Moving from Uncertainty in a Rapidly Evolving Healthcare Crisis

I like to distinguish between two kinds of risk: risk to which we can assign a probability, and risk for which we don’t have enough information to assign a probability. Understanding risk is critically important for public and private decision-making at all levels—and city leaders, who are at the front line of this crisis, have to manage so many aspects of this pandemic, from public health policy to logistics to coordination with their state and federal peers. Until we have widespread testing for SARS-CoV-2, the coronavirus that is circulating now, we don’t have the data we need to move from uncertainty to risk.

People sometimes ask me how SARS-CoV-2 compares to the flu. SARS-CoV-2 has a much higher R0 which is the measure of how many people the average patient infects. It appears to spread even while patients are asymptomatic, which means it’s difficult to know when someone is contagious. It has a much higher mortality rate. In addition, we don’t yet have mitigation measures—vaccines and proven anti-viral medicines, other than nonpharmaceutical interventions such as social distancing.

Although we are in an uncertain environment, we can take steps to prepare and protect ourselves and our communities. I think of preparation as a three-pronged approach, with roles for individuals, communities, and governments. Individuals can wash and sanitize their hands, cover their mouths when coughing, and practice social distancing. Communities can take care of the vulnerable and adopt work-from-home and similar policies to limit the spread of the virus. Governments at all levels—city, state, and national—can get widespread testing underway, develop counter measures, and think outside the box as far as bringing resources, such as military resources, to bear to manage this crisis.

Finally, we can’t lose sight of the future. I’ve done a lot of research in West Africa; after the Ebola outbreak in 2014, vaccine-preventable illnesses among children spiked because parents, who were afraid to go to healthcare facilities, weren’t getting their children vaccinated. I’m concerned we could see that happen here too—a spike of vaccine-preventable illnesses in a year or so. We absolutely need to address this immediate healthcare crisis, but we also need to keep an eye on what is coming down the pike.

Harvey Rubin is Professor of Medicine, Perelman School of Medicine.

Return to Table of Contents