President Donald Trump took a lot of flack recently for comments he made about the coronavirus outbreak, including an assertion that because the illness caused by the virus is mild in most cases, many “go to work, but get better.”

The president didn’t come right out and say everyone should head on in, regardless of whether they have a cough, fever or other COVID-19 symptoms. But his comments acknowledged that working while sick, in America at least, is commonplace.

In doing so, he missed an opportunity to decry this particular practice, public health experts say.
The president’s remarks were technically correct; symptoms are indeed mild for most, and many don’t even get sick enough to bother seeking medical attention.

But that’s only part of the story.

Paul Offit, an internationally respected and often-outspoken virologist and immunologist at Children’s Hospital of Philadelphia who has authored several books that push back against the anti-vaccination movement, said that communicating the bigger picture is particularly important in a situation where a “novel” virus is involved.

Because most immune systems have not yet encountered this particular microbe, most people that an infected person encounters are fertile ground for transmission. That’s not the case for something like a regularly circulating strain of the flu where some who are exposed won’t transmit because they’re already immune.

“COVID-19 is likely to spread through the United States because there is no population immunity in place as there is with other viruses that we’ve seen before,” Offit said.
It’s probably too late to stop this particular virus from making its way through communities from sea to shining sea, experts say. There are just too many complex interactions between the hundreds of millions of people who live here to quarantine everyone with possible exposure.

In that kind of environment, then, it’s on individuals and organizations to do what they can to limit the spread. The key is to limit the number of cases to a level that can be served by available medical resources.

The truly heartbreaking aspect of China’s outbreak was that it snowballed so fast from a few cases to thousands that the demand for relatively commonplace medical interventions quickly overcame available treatment capacity.

Absent an effective vaccine, one of the most important ways that people can put the brakes on transmission is to stay away from others when symptoms appear.

This is nothing new. It’s the same old advice that public health departments give every year when flu season approaches. The problem has nothing to do with medicine and everything to do with culture, says Dr. Ashish Jha, incoming dean of the Brown University School of Public Health and outgoing director of the Harvard Global Health Institute.

The physician is the first to admit that he has been part of the problem. Everyone has.

“As a practicing physician, I’m embarrassed to say that I have gone to work sick, because that is the cultural expectation,” Jha said. “Every other physician I know has also gone into work sick. I’ve seen nurses come to work sick, not because any of us want to infect other people, but because it’s the cultural norm that you’ve got to be tough, and you’ve got to carry your responsibility.”

But, thinking like an epidemiologist, it’s the exact wrong approach.

Staying home, if you’re trying to stop something from spreading, should be lauded. And it’s not like anyone is really saying that workers and students should come in if they’re unwell. Everyone says to stay home but there is a cultural understanding that the social expectations are often different than the official message.

What’s needed, public health officials say, is cultural change.

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