California’s governor continues to (slowly) devolve authority to the county public health agencies across the state. Sacramento, which earlier this month had the lowest coronavirus infection rate of the fifty largest metropolitan areas in the US, has been cleared to re-open into Stages 2 and 3 of the state’s pandemic roadmap. There are only 4 COVID-19 positive ICU patients in my county’s hospitals; two weeks ago, there were 7. (Click here for CA county by county status.) This is ahead of Los Angeles County, for example, where the epidemic is hitting harder and they have an incidence rate almost twenty times as high as here.

With modifications to enforce social distancing / non-pharmaceutical interventions (NPIs), all (non-essential) in-store retail is now allowed in Sacramento County, as well as hair salons and restaurants. I’m not sure what the deal is with places of worship; I know that my own Catholic diocese has not yet started any in-person Masses. Gatherings (bars, theaters, live sports), swimming pools, gyms, nail salons, and non-essential travel & hotel stays remain off limits.

Updates on topics I’ve covered previously: Wastewater monitoring

STAT News, one of my trusted sources, alerted me that a preprint report has been released on monitoring wastewater (sewage) for SARS-CoV-2 RNA. I’ve been an advocate of this for quite a while. Given the numerous problems with coronavirus testing (availability, reliability, and uptake), wastewater monitoring could become our most important leading indicator for a surge. It’s easy and it’s cheap, and this paper indicates it may be effective. Remember, we’re in the “dance” phase of our pandemic response. The coronavirus is out there, circulating at a low level. People without any symptoms may be contagious. Our goal is to keep the number of COVID-19 cases below the capacity of our hospitals. If we are not diligent enough with our non-pharmaceutical interventions, cases will increase. In the absence of comprehensive testing, we won’t know about a surge until it’s too late. Monitoring an entire community via wastewater can warn us to tighten restrictions before the wave hits the emergency rooms.

(Summary courtesy of STAT News) “SARS-CoV-2 MONITORING IN SEWAGE Researchers from Yale University (Connecticut, US) published (preprint) findings from a study that evaluated the presence of SARS-CoV-2 virus in a local sewage system. The study aimed to determine the potential for monitoring SARS-CoV-2 presence and concentration in sewage systems to provide insight into the level of local community transmission. Utilizing daily samples taken from a local sewage processing facility (March 19-May 1), the researchers performed quantitative viral RNA testing (qRT-PCR) for SARS-CoV-2 and compared the concentration to local COVID-19 reporting. They found a strong correlation between the amount of SARS-CoV-2 present in the sewage and the number of confirmed COVID-19 cases and hospitalizations several days later. The trend in hospitalizations lagged 3 days behind the peak viral concentration, and the reported cases lagged the viral concentration by 7 days. Because viral shedding often occurs before SARS-CoV-2 infections can be diagnosed, this study illustrates that conducting surveillance on the concentration of SARS-CoV-2 in wastewater systems could potentially provide several days advance warning of increased COVID-19 incidence in the community.”
Link to paper preprint: https://www.medrxiv.org/content/10.1101/2020.05.19.20105999v1.full.pdf

Updates on topics I’ve covered previously: Coronavirus on campus

This week presidents of both Notre Dame and Purdue University came out with editorials in major newspapers explaining how and why they plan to reopen their campuses this fall.

Notre Dame’s president uses language similar to what I said in my blog post. He says, “How ought these competing risks be weighed? No science, simply as science, can answer that question. It is a moral question in which principles to which we are committed are in tension…The pivotal question for us individually and as a society is not whether we should take risks, but what risks are acceptable and why.”

Purdue’s president echoes my other main point. He addresses the near-panic of the decision to suddenly close in March as justified by all we did not yet know about SARS-CoV-2. Then he correctly says, “The most salient discovery the world has made during these terrible two months is that COVID-19 is a very dangerous disease, specifically for the elderly and the infirm, particularly those with diabetes, hypertension, other cardiovascular illnesses or the obesity that so frequently leads to these disorders. The companion discovery is that this bug, so risky in one segment of the population, poses a near-zero risk to young people. Among COVID-19 deaths, 99.9 percent have occurred outside the 15-to-24 age group; the survival rate in the 20-to-29 age bracket is 99.99 percent. Even assuming the United States eventually reaches 150,000 total fatalities, COVID-19 as a risk to the young will rank way below accidents, cancer, heart disease and suicide. In fact, it won’t even make the top 10.”

A point which is not mentioned in either of these editorials is worth highlighting. Both Purdue and Notre Dame are elephants in tiny rooms. They dominate two relatively rural, relatively isolated communities in Indiana. The economic imperative to reopen is overwhelming. Without those universities, West Lafayette and South Bend virtually cease to exist.

On the other hand, for the same reason, they are in a uniquely good position to control an epidemic. These two can test or screen pretty much everybody who comes to campus from out of town; then keep them there, and minimize cross-contamination of infected people both into and out of campus. Not easy, but it’s much harder for an urban college like Harvard, for example, where there are few boundaries between the student body and a major, densely populated city. I predict that colleges and universities in geographic situations more like Purdue and Notre Dame will mostly reopen (for example, Cornell), whereas colleges and universities in urban centers will have a harder choice, and the surrounding community may be less encouraging to take the risk.

Amy Rogers, MD, PhD, is a Harvard-educated scientist, novelist, journalist, and educator. Learn more about Amy’s science thriller novels, or download a free ebook on the scientific backstory of SARS-CoV-2 and emerging infections, at AmyRogers.com.