4/18/20: THE BEACON SPEAKS ABOUT THE RETURN OF NON-RESIDENT PROPERTY OWNERS AND ‘NORMALCY’ ON THE OUTER BANKS

I have taken some heat lately from loyal local readers who believe I have “aligned” myself with non-resident property owners and realtors against the interests of their continued health, safety, and welfare.

I cannot control the way people think, but I can say that I have no “side” in any conflict that may exist between Outer Banks resident property owners and non-resident property owners except the one that supports reason, science, reality, and the dissemination of information.

Non-resident property owners make up a large segment of The Beacon’s readership, and I am cognizant of giving them news that they can use to make informed decisions—in much the same way as I seek to empower locals with reliable information.

Non-resident property owners also make up a large segment of the Outer Banks community. Our coastal community, as we know it, would not exist without non-resident property owners. That’s a simple reality.

I believe it is a mistake to regard non-resident property owners as barbarians at the gates who potentially bring disease with them, rather than as good neighbors who will work with us to continue our successful mitigation efforts.

Those who do not choose to work with us in preserving and protecting the health/safety/welfare of Outer Bankers should face serious legal consequences.

If I had been on the Dare County Control Group a month ago, I would not have been so quick to bar non-resident property owners from access. I do not see the Control Group’s decision as a tough one, but as a “light-switch” easy one. Black-and-white. I am inclined toward more nuanced thinking and problem-solving.

If I had been persuaded, however, by both the scientific evidence and recommendations by credible public-health officials that a temporary ban was advisable, I would have at least given non-residents a weekend’s notice so that they could make plans. The County could have asked all non-resident property owners who arrived over the weekend of March 20-22 to self-quarantine for two weeks, as other jurisdictions nationwide have done.

The County also could have made mandatory protective measures such as social distancing, wearing face coverings in public spaces, limiting the size of group gatherings, etc., etc.

We locals seem to be living in a magical castle now, and the Currituck Sound is our moat, but sooner or later, the drawbridge must be lowered. The operative questions for all concerned are when and how?

THE VIRUS IS ‘OUT THERE’

I think of what appears to be our safe Outer Banks environment—even though we know the new coronavirus, SARS CoV-2, is “out there”—as a bubble or a cocoon. I am astonished by the number of people who do not cover their faces in stores and who are out and about, doing goodness knows what.

I also think it is a mistake to analogize the COVID-19 pandemic to a hurricane, which inevitably passes, and to think of non-resident property owners as having been evacuated, although I support a staged reentry that would allow non-resident property owners access before visitors when the restrictions are lifted.

I see the task before the Dare County Control Group now as figuring out how to reunite the Outer Banks community without endangering the people who are already here.

I do not think the reunification has anything to do with who pays how much in property taxes, how much rental income may be lost, or even about someone’s right to travel. It is, and always will be, about public health.

This new SARS (severe acute respiratory syndrome) coronavirus is not going to “miraculously disappear,” as President Trump incorrectly informed the public some weeks ago, much to his real scientific advisers’ chagrin.

That description might be applied to the coronavirus strain that caused the SARS epidemic of 2002-04, which killed 774 people, mostly in China and Hong Kong, but the reality is that intensive contact tracing and case isolation likely contained the spread of SARS CoV-1.

The transmissibility of SARS CoV-2 is far different from the transmissibility of the earlier strain. It is much more aggressive and insidious. It is highly contagious.

Dr. Anthony S. Fauci of the National Institute of Allergy and Infectious Diseases has made this point on numerous occasions. Just last Thursday, he reportedly told Fox News host Laura Ingraham during an interview: “[T]he degree of efficiency, of transmissibility of this is really unprecedented in anything that I’ve seen. It’s an extraordinarily efficient virus in transmitting from one person to another. Those kinds of viruses don’t just disappear.”

SARS CoV-2 is what a background source of mine, who formerly served as chief of the Bureau of Drugs at the U.S. Food and Drug Administration and maintains high-level contacts there, calls “a wily opponent.”

It is both wily and unpredictable.

THE POST-ACUTE PHASE OF COVID-19

I contacted Southern Shores Realty Co. for comment last week, and I published owner Mike Stone’s letter to SSR’s homeowners about realtors’ discussions with the Dare County Control Group, because I believe people should know how the predominant rental company in Southern Shores is operating during the COVID-19 emergency and how it views the upcoming summer rental season. This is what I consider important public information.

We have no investigative reporters on the Outer Banks. If we did, we might already have had the benefit of articles written about the viewpoints of a sampling of rental property companies, as well as restaurant owners and other businesspeople affected by the COVID-19 restrictions, and we definitely would have more accountability from the Dare County Control Group than just videotaped messages from its chairman, Bob Woodward.

(It appears that today’s Dare County Emergency Management bulletin is a message from Mr. Woodard that was posted yesterday. See https://www.darenc.com/departments/health-human-services/coronavirus.)

What passes as news in our local media is mostly what public-information staff for government officials print in press releases.

If I could investigate, I would most want to speak with local, state, and national public-health officials, as well as prominent scientists, such as Dr. Fauci, about what we can expect in the post-acute phase of COVID-19.

Once the acute phase of this severe respiratory disease subsides, that is where we will be, and we need to plan for that. Anyone who thinks we will simply pick up where we left off in February is sadly mistaken.

In an editorial published online yesterday by the Journal of the American Medical Assn. (“JAMA”), two physicians write:

“It is impossible to know exactly what the future pattern of COVID-19 disease activity might be, because it seems that the only predictable aspect of this pandemic is that it has been unpredictable. For instance, it is unknown whether there will be substantially less disease over the coming months, or whether a second wave of pervasive severe disease will emerge.”

The authors—one of whom specializes in emergency and preventive medicine—go on to say that as “more reliable data and evidence from the acute phase of the pandemic” become available, it may be possible to provide “some insights about the future potential consequences of COVID-19” for the nation’s health-care system.

See “COVID-19: Looking Beyond Tomorrow for Health Care and Society” at https://jamanetwork.com/journals/jama/fullarticle/2764952

Another recent editorial in the JAMA identifies the fall of 2020 as a “key milestone.”

These physician-scientists, one of whom is at the prestigious Johns Hopkins Bloomberg School of Public Health, write:

“If the initial social distancing and perhaps warmer temperatures reduce the scale of the outbreak this summer, there is a major risk of a resurgence during the traditional season of respiratory viruses.”

They recommend that the United States suspend the first year of medical school for one year and give the incoming 20,000 medical students the opportunity to join a national service program for public health that would begin with their receiving training in July on infectious disease epidemiology, outbreak response, etc., so that by August, they could deploy to state and local public-health departments to support a “test, trace, track, and quarantine strategy.”

See “A Bold Response to the COVID-19 Pandemic: Medical Students, National Service, and Public Health,” at https://jamanetwork.com/journals/jama/fullarticle/2764427

You also may be interested in a Jan. 23, 2020 JAMA article that Dr. Fauci co-authored, titled “Coronavirus Infections: More Than Just the Common Cold,” available at https://jamanetwork.com/journals/jama/fullarticle/2759815.

THE ‘NEW NORMAL’ AFTER THE SURGE

Governor Roy Cooper talked broadly last week about testing, tracing, and trends in the post-acute phase. He gave the outline of a plan, but no details.

How exactly will statewide testing and tracing occur after restrictions are lifted so that we all can be protected—both residents and non-residents alike?

Will we have throughout North Carolina, as well as in Dare County, the public-health infrastructure, personnel, and the supplies that we need to do it properly?

I am eager to know more.

In yet another JAMA editorial, two infectious disease specialists, one at Harvard, the other at Emory, discuss how the United States can safely resume “normal activities.”

“In the absence of a breakthrough treatment or vaccine,” they write, “the U.S. must navigate from mitigation back to containment, using the brute-force strategies effectively mobilized by South Korea.”

First, they say, “density must be limited.” The areas in the United States that have been most affected by the disease share in common either having dense urban conditions or temporarily dense population influxes—such as Mardi Gras in New Orleans, or the usual influx of vacationers to the Outer Banks in the summertime.

Decision-makers, such as the Dare County Control Group, must consider the risk of “large gatherings, festivals, conferences, and sporting events” when they determine how to proceed, they write. Businesses and health-care settings should work out schedules that limit crowding, and retailers should consider [continuing] limits of their store occupancy.

“[T]he immediate future of restaurant dining,” these experts write, “is unclear.”

Questions: How many people should be allowed to occupy a rental dwelling at one time or to congregate in close proximity on the beach?

The authors describe “massive testing” as the “cornerstone” of the post-acute phase, both testing of antibodies and of active disease.

I find what these authors say about the second form of testing quite instructive. They give me a sense of the details that Governor Cooper has not offered yet.

“These [active disease] tests,” the physicians write, “must be easy to perform, quick to result, readily and equitably available outside of the health care setting, and inexpensive. Testing must be immediately accessible to anyone with any symptom suggestive of COVID-19, such as headache, fever, runny nose, cough, shortness of breath, diarrhea, malaise, or anosmia [which is the loss of smell].

“Furthermore, because asymptomatic and presymptomatic transmission is important, additional wide-scale intermittent testing (e.g., weekly) of asymptomatic persons also may be required, particularly for individuals with significant exposure to others, such as athletes, teachers, service industry employees (e.g., in retail and maintenance), and health-care workers. Strategies such as home testing should be aggressively pursued to allow people to self-test whenever necessary.”

I would like to know how feasible home testing is, and, if it is feasible, how far away we are from having such testing available.

Of course, once people are identified with COVID-19, the authors write, they “must be immediately informed, educated, isolated, and then their contacts efficiently identified” and, in order to achieve effective control, “quarantined within 24 hours.”

The authors also discuss attending to the most vulnerable populations and investing in national public-health infrastructure, plans, measures, and supplies. They suggest an investment of $5 billion would be required.

See “From Mitigation to Containment of the COVID-19 Pandemic: Putting the SARS-CoV-2 Genie Back in the Bottle” at https://jamanetwork.com/journals/jama/fullarticle/2764956

In his interview with Fox’s Laura Ingraham, Dr. Fauci said again, as he has many times before, that the COVID-19 threat is “not going to be over to the point of our being able to not do any mitigation until we have a scientifically sound, safe and effective vaccine.”

While the Dare County Control Group waits to see how Governor Cooper will gradually “reopen” the state, it should be conferring with public-health and scientific experts now about how to prevent an increase in COVID-19 cases on the Outer Banks when people start arriving. Members should be educating themselves and doing what they can to help the local health-care system and the population prepare.

There is not going to be a return to business as usual. The mitigation steps that the Control Group leaves or puts in place will be critical to our immediate future.

DRUGS IN THE PIPELINE

Just as a postscript, I would like to note that my FDA source has said that he is “not optimistic that any of the drugs now being tested will prove to be dramatically effective against COVID-19. Certainly hydroxychloroquine is not.”

“To be really useful,” according to my source, who was a trusted associate of my late drug-czar father (about whom I have written), “any new drug has got to reduce mortality and/or the number of people who need the ICU, and that should be easy to determine in well controlled short-term trials.”

If you would like to read the latest about therapeutic drug trials, see:

The NIH: https://www.niaid.nih.gov/diseases-conditions/coronaviruses

The CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html

Reports I read in medical journals, particularly The New England Journal of Medicine, indicate that the most promising therapeutic trials have occurred with Gilead Sciences’ antiviral drug, remdesivir, which has been used to fight the Ebola virus. All data on its effectiveness so far are limited and preliminary, however.

Have a good Sunday, everyone.

Ann G. Sjoerdsma, 4/18/20