Experts: Strategies Can Reduce Risk of COVID-19 Outbreak

Since March, researchers at the Jacobs School of Medicine and Biomedical Sciences and the School of Public Health and Health Professions have been working on modeling COVID-19 transmission rates for the Erie County Department of Health.

In July, the researchers presented to physicians and New York State public health officials a mini-grand rounds session hosted by Kaleida Health titled “Go Masked or Go Home.”

It depicted how COVID-19 might affect Western New York in the coming months, depending on how closely community members follow public health recommendations.

Data were presented by:

• Peter Winkelstein, MD, executive director of UB’s Institute for Healthcare Informatics and clinical professor of pediatrics in the Jacobs School
• Matthew R. Bonner, PhD, associate professor of epidemiology and environmental health in the School of Public Health and Health Professions
• Gabriel Anaya, MD, a trainee in the clinical informatics fellowship program, and Sarah G. Mullin, a student in the doctoral program in biomedical informatics, who are both mentored by Peter L. Elkin, MD, professor and chair of biomedical informatics

The number of cases locally is still low and the percentage of positive tests is currently between 1 and 2 percent.

However, the UB researchers warn that this situation could be about to change, especially with so many states in the midst of outbreaks that have overwhelmed their health care systems.

“There are rising cases in the states all around us,” Winkelstein says. “They’re coming closer and closer. There are multiple prongs of danger facing us in the next month or two. As a community, there are steps we can take to manage the risks.”

“Until we get a vaccine, we’ve got a limited set of strategies with this,” Bonner notes. “We must wash hands, wear masks, and stay socially distant. The more we practice these strategies, and the more masks are worn in Erie County over the next few months, the more we might be able to avoid what’s happening in other states.”

Winkelstein adds: “Right now, we are benefiting from warm weather, so people are spending a lot of time outdoors. Once the weather isn’t so nice and we get into flu season, wearing masks will become even more essential.”

A key aspect of the models that Winkelstein and Bonner and their UB team have developed is that they illustrate how people move through the stages of COVID-19, from exposure to asymptomatic infection and then, in many cases, on to symptoms.

The UB models address both presymptomatic and asymptomatic transmission. Presymptomatic transmission is a period of a couple of days where people are spreading virus, but have no symptoms. It appears that every infected person goes through this period.

But some infected people never develop symptoms; they are asymptomatic. A recent publication in the Annals of Internal Medicine put the percentage of people infected with COVID-19 who remain asymptomatic and never show symptoms as high as 45 percent. 

“That’s one of the things that makes this virus dangerous,” Winkelstein says, “unlike the flu, where people feel sick and in most cases stay home. This is why you have to wear a mask all the time because you may have it, but not realize it because you still feel well.”

In the graph below, the UB models, based on the literature and the team’s mathematical modeling of how face masks work, illustrate how different levels of mask-wearing by Western New Yorkers could affect COVID-19 hospitalizations in the coming weeks.

The graph shows that if 75 percent of the community wears masks whenever they are in public, the number of patients in local hospitals would stay very low through September.

But if only 25 percent of community members wear masks in public, the number of patients hospitalized with COVID-19 increases dramatically, which would potentially overwhelm the local health care system.

That simple fact, say Winkelstein and Bonner, is the most powerful reason why people need to wear masks in public, nationwide.

“The level of infection in the community is an incredibly powerful driver,” Winkelstein adds. “Once it’s out of control, you’ve got to get it under control before doing anything else.”

The UB modeling team works in close collaboration with the Erie County Department of Health and other organizations in Erie County, including Kaleida Health, Erie County Medical Center, Catholic Health, UBMD Physicians’ Group, Independent Health Association and HEALTHeLINK.