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By year's end, the warning forecast from the University of Washington health institute states that 410,000 deaths -- 30 percent of which could be avoided through the cautionary practical use of wearing protective face masks -- will materialize. By December under lax conditions of prevention, deaths could conceivably rise to 3,000 daily.

The fearsome message was leavened with the advice that such totals could see a substantial reduction were more Americans to take medical advice more seriously and commit to wearing face masks just as epidemiologists have advised. But the advice comes in the face of cautionary fatigue, when people are fed up with social isolation, of facing a reality where normal routines have been interrupted, and a spirit of defiance has overtaken many groups within society.

Those who delight in denying the efficacy of wearing face masks to prevent the spread of the SARS-CoV-2 virus causing COVID-19, flaunting safety rules for the spontaneity and freedom that is their right. Attending protests against wearing face masks, a kind of collective euphoria at flouting medical authorities' recommendations to protect the entireity of the population while stunting the freedom of others.

 

The IHME model projects a death rate cited by the White House Coronavirus Task Force where tripling the current death rate of about 850 daily is entirely feasible. A message that appears to be passing by the spirit of the brave and the young who can never imagine anything smacking of danger and early death threatening them. And appear to have difficulty thinking beyond the well-publicized fact that youth contracting COVID-19 rarely results in death.

Calculating beyond one's own potential safety in the balance and choosing to celebrate life in youth's usual carefree manner, challenging fortune to alter the course of their chosen goal of pleasure and liberty to do as they wish -- to steer thoughts toward the realm of personal responsibility as part of a community of family, extended relatives, co-workers and friends is analogous to surrendering the beauty of youthful years to those of stodgy maturity.

The same modelling projection was extended to a report on the situation globally as pertains to the global pandemic and things don't look much rosier in that direction either. Deaths projected to triple to 2.8 million by January 1, 2021. Appearing to entirely discount a global inoculation that may be accelerated before the end of the current year in reflection of a vaccine already in use in Russia, with other researchers in hot pursuit of their third trials and the possible release of authorized doses to begin a global push to inoculate.

In the meanwhile, the nation with the world's third largest population is in the dubious position of leading the world with over 186,000 COVID-19 deaths amongst 6.1 million infections and growing. A situation that makes it all the more puzzling that a significant group within the population refuses to offer protection to the more vulnerable within society by the simple, albeit irritating expedient of wearing protective masks and practising logical social distancing.

 

"We're doing our very best. Sorry, Manila", President Rodrigo Duterte said  in response to the number of cases breaching 100,000 as he reintroduced a "modified enhanced community quarantine", for the capital and its outlying areas to restrict non-essential businesses while permitting people to leave their homes only for work or to buy food. On Sunday, the Philippines recorded 5,032 additional infections, representing the country's largest single-day increase for a total of 2,104 deaths.

In Iran, new data has emerged suggesting the number of deaths recorded by the government stood at 42,000 until July 20, as opposed to the total of 14,405 deaths released in a report by the health ministry. The same data showed 451,024 cases, close to doubling the 278,827 officially reported. BBC Persian had obtained the documents even while a resurgence was reported by the health minister. In rejecting the BBC report a health ministry spokesman claimed foreign media relied on anonymous sources and unscientific methodology for their own political purposes.

Dr. Tedros, speaking from the Geneva headquarters of the World Health Organization, issued his warning in response to the over 18 million cases of COVID-19 recorded world-wide, of which the United States, Brazil and India continued to report new infections in ongoing high numbers. Australia and Vietnam are also reporting a resurgence of cases, requiring a return to lockdown conditions. The death toll globally stands at a grim 688,080.

Leading Mr. Tedros to urge countries to continue testing, isolating and treating patients while tracing and quarantining their contacts. Melbourne, Australia closed all non-essential businesses in re-instituting lockdown measures in wake of a recorded 429 new cases and 13 deaths overnight on Monday. In the United States, Dr.Fauci emphasized how crucial it is that the outbreak be contained before the arrival of autumn when influenza numbers have the potential to spike alongside COVID-19.

He cautioned as well that though young children don't become seriously ill from COVID-19, they may still become infected and spread the virus in the community. As people begin to assemble indoors when cooler weather arrives with the fall, the risk of contagion steadily increases. Countries with high transmission rates, including Brazil and India, need to be prepared for the future, according to the WHO's head of emergencies. "The way out is long and requires a sustained commitment", reminded Dr.Mike Ryan.

And then, the interesting news that a WHO-led team comprised of Chinese and international experts is to be set up for the purpose of studying the SARS-CoV-2 virus's origins in the city of Wuhan.

Social Distancing in Closed Environments

"Very early on, we wrote two letters that we posted on social media that got tonnes of attention."
"Our method of protecting ourselves and the public from being infected is social distancing. And if  you can't social distance ... you're just inviting disaster to strike."
"If you've got two people who are in a stadium and you tell them, close your eyes and just start walking around, the odds that they're going to walk into each other are pretty small. But if you have those same two people doing that in a room that's six-by-six metres, there's a pretty good chance that they're going to knock into each other. It's a simple function of the ability or the inability to distance." 
"One of the advantages we have with long-term care facilities is at least we've been able to understand some degree of the problem. Someone's peeled back the scab, so to speak, to look under the bandage and we can see how absolutely horrific what was going on has been."
"The residents in these populations, we're just going to lose them. And that's a scar upon us if we can't protect our vulnerable."
"These are not closed systems. There are people who go and work there. And if we can't protect the healthcare workers, then almost certainly we're not protecting the health-care workers' families and therefore we're not protecting the public that is in contact with the health-care worker and their families and therefore we're not going to be able to get a hold of this whole problem."
Dr.Andrew Morris, professor of medicine, University of Toronto

"I think we're starting to see very quickly that hospitals are not really the front line of this pandemic in Canada."
"I think now people are almost playing a game of catch-up when you start looking at these settings [care homes for the elderly or disabled]."
Dr.Samir Sinha, director of geriatrics, Mount Sinai Hospital, Toronto

The Quebec coronor's office has launched an investigation into a long-term care home in a suburb of Montreal where 31 people have died in a conditions the premier has called "deplorable"

It has now been six weeks and ongoing, where Canadians across the country have been counselled that it is up to everyone to 'flatten the curve'. To remain sequestered in their homes, to go out only on rare occasions when it's absolutely necessary, to remain distant physically from others. Schools closed, non-essential businesses shuttered, public spaces and events off limits, borders closed, travel plans nixed. All well and good, but none of this affected long-term care homes, yet fully 78 percent of all COVID-linked deaths have occurred in long-term care homes.

All of these measures to try to control a hugely infectious and sometimes morbidly-threatening new cornavirus were predicted before the virus entered North America. Dr. Morris, for one, was alert early on that COVID-19 would present an enormous problem to Canada when it arrived, as it surely would. But even he and colleagues of his whose thoughts took a similar track, were unable to visualize just how dramatically the Canadian reality of life-normalcy would ultimately be affected.

The Eatonville Care Centre, where multiple deaths from COVID-19 have occurred, is shown in Toronto on Tuesday, April 14, 2020. THE CANADIAN PRESS/Nathan Denette

He and his colleagues got together to draft several letters outlining the situation that would unfold and their recommendations for an early response to the situation before it became a reality. At the time it seemed so difficult to believe that the country would swiftly be engulfed in a seemingly unstoppable epidemic they scarcely thought their communications would be given the serious consideration it required. Later, it would occur to them that though that attention was forthcoming, they had themselves failed to communicate the extent of the dire conditions that would ensue.

Now that Canadians have embarked on a voyage of countradicting the basic human impulse of sociability in an effort to halt the spread of the virus causing COVID-19, the very enormity of the threat takes on new proportions to our understanding of just how vulnerable we are as a population. But it is a readily identifiable demographic of the population that has borne the brunt of the infections.

Precautions were taken to close schools and daycares to shield children from the SARS-CoV-2 virus, the most readily identifiable group within any population that is given first thought. Fears of overwhelmed hospital emergencies failed to materialize, with hospital admissions and ICU capacity at not only manageable levels, but anxiously awaiting the arrivals of other emergency situations more commonly making use of those facilities that have suddenly disappeared.

People are withholding their presence at Hospital Emergencies, hoping that their worrying symptoms of heart problems, stroke, appendicitis, accidental injuries will somehow abate, rather than subject themselves to the possibility of appearing at a hospital teeming with infectious agents and find themselves infected with the dread virus. And then there is another casualty that few had given prior thought to, but several of Dr. Morris's colleagues had.

The virus that thrives in the company of groups of people in close communion, and sees its opportunities dwindling when people exercise caution to keep physical distances, found its metier when it entered the confines of closed gatherings, where people are placed in situations with tight physical spaces and an abundance of potential targets. Places like nursing homes and long-term care homes, prisons and shelters for the homeless. "Congregate settings", perfect for a virus to thrive.

If more isn’t done to protect shelters, prisons and in other so-called “congregate settings,” advocates warn more mass outbreaks are inevitable. Francis Georgian/Postmedia/File

And in long-term and nursing homes the virus has done precisely that. Shelters and prisons next on the list. "I think we're going to see numbers jump dramatically", Cathy Crowe, a nurse with decades of working with the homeless in Toronto, stated. While many shelters are attempting to implement some elements of social distancing, in their limited spaces it is beyond difficult to adequately achieve.

"It's pretty much impossible to maintain social distancing in pretty much every congregate setting of a shelter or a drop-in, to be perfectly honest", Diana McNally, with her years working in Toronto shelters, offered. "The diagnostic differentiation of COVID among people experiencing homelessness is very challenging", Dr. Naheed Dossani, palliative care physician who often works with the homeless, pointed out.

In prisons and jails outbreaks are beginning to occur. "I'm speaking to senior citizens who are serving prison sentences and telling me, I didn't know this was going to be a death sentence", Paul Champ, a lawyer in Ottawa stated. As for long-term care homes where well over fifty percent of the COVID deaths not only in Canada but globally, have been taking place, the sheer vulnerability of the aged, infirm and health-compromised has shocked the world.

Hong Kong's Social Distancing Success

"As soon as the virus started to break out, and people read 'China' and 'coronavirus', people remembered."
"The social part is one of the reasons why we've been able to keep the virus cases so low, because in some way the public has been able to make the government take measures."
"There is a strong responsibility of people to adhere to social norms and respect the wider community."
Nicholas Thomas, associate professor, City University of Hong Kong

"Social distancing becomes more important if there's sustained transmission in the community and we want to slow it down, because at that point, the first two measures won't be as effective."
"And hopefully the U.S and Europe and other countries can learn from Hong Kong and Singapore in how social distancing can be applied and how our populations can be aware."
Benjamin Cowling, professor, co-director, World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, Hong Kong University School of Public Health

Almost 300 people were killed out of the 1,700 infected with Severe Acute Respiratory Syndrome (SARS) in Hong Kong; the most outside of mainland China. That event had an impact on the psychology of the city, according to Nicholas Thomas. Residents wore surgical masks, avoided gatherings from the very beginning of the outbreak, and that practise during the more current zoonotic novel coronavirus is still ongoing. Which is just as well, considering that COVID-19 appears to have gathered steam and may be re-appearing for a second wave.

Still, Asia appears to have shed most of the anxiety about the exponential spread of this new and sometimes deadly virus; in a steady state where the number of cases are diminishing and control is being rewarded. Its spread in Europe and the United States as its newer destination has placed them in a similar position to which China and Hong Kong found themselves a month earlier. Now, the need to avoid large gatherings is being recognized where recent high-profile infections -- including the Australian home affairs minister and the wife of Canadian Prime Minister Trudeau have become infected -- has certainly raised awareness of self-isolation.

At the end of January when the world was just being introduced to the fact that a new virus had unleashed itself in China, Hong Kong had already put most of its restrictions in place though there were but a handful of cases there. In total Hong Kong, as a result of its swift reaction to cut off the virus, had a total of 139 documented diagnoses. Of that number four deaths occurred in contrast to South Korea which failed to begin taking measures until a month later, February 23, when hundreds of its citizens had already been infected. It registers over 8,100 people infected, with 75 deaths.

Travellers wearing protective equipment enter the arrival hall at the Hong Kong International Airport on March 17, 2020 in Hong Kong.

Hong Kong's relative success came despite a devastating 12 months for the economy and where the virus is further curbing growth, in the wake of violent pro-democracy protests that periodically shut down parts of the city during the second half of 2019. Hong Kong's beleaguered Beijing-appointed leader's popularity is in such high dudgeon that even the effective virus response hasn't lifted her approval rating beyond 13 percent. Carrie Lam had initially resisted shutting the border with China, despite public pressure.

Hong Kong ably demonstrated that the deployment of measures early on would have a dramatic effect. Cities that had implemented multiple 'non-pharmaceutical interventions', closing schools and churches, experienced death rates up to 50 percent lower, with less severe outbreaks than those that did not, during the 1918 influenza pandemic, according to research. Now, according to medical researchers, had China implemented non-pharmaceutical interventions -- from containment and isolation to social distancing -- three weeks earlier, the number of confirmed COVID-19 cases could have been reduced by up to 95 percent.

According to a study released this month, funded partly by the Bill & Melinda Gates Foundation, China's cases could have been reduced by 60 percent if those non-pharmaceutical interventions had been undertaken one week earlier. On the other hand, the number could have increased 18 times had such measures arrived three weeks later.Clearly, social distancing measures are to be regarded as a critical part of halting the virus after other containment measures have been implemented by governments.

Governments are required to conduct tests to identify and quarantine infected people and those with whom they had contact while also reducing imported cases from overseas, pointed out Benjamin Cowling. Once an outbreak occurs it becomes increasingly difficult to track down suspected cases, and social distancing measures like closing schools, working from home and voluntarily avoiding crowded areas are key to success in social distancing.