When the IMHE models were introduced, there was a pretty high peak in the number of COVID-19 infections. Related to this high peak, there were a significant number of hospitalizations and deaths in a very short time period. The fear was we would run out of hospital beds and critical care resources such as ventilators. The Coronavirus Task Force extended their original guidelines to slow the spread from 15 days to 30. The goal was to flatten the curve on the IMHE model.
What It Is
What does “flatten the curve” mean? It meant we as a nation were buying time to ramp up medical resources so that every patient could receive needed care and to try and identify effective therapeutics. Largely, these goals have been met. Every patient who has required an ICU bed or a ventilator has been provided one. We have been able to shift these resources between regions with outbreaks. The federal government continues to build additional capacity in the event it is needed.
There are also dozens of clinical trials going on for therapeutic drugs. Clinicians have offered anecdotal information based on patient experience and we continue to refine how those with severe disease are cared for. Our testing system has been significantly upgraded. Supply chain management has been upgraded through public/private partnerships and new systems to identify and deliver resources on a just in time basis.
What It Isn’t
This is why the United States in among the lowest global mortality rates from COVID. However, this period of severe social distancing and economic shutdown was never meant to stop the virus from circulating in the population. It was meant to slow the rate at which it moved so our healthcare system would not be overwhelmed. When you flatten the curve, the area under it remains largely the same. The curve just extends over a longer period of time and the peak is blunted.
Anyone expecting COVID to disappear from our lives is under a serious delusion. As we open up, people are going to continue to test positive. Some will get severely ill. A small number will unfortunately die. What we can be assured of is that every patient will be properly cared for. We can also have great hope that treatment will continue to improve lowering the number of severe cases and fatalities.
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I feel the need to make this distinction because my state, Georgia, will be one of the first to emerge from severe lockdown. On April 3, Governor Kemp issued a statewide stay at home order. Until that point the response was being managed at the local level. My particular area had been closed with stay at home orders for two weeks prior to that point. Most of us have been hunkered down for over a month.
The Governor has now authorized opening up certain types of businesses with conditions beginning Friday. Like other Governors who have opened beaches or are inching back to somewhat normal operations, Governor Kemp is coming under significant criticism. Media talking heads and Democrats like failed gubernatorial candidate Stacey Abrams are screaming. “People are going to get sick!” “People are going to die!”. More than likely, this is the case. No one ever said it wouldn’t be.
Other Public Health Costs
However, no one is calculating the real public health cost of continuing to stay locked down. What are the cost in lives of missed mammograms, colon cancer screenings and blood A1C labs? How many new cancers have we missed and heart stents haven’t been placed? What are the life threatening effects for those awaiting joint surgeries who have lain immobile for 45 days? COVID-19 is not the only illness that people become very ill or die from. It is not even the most common.
There will absolutely be deaths that can be attributed to delay or denial of treatment during this time period. Hardly anyone is talking about them. Meanwhile in Georgia, healthcare workers are being furloughed and ancillary services like physical therapy have closed their doors. Given our total COVID-19 experience to date, it makes no sense to continue these policies regarding so called “elective” healthcare.
We Are Smarter Now
Additionally, we know who are most vulnerable to COVID-19 and how to protect them and the public. No one in Georgia or is suggesting we throw open nursing homes to visitors. Or that those with pre-existing conditions change what they are currently doing. However, for large swaths of the population the risk is relatively low. This becomes even more evident as data on asymptomatic cases continues to accumulate.
So long term we will have to make accommodations for children with asthma and continue to help and support the elderly with heart disease. This doesn’t mean an entire generation of children needs to miss another school year. It doesn’t mean the local hair salon can’t service half the clients they normally do with proper precautions. That the local movie theater can’t improve cleaning between shows and sell a third of their tickets. Or that family groups can’t eat in a well cleaned half empty restaurant.
It is imperative to remember that the people screaming the loudest generally have not missed a paycheck. For some reason they also think you are incapable of taking in information and making good decisions. They have also been wrong about almost everything. From comparing COVID-19 to the flu in January, then calling the China travel ban xenophobic, to the estimation of the impact. The experts were building the plane while they were flying it. As one might expect, their models were way off.
Experts have a narrow focus by definition. It is time to let Americans look at the big picture and make their own decisions based on all available information. They asked us to help flatten the curve. We did exceeding all expectations. It would seem we can be trusted not to screw it up now.
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