Decisions on how to try to contain and control the coronavirus have largely been left to state and local officials, rather than those at the federal level.
"The decision of what steps to implement will be local," Dr. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said last week. She added, "CDC's role is to provide technical advice to states and counties."
Sacramento's new policy is similar to the approach in King County, Wash., which now has 116 coronavirus cases and 20 COVID-19 deaths. The county health department's page of recommendations for dealing with the virus doesn't mention quarantines at all. Instead, it advises people to stay at home if they're sick and to limit chances for the virus to spread by taking precautions such as teleworking and practicing excellent hygiene.
"Once you get a certain number of cases, it's hard to continue to contact-trace back the way you tried originally," Dr. Peter Beilenson, head of Sacramento County's Department of Health Services, told The Sacramento Bee. "So we move to mitigation, which is basically trying to mitigate the risk to those who are most at risk: the elderly and those with chronic underlying conditions."
Such policies can also reduce the toll on health care providers and first responders who might otherwise be compelled to self-quarantine if they have been exposed to someone who has been diagnosed with the coronavirus. Without those medical workers on the front lines, the broader response could be hobbled.
California and Washington state emerged as the first hot spots for the coronavirus in the U.S., which currently has more than 760 cases. Both states have reported cases of community spread, in which an infected person has no history of travel to affected areas or exposure to someone known to have the COVID-19 illness.
Sacramento County includes the University of California, Davis Medical Center, the facility that housed the first U.S. case of novel coronavirus infection through community spread. The patient was left undiagnosed for days because, according to the hospital, a request for testing wasn't granted on the grounds that the person didn't fit official criteria, which at the time included international travel. That criteria was quickly revised — but 36 nurses and roughly 188 other hospital workers were sent into self-quarantine for 14 days.
Messionier and other CDC officials say the U.S. response to the coronavirus won't be one-size-fits-all, with varying methods used in different parts of the country. In large part, they say, that's because the effort must adapt in areas where there has been community spread.
Even when an agency emphasizes mitigation over containment, Messionier said during a briefing on Monday, there's no "on-off switch." In many cases, she added, the local response will be a hybrid of the two.
"In Seattle and in California, they haven't stopped entirely contact tracing, but they have started mitigation," Messionier noted. "And I think that you will likely see local health departments deciding when there is community spread to start turning on more of the mitigation measures, even while they're still doing some level of contact tracing."
Messionier said she expects to see more agencies adopt similar approaches.
"You will see, I think, lots more communities starting to implement some kind of mitigation measures when they're seeing community spread. It will look different in different places. And that's why it's really important for folks to stay informed of what's going on in their local area and to follow their advice of the local health department."
Coronavirus symptoms and prevention
To prevent the coronavirus from spreading, the CDC recommends washing hands with soap and water for at least 20 seconds or using a hand sanitizer if a sink isn't available. The World Health Organization says people should wear face masks only if they're sick or caring for someone who is.
"For most people, COVID-19 infection will cause mild illness; however, it can make some people very ill and, in some people, it can be fatal," the WHO says. "Older people, and those with pre-existing medical conditions (such as cardiovascular disease, chronic respiratory disease or diabetes) are at risk for severe disease."
The most common symptoms of COVID-19, according to a recent WHO report that draws on more than 70,000 cases in China: fever (in 88% of cases); dry cough (68%); fatigue (38%); sputum/phlegm production (33%).
Shortness of breath occurred in nearly 20% of cases, and about 13% had a sore throat or headache, the WHO said.
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