalized or recovered.

In a recent press briefing, Birx stated, “When people start talking about 20% of a population getting infected, it’s very scary. But we don’t have data that matches that based on our experience.”

This is factually incorrect. In the NYC metro area, 30% of coronavirus tests are positive. Ah, Dr. Birx would counter argue, but we are only testing ‘high risk’ patients, not the general population so of course that number exceeds 20%.

At Santa Monica Primary Care, we have been testing patients in whom a positive test or a negative test would have some consequence. As I outlined before, we may test a patient with vague symptoms but is caring for a susceptible elderly parent. Or we may not test a patient with more typical symptoms who is already quarantined and doing well.