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Talking to Melissa Graboyes is like fast-forwarding three weeks into the future of Oregon's coronavirus outbreak.
Graboyes, an associate professor at the University of Oregon, has been living in Italy, the country with the second worst outbreak in the world, after China. She's on a year's leave to research and write a book about malaria.
Graboyes has a master's in public health and tracks disease as a historian of medicine. For the last three weeks, though, she has been living through an outbreak.
On March 11, she and two other University of Oregon professors sounded the alarm on the university's tepid response.
Hours after WW published their letter yesterday, the university announced plans to move the courses online.
Now these same professors asking that Oregon leaders more broadly move to follow Italy's lead in enacting social distancing. Their second letter is expected to arrive this week.
Graboyes spoke to WW by phone from the Veneto region of Italy, in Belluno Province.
WW: Accounts of Italian hospitals overwhelmed with patients brought home for me the urgency of the pandemic. Was there a moment like that for you?
Graboyes: About three weeks ago was when local transmission was first reported here in Italy—and it was reported in three towns that were just about an hour outside of Milan, which is where we've been living since the summer. And as soon as I saw that I knew that we needed to leave. [We] packed up our stuff and left the next day. And we haven't been back to our apartment since then.
The first thing we did was we went to [my husband's] parents' in Switzerland and we stayed put for a week and didn't go out of the house because we had colds at that time. And I felt really strongly that if we were showing any symptoms of anything we needed to help isolate. [They have since moved back to a small town north of Venice that is her husbands' family's hometown.]
What would you do if you were home in Eugene?
I would act as if Eugene had a lot of cases and I would begin the preventative measures that Italy started three weeks ago. And I would begin to isolate and practice social distancing, which means minimizing as much as possible your public contact with others. And that means not just minimizing contact with sick people, but minimizing contact with all people.
Because one of the things that's very tricky about this disease is that most people when they've done citywide testing here in Italy, the people who are actually positive for coronavirus, a vast majority of them do not have any symptoms.
Which is great on the one hand, because it means it can be very mild for most people. On the other hand, it means that every single one of those people who do not show symptoms are actually very contagious and on average are infecting two to three other people that they come and talk tact with.
What do you recommend for the average citizen?
The first thing we're advocating is that you need to practice extreme social distancing right now.
And that means working from home, canceling all non-vital appointments, taking your kids out of school, avoiding public places, do not go to the cinemas, do not go to the theaters. Now is not the time to take a plane trip or train trip. Now is the time to really stay at home and sit and wait and not bring yourself in contact with others who may be sick.
Why should people listen to your advice on that?
You could listen to me because I'm in the unfortunate situation of living it three weeks ahead of what is going to come to the United States and maybe it's going to be two weeks from now.
I really hope, I sincerely hope, that Eugene is not hit hard by this, but from an epidemiological perspective, there's every reason to think that it will come to the United States and it will behave in similar patterns.
I've actually spent my academic career looking at infectious diseases. I know for my epidemiological work that the best thing to do right now is to take precautions while you can. And these precautions cost you very little. They're inconvenient. And they might be embarrassing to tell people that you're canceling something cause you're worried about this. But they cost you very little in the long run.
And if, in two to three weeks from now, we discovered that the Pacific Northwest is not an area that's going to be hit hard, it's easy to revert to your normal habits. You've lost very little.
Should we close the schools? Elected leaders don't want to hurt the most vulnerable. What about kids who are hungry or in difficult home situations
Schools need to close as soon as possible. I don't think there's any doubt that there are many, many uncounted coronavirus cases in the Pacific Northwest and in Oregon right now.
We also know that kids are amazing vectors for this disease. Kids are lucky in the fact that they have their resilient immune systems and they have not been hit hard in general by this virus. But it also means that kids in schools touch each other constantly. They put their hands in each other's faces, they put their faces in somebody else's face, they put their hands in their mouth, they share tables, they eat together.
Once those children are infected, they not only infect other kids in the school, they go home and they infect their parents.
There's no easy answer about for children who are in unsafe home situations. I will just say it is an emergency situation. All of Italy, 60 million people, are on home quarantine, starting this morning for a minimum of two weeks. It is an emergency situation, which means that extreme sacrifices are being made and extreme discomfort is being endured by millions of people.
So what, what's your day like now?
For the last four days, almost every 24 hours, we've had a new government directive that has made restrictions tighter than what they were the day before. And so today when we woke up and we, that the new news was we couldn't leave the house.
The president of Italy was on the radio this morning and he said his hope is that Italian towns look like ghost towns. He doesn't want to see anyone out because the civic responsibility right now is for every person to stay at home and protect others.
So are full-fledged home quarantines what you think we should skip to now?
You know, I'm not sure. I think that what they're doing in Italy is responding as fast as they can. The severity of the steps they're taking match the severity of the public health emergency that is facing them.
And this is a well developed, well-funded, well-functioning healthcare system that in some ways rivals or even surpasses the United States in certain metrics.
What models could Oregon follow from abroad?
In Italy at this point, for the most part, they're [only] doing testing for people who are having those general flu symptoms plus a difficulty of breathing. The difficulty of breathing is what they're using as a trigger to say, okay, now we need to test this to see if this is a case that needs to be hospitalized or need some of intensive care. In a few cases they're doing community-wide testing where transmission is really, really high in the outbreak area. [They're assuming] it's widespread in the community and you ask everyone to self-isolate for a period of time to minimize social contact. And you hope that you reduce cases that way.
South Korea took a really different approach and they tested enormous numbers—like tens of thousands of people—in a matter of days. They used a different method which was find every infected person, as many infected people as you can and get them in hospitals and get them in quarantine and off the streets. Even if they're not showing symptoms, you tell them that they're infected and that is the way to stop the transmission cycle or slow the transmission cycle early in the epidemic.
So there are different strategies, but unfortunately Oregon isn't practicing either of those strategies.