Representative Ami Bera, congressperson with California's 7th congressional district in Sacramento, told researchers on a video call Wednesday morning that the shutdown of US states in response to COVID-19 will probably be eased in stages by geography, with some areas of the country opening before others.
"I think specific geographies and communities will open up first," said Bera, who is the former chief medical officer for Sacramento County, before coming to Congress in 2013. "We have to know what level of immunity exists in a community," said Bera.
At issue, said Bera, is the uneven way in which some states moved quickly to "flatten the curve of infections," while others had taken their time. That meant some states were ahead of others, he suggested.
Strict measures in California in early March "gave our hospitals the capacity to prepare, to get protective equipment in place, as they could, and gave us time to ramp up our diagnostic capabilities," said Bera. "Unfortunately, states like Florida and Texas still have not issued mandatory stay-at-home orders," said Bera.
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As a consequence, he implied, "We are leveling-out in California and Washington [state]" in terms of the rate of cases. "But looking at New York and New Jersey and Louisiana, they are seeing this very fast rise."
Bera was addressing a global audience of researchers in artificial intelligence attending a virtual conference via live streaming. The conference, organized by Stanford University's Institute for Human-Centered AΙ, was originally going to be a gathering of about 800 people in California. Organizers decided March 3 to make the conference virtual. The conference has consequently surged to over 10,000 registered attendees, organizers said.
Key to opening up any counties, said Bera, is serological testing. A serological test is not the same as the test for the disease. So-called real-time polymerase chain reaction, or RT-PCR, is the genetic test that is the main way of telling if someone has COVID-19. But a serological test is a way to find out if someone has developed antibodies in their blood as a result of being exposed to the disease, including people who have recovered or who are asymptomatic.
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The tests can indicate how much immunity there is among individuals, which can help gauge how much risk needs to be expected by the healthcare system.
Serological tests have been developed by Stanford and other institutions, said Bera. "We have the test available, and we are now working with the commercial sector to see about funding there to massively ramp up" manufacturing and distribution of the tests, said Bera. "That will tell us how many people in the community have already been infected, recovered, and now have some immunity," he said. "That will help us make a scientific judgment as to when can you open up parts of the community."
Bera's comments suggested an uneven landscape to US status. That sense was echoed and even amplified by Stanford professor Michele Barry, the Senior Associate Dean for Global Health and the director of the Center for Innovation in Global Health at Stanford University, who spoke to the conference following Bera.
"There is clearly going to be a surge" in parts of the US that is still to come, said Barry. "It is going to be very different in different parts of the country, and it has a lot to do with density, that's why you seeing New York City taking off." She said factors such as the "heterogeneity of our population" affect, like age. But although Europe is seeing "lots of deaths," from COVID-19, said Barry, "we are still seeing young deaths, it is not just the older people who have the high mortality."
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Bera suggested to the assembled researchers that "big data" can help with the serologic effort. "That's where it's important the ability to use big data to sort through that, to determine what is the level of immunity not just in a particular part of the country but all across the country."
The serologic test needs to be combined with the RT-PCR tests, to determine what areas to open up, Bera said. "We have been told a lot by the administration that the testing is coming," Bera said, referring to White House comments in recent days. "[Drug maker] Abbott does have a point-of-service test ready that should be distributed fairly soon," he observed.
"The diagnostic test will tell you whether you have disease, and the serologic will be a finger-stick blood test to tell you if you have immunity, maybe even if you never had symptoms -- that also will be incredibly important to make decisions how to reopen."
"We need that to make decisions about re-opening," he said. "We still see pockets of clusters emerging" with the disease, and "we have to have the ability to go into those clusters and do contact tracing," he said, referring to the detective work of finding out with whom infected people have been in contact.
Out of 750,000 or so cases of COVID-19 globally, the US now leads the world with 140,640 cases as of Tuesday, and 2,398 deaths from the disease, according to the latest report from the World Health Organization.