Interactive map courtesy of Johns HopkinsCenter for Systems Science and Engineering.

Ordinarily, the initial public health response to a pandemic is to aggressively isolate infected persons and quarantine close contacts. This is called containment and is dependent upon accurate and widely available testing. As most know from media reports, several weeks into this pandemic, testing in the United States is still inadequate to fully come to grips with the burden of this virus, leaving authorities with only one option: widespread social shutdown.

This novel coronavirus spreads exponentially. No one has immunity to it until after they’ve had it, and it is much more contagious than the flu. On average, one person gives it to two or three people, meaning the rate of spread will pick up with dizzying speed if not slowed. During a bad flu season up to 15% of the population might get sick. With this particular coronavirus we can expect two, three or even more times that number to become ill. While the focus early on was directed at travelers to countries with sustained transmission, there isnowwidespread community transmission across the United States and community transmission is occurring in North Dakota. At this point, anyone paying attention has become familiarwith the behavior of exponential spread.InNorth Dakota we’re still on the relatively slower upslope and while we hope that strict socialdistancingwill keep us there for awhile, a time will come when cases increase rapidly. Even in rural North Dakotawhere population density is very low compared to major metropolitan centers, the mostoptimisticmodels project our hospitals will reach capacity in the next month. Some models, including one out of the Harvard School of Public Health, project an overwhelming of hospital and ICU beds in our area.

The one bright spot in this pandemic is that only a very small percentage of persons become seriously ill. Many have few if any symptoms. However, even a small percentage can become a big number when illness is widespread.Therefore, do your part to avoid getting sick in the first place, but ifyou do happen to catch this new coronavirus, called COVID-19, don’t panic. You will likely recover without a problem but you must stay isolated at home until your fever and other symptoms of illness have disappeared for at least 72 hours. Additionally, your household and other close contacts will need to quarantine for 14 days to make sure they do not come down withillness. It cannot be stressed enough that in order to protect those who are at greatest risk for becoming seriously ill—the elderly, frail and those with underlying heart disease, lungdisease and suppressed immune systems— as well as hospitals andhealthcareworkers who are going to be stretched to the limit, everyone must do their part to avoid becoming ill and if they do, to avoid spreading COVID-19. Put another way, most do not need to be concerned about becoming ill, but we cannot be concerned enough about everyone becoming ill at the same time.

Don’t forget that the region continues to see significant cases of influenza. As a result of social restrictions, numbers of flu cases are finally on the decline, however, as was the case in 2009 when the novel H1N1 flu virus first appeared, seasonal flu vaccine remains important in slowing the spread of influenza and to reduce the burden of disease that can be reduced. If you do become ill with the flu, stay home. If you have underlying illness like diabetes, heart disease or asthma, don’t forget that prescription anti-viral medication in the first 48 hours of illness can help reduce severity and shorten the course of influenza.

These are extraordinary times, but they are not unprecedented. There have been other global pandemics and world wars which have tested the mettle of previous generations. Now it is our turn to come together to weather thistemporarychallenge. If the saying that adversityintroduces us to ourselves is true, may we discover a character brimming with kindness, selflessness, neighborliness and responsible citizenship.

Stay tuned to health authorities for updates on this evolving outbreak.

Review now this preparation checklist from the North Dakota Department of Health.

Urgent Medicine Associates, 2020