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What makes President Trump and his medical advisors think people are going to comply with their new Coronavirus guidelines when most of us are healthy and don’t know anyone who has become infected or died? Why are we being expected to continue to suffer the economic and social impacts imposed to control the spread of the virus in a few “hot” spots around the country when it isn’t a threat to us where we live? We want to get back to normal and we want to do it quickly, not slowly.
On Thursday the White House announced a three-stage plan for getting us on the path back to normal. While it is a welcome change from the control measures we’ve been enduring, the plan faces some significant challenges that my prevent them from being achieved.
- We’re losing our confidence in the numbers being shared by the White House Coronavirus Task Force. First were told that up to 2.2 million people might die from the COVID-19 virus, then it was less than a million and now that prediction is below 70,000 and it may get revised downward. Seeing such a prediction fall 34 times short is causing us to take any predictions we hear with at least a few grains of salt, if not a handful of rock salt.
- We’ve been inundated with reports about the high death toll in New York City. We saw the Javits Center being turned into a temporary hospital and a Navy hospital ship sailing into the harbor. Yes, it’s been bad there. Our hearts go out to those who are suffering and we hail as heroes those who are caring for them. But that doesn’t match the reality most of us see every day as we wonder why the draconian control measures that were needed in a “hot spot” somewhere have been imposed where the rest of us live. That makes it very tempting to just ignore the new guidelines and go back to life like it was before the virus.
- Some of the key elements listed as essential for moving from one stage to the next may be of little or no value. Key among the measurements listed by Dr. Birx and Dr. Fauci is contact tracing, something that works well if you are dealing with a limited number of individuals and trying to contain the spread of a sexually transmitted disease (STD), but the sheer amount of work involved in doing that on the scale of a pandemic makes it largely ineffective.
- The guidelines are designed to be applied on a state-by-state basis. Just as New York City, Detroit, New Orleans, Chicago and a few other places are America’s COVID-19 hot spots, the states also have large “cold” areas that are largely or completely unaffected. So a more practical approach would be applying the guidelines on a county-by-county basis. Doing this will speed our economic recovery because the entire state will not be suffering the same restrictions that may be justifiable in a single city.
- Starting on the path back to normal requires seeing the number of COVID-19 cases to be declining but that number is a largely irrelevant measurement as only a fraction of the people testing positive have worse than mild symptoms. A far more indicative number to use is a decline in the number of new hospital admissions. We also need to consider that the virus incubates for a period of time before symptoms appear so the symptoms seen today were initiated two or three weeks ago.
- Testing for the COVID-19 virus is a critical element in the phasing plan. Testing is essential if medical researchers are to measure the impacts of the virus accurately. However, we Americans tend to have short memories and a threat in the past is often a threat forgotten. So if things are getting better or you’re not seeing a threat to your health why would you be motivated to get tested?
- Stage Three of the President’s plan projects some limits on public activities until we have an effective vaccine. This is a perfect objective but utter nonsense because we don’t have vaccines for the common cold (another coronavirus), HIV/AIDS, Malaria, Ebola or a long list of other diseases that range from a nuisance to life-threatening. That flu shot you are encouraged to get isn’t a vaccine because the formula is changed every year in anticipation of what types of the flu will be spreading and its effectiveness varies from year to year. Pursuing a vaccine distracts our attention away from finding effective therapeutics. Hydroxychloroquine appears to be a potent therapeutic that is more effective the earlier it is given in the course of a patient’s illness. Other therapeutics are in development. We need to temper our hopes for a vaccine with the knowledge that the majority of experimental vaccines fail to prove effective so they are never brought to market. We can’t afford to delay our return to normal by waiting on what may never arrive.
- The COVID-19 virus has been portrayed as a threat to healthy people when the death statistics published by state departments of health and the CDC paint a very different picture. The great majority of the sickest patients and those who die are already weakened by one or more underlying medical conditions that already have the patient on a path to the grave that gets accelerated by the virus. Patients with obesity, diabetes, kidney disease, chronic lung disease, heart disease and some forms of cancer are the ones at greatest risk of having the worse disease outcomes.
This last point presents us with perhaps the most difficult aspect of dealing with the COVID-19 virus because it asks us to examine how we relate to both our health and death. President Trump speaks of the battle against the virus as a war. Combat produces casualties and one of the principles of emergency medicine that was developed by military doctors is helping who you can help and recognizing when someone is beyond helping.
The death statistics are showing us that the people who died were beyond saving because of how the virus worked with their underlying conditions and doctors having no effective way of saving them. At the same time we have millions who are in the earlier stages of these same life-threatening conditions, virtually all of which were the self-induced result of making poor lifestyle choices. In other words, those killer conditions were almost totally preventable just by making good lifestyle choices.
The problem is that as Americans we love to eat what is not good for us, eat in excess, sit on the couch and get flabby. We’ve come to accept that getting fat and getting sick are just things to expect as we get older. But it doesn’t have to be that way. So if there is a lesson we can learn from our war with the COVID-19 virus it is our need to learn to live more healthfully so we won’t be as likely to suffer or die from the next virus that comes around.
We’re waging war on the virus to save lives. Where is the war on the conditions making people more likely to die when they become infected?
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