Category Archives: Later, on health

No Time To Relax

There was a lot of discussion about when to “open the country” again. The president was hoping to do it “very, very, very, very soon.” He would decide when that should be, he said, based on some miraculous metrics in his head. It had to happen soon because “the cure could not be worse than the problem.”

I didn’t know what any of this meant. I suspected he mainly wanted to preen. He wanted the credit for “opening the country” but none of the blame if anything went wrong. Blame was for governors (losers) who had issued stay-at-home orders in their states.

He had boldly announced on April 13: “The president of the United States calls the shots.” In what surely would have been news to Thomas Jefferson, he said that the president had “total authority” to tell state governors when to “reopen.”

The next day, he said that he would soon be “authorizing each individual governor of each individual state to implement a reopening and a very powerful reopening plan of their state.” But, he said, “We will hold the governors accountable.” The federal government, he said, would be “watching them very closely.”

I supposed that any day now he would declare the nation open for business, and if the economy did not “roar back” as he had predicted, then it would be because the governors failed to fall in line. Behind the scenes, I presumed, he would try to make governors cooperate with his “open the country” edict by withholding vital medical equipment or other assistance that the federal government could provide but only if governors were sufficiently appreciative of his efforts.

Most governors who had weighed in on the subject did not seem to be falling for this foolishness. The governors of Washington, Oregon and California announced a coordinated “West Coast framework” for cautiously easing up on the mitigation measures that had been put in place to slow the spread of the coronavirus—measures that so far appeared to be working.  

The president’s fantastical I-will-open-the-country notion was illusory. The coronavirus would continue to spread, and for now, our only defense was to slow it down. It was not a question of whether or not to “open the country.” Ninety-five percent of the people were still susceptible and vulnerable to the coronavirus. The real public health challenge was how to maintain our only defense against the virus—blocking its transmission—while creating safer environments where more people could get back to work, more businesses could operate, and more friends and families could be together—in actual, not virtual space—and feel less isolated.

Modification of stay-at-home orders would come when the rates of new infections declined and stabilized at a level that medical facilities could handle. It would come when widespread testing for coronavirus infection had at last become possible. It would come when each state had adequate stocks of necessary medical equipment and supplies of all sorts. It would come when it became possible to test, quarantine and contact-trace.

We already had the template for economic life in the shadow of the virus because, in fact, much of the economy had never closed (grocery stores, mail and package delivery, construction, public safety, and medical facilities to name a few areas of economic activity considered “essential” and therefore exempted from stay-at-home orders). Many of these activities had adapted to the risk by adopting mitigation measures that effectively interrupted the transmission of the virus.

I had no doubt that, in time, other types of economic activity would adapt. “Opening the country” would not happen by presidential decree on a date selected by the commander-in-chief. We, the People would decide. The economy would not begin to approach normal until we felt safer—safer to work, safer to shop, safer in numbers. It would be gradual, and there would be setbacks. A second COVID-19 wave seemed likely in the fall.

Would people feel safe going to restaurants any time soon? Would theaters re-open if audiences continued to fear potentially fatal infections? Would fans feel safe enough to fill arenas and stadiums to watch sporting events without wondering whether they would be risking their lives? When would parents have confidence that their children would be shielded from the virus at school? How could we be protected from the virus while receiving various kinds of personal services that by their nature involved close person-to-person contact?

No one had all the answers, least of all the fat guy in the White House with the Super-Bowl ratings. The economy had already been severely damaged and damaged beyond repair for some businesses. Things would not get “back to normal” until people could safely mingle more, and normalcy ultimately implied having an effective vaccine. The timeline for vaccine development was uncertain. The most optimistic estimate was a year, but it could take much longer, perhaps three to five years.

What we did know was that this particular coronavirus, left to its own devices, could spread at an astonishing rate. We had watched it happen.

By March 13 (the day the president declared a national emergency) there had been 1,629 reported COVID-19 cases in the United States, and 41 people had died from the disease.

One week later, the cumulative number of COVID-10 cases had grown to 15,219, and the number of deaths had grown to 201.

One week later, there had been 85,356 cases and 1,246 people had died. Meanwhile, in my state, 414 cases had been reported and 12 people had died.

One week later, the cumulative number of cases in the US had grown to 277,205 and 6,593 people had died from COVID-19, and in my state, there had been 899 cases and 22 deaths.

One week later, by April 10, the number of cases had grown to 492,416 nationwide and there had been 18,599 deaths; in my state, there had been 1,371 cases and 48 deaths.

It appeared from the data that a peak fatality rate of 2,150 deaths per day had been reached on April 13.

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Is All This Really Happening?

As April began, more than 277,000 people had tested positive for the coronavirus and 6,600 people had died from COVID-19 in the United States. Worldwide, deaths now exceeded 57,000.

It was estimated that 80 percent of the people infected with the virus would recover without needing special treatment, but the other 20 percent would become seriously ill and many would require hospitalization. Too many would die a horrible death. Unable to breathe on their own, they would be put into an induced coma, intubated and hooked to a ventilator, with the weak hope that their ravaged bodies would still be strong enough to fight off the virus.

As an “older person” (over 65), I was at higher risk of severe illness if the virus were to get to me. The last place in the world I wanted to be was in a hospital. Fortunately, I did not have any of the underlying medical conditions that would make a person even more vulnerable to life-threatening illness. Still, it was unnerving to be an older person–a cohort that some whippersnappers called “elderly.” Good God.

Our best defense was to hide from the virus: stay home, stay safe. When it was necessary to go out, we were told to practice “social distancing”—keeping at least 6 feet away from other people. We were advised to wash our hands a lot. Our hands could betray us by straying to our face, mouth and nose, possibly transporting a little gang of coronaviri to our respiratory tract where it would soon grow into a larger gang and quickly into an army.

Whether we should wear home-made cloth facemasks was a hot topic. The answer was complicated. The mask would not protect the wearer from the tiny virus itself, which could penetrate most fabric face coverings. But a mask would filter moisture droplets exhaled by the wearer, droplets that could carry the virus to another person. You could be symptom-free and yet have the virus and potentially spread it to others. Wearing a mask was less about self-protection and more about showing care for other people.

Because the country was not prepared for a pandemic, masks that could block the virus (N-95 masks) were in short supply, and available N-95 masks were rightly being reserved for hospital personnel, who were risking their lives to treat COVID-19 patients.

We did all of the things that we were advised to do. In the past month, I had left the house only to go to the grocery store (once a week) or to take walks (daily). I felt that maintaining my health and strength was my last best defense against the virus, and daily walks were part of that health-maintenance regimen. I rarely encountered other humans on my walks, and I was careful to social distance from them.

My isolation at home was not total. I was blessed to share the solitude with my wife. We were thankful for each other’s company, and spending time away from other people was not a big change in our life-style. And yet, isolation was more difficult than it looked. On the surface, physical isolation was not difficult. Our home was our refuge, but I felt besieged. I could not psychologically isolate.

I could not make it through a day without knowing the latest coronavirus news. What the virus had done to the world was frightening. When the pandemic would end was unknowable, and the end would not come any time soon. I knew that it was months away. Estimates were that it would be at least a year before an effective vaccine would be available.

The Institute for Health Metrics and Evaluation at the University of Washington estimated that the “end” of the “current wave” of the pandemic in the United States would come in early June, defining the “end” as the soonest that carnage from COVID-19 would drop below 10 deaths per day. Meanwhile, we would reach the peak of the wave (3,130 deaths in a day) on April 16.

The IHME projections assumed that everyone would maintain recommended social distancing and other precautions against spreading the virus. And there could be a second wave ahead: “By end the of the first wave of the epidemic, an estimated 97% of the population of the United States will still be susceptible to the disease, so avoiding reintroduction of COVID-19 through mass screening, contact tracing, and quarantine will be essential to avoid a second wave.”

The IHME estimated that 81,800 people, possibly many more, would die in the US by the end of the current wave.

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