Many states have reopened at a time when COVID-19 cases and deaths remain high. Despite the optimism around the reentry plans, we cannot defy the rules of epidemiology and a very infectious virus. We are beginning to see new cases of COVID-19 rise as people resume public interaction. Several countries that have reopened have reported a surge in new cases, and some have reimposed lockdown restrictions. The COVID-19 battle is far from over. We must have accurate data on new COVID-19 cases and deaths as an indicator of going too far in the reentry.
Pandemics are gauged in numbers — the number of cases, fatality rates, and spread (how many people become infected by one infectious person). Accurate pandemic numbers are essential to shaping an ongoing response, defining when mitigation strategies have been successful and in making informed decisions on easing restrictions. A sustained reduction in the number of new COVID-19 cases and deaths over two weeks is the public health benchmark required for easing restrictions.
We are not there yet. In terms of rate of spread, in most states, the number has fallen to below one new infection per infected person — being below one is a prerequisite to controlling the pandemic. However, since the reopening, many states are edging back towards one, and Utah, North Dakota, Tennessee, and Texas have exceeded one since the end of their shelter. Stay home orders reduced the rate of transmission, but current numbers show these gains are quickly lost.
To further compound the problem, the accuracy of these numbers in the U.S. is problematic. Testing remains too low to measure new COVID-19 cases and rates of spread accurately.
As a result, new cases and deaths are drastically underreported. President Trump continues to impede widespread testing because increased case numbers make the U.S. “look bad.” As a result, the decisions affecting the lives of millions are made in a void of information and data. Currently, 30 percent of all COVID-19 cases and deaths worldwide are in the U.S.
COVID-19 numbers are inconvenient to political agendas. The need for reopening to be seen as a success creates pressure to manipulate or suppress COVID-19 data. We have already seen examples of this. The Governor of Florida attempted to prevent information on Florida COVID-19 deaths from becoming public to claim success in mitigating COVID19.
Georgia justified reopening using a graph with case numbers shown out of order to convey a downward trend. The Governor of Kansas ordered a stop to report the rising number of cases and deaths in meatpacking plants. The Governor of Arizona tried to silence a COVID19 epidemiological modeling group that said analysis of cases and deaths, a decision that was later reversed in response to public protest.
Data related to increases in COVID-19 deaths may become challenging to obtain and appreciate. President Trump incrementally increases the expected death toll that will result from reopening in an attempt to desensitize the public to a gruesome new normal. He portrays Americans as “warriors” who “might be affected badly.”
Unfettered spread, often advocated to attain herd immunity, comes at a staggering cost in morbidity and mortality. Also, attaining herd immunity by unfettered infection is a dangerous gamble since it is not clear if effective long-term immunity can be achieved in those who were infected and survived.
Unfettered spread also risks potentially long-lasting complications for many. Research by virologists and clinicians to understand the SARS-CoV-2 virus and how to best treat COVID-19 has only just begun. As we have only been aware of this virus for five months, we know very little about the long-term consequences of having had even a mild case of COVID-19.
Many new manifestations of SARS-CoV-2 pathogenesis are being discovered, some occurring after patients have seemingly recovered. Many viral infections, including hepatitis, herpesviruses, measles, and papillomaviruses, result in life-long pathogenesis or predispose us to complications later in life. Thus, beyond the deaths associated with unfettered infection, those that survive may suffer long-term health consequences.
As we reopen, citizens become pawns in a desperate game. Our political leaders will continue to obfuscate the inconvenient truths in the numbers of COVID-19 cases and deaths to create a false sense of security and “success” to justify reopening. COVID-19 data must be collected and released independently of politics.
Data manipulation and suppression will only endanger us and our society further. As we move forward, there must be transparent accounting, so we know when we have gone too far. Without that, we risk the more significant economic loss of recurring cycles of lockdowns and a higher number of deaths. The best battle is fought by maintaining the gains made and steadily increasing them through a well-monitored, data-driven easing of restrictions.
James Alwine is a virologist, a fellow of the American Academy for Microbiology and of the American Association for the Advancement of Science. He is a professor emeritus at the University of Pennsylvania and a visiting professor at the University of Arizona. Felicia Goodrum Sterling is a virologist, president-elect of the American Society of Virology, and a fellow of the American Academy of Microbiology. She is a professor and scientist at the University of Arizona.