The World is Not Ending – by Doctor TANSTAAFL
When word came of a new deadly virus from China, our grown children asked what we thought. We said, “Wash your hands, and don’t pick your nose”. They claimed that was our answer to everything medical, along with ”take ibuprofen and walk it off”. Why were we so convinced the world wasn’t ending?
New viruses come along fairly frequently. Most of them never get noticed. Some of them cause human diseases. Most of them cause something indistinguishable from a cold. Occasionally, there is one that causes more severe problems. Then comes a familiar pattern. The worst cases hit the medical system first making all cases of the illness appear severe and with a high mortality rate. Patients show up really sick and dying and we don’t know what’s wrong. They don’t fit any of our familiar disease patterns. We start thinking a bad pandemic is going to hit, and everyone will die. Then we start recognizing the not-so-sick patients with the disease. As people hear about it, they come to the doctors earlier. We then realize that there is a whole host of people that have it, but aren’t sick enough to come see the doctors. Then, it’s just one of many viruses to worry about. We’ve seen this pattern before…
Remember West Nile Virus? Initially very sick people presented to the medical systems. What if a large number of people caught this new threat and became this sick? Before we knew it people were very upset, we got calls from people saying they had found a dead bird and could we test it for West Nile Virus. One mother called saying she had seen a dead crow and the kids were near it what should she do. As it turned out West Nile Virus was widely disseminated with many asymptomatic cases and most symptomatic patients had a mild cold and a headache. In the end the probability of serious or fatal disease from West Nile Virus turned out to be low and today it has not changed how we live our lives.
Some people did get very sick and some people do die of West Nile Virus as well as other viruses. Each death is a loss, a tragedy to the families involved. We understand. Our jobs are to keep it from happening whenever possible. We know there are always those who are more at risk, every year, from viruses. Older people, people with compromised immune systems, anyone with lung disease. And always, the very unlucky.
Where are we now with this Corona virus? Initially, only severe life-threatening cases presented to the medical system. We did not know how high the mortality rate was and how easily the virus spread. What if a large number of people caught this new threat and became deathly sick? Over the past few months we have learned that the virus is widely disseminated, there are many more asymptomatic cases and people with very mild symptoms then people who get deathly ill and that certain populations are greater at risk than other populations.
Now that we know the novel corona virus is widely disseminated and has a generally lower mortality rate in most populations but a higher mortality rate in some populations, isolation and contract tracing amounts to closing the barn door once the horses have left. Putting a high tech alarm system on the barn and reinforcing it with high carbon steel will not get the horse problem resolved. We should be planning to deal with the now wild and free horses not hoping they return to the barn. It would be nice if we had a medicine to cure the virus or a safe vaccine to prevent the virus from spreading. We don’t, and achieving a medical cure or a safe and effective vaccine in record time is a Hail Mary, good for the end of college football games but not a useful overall game plan. Protecting our vulnerable population, those in nursing homes and care centers and those with altered immune systems, should be our strategy at this point. If a virus is widely disseminated, having the general population self-isolate from each other will not protect our vulnerable population and may in fact prevent natural herd immunity. Healthy children playing and learning together are at minimal to no risk as the number of severely ill children with this new corona virus is extremely low. Passing the virus among normal healthy children and obtaining some degree of immunity offers some immunity for the herd. Passing the virus to low risk adults would likewise be a low risk proposition and would further add immunity to the herd. Unfortunately low risk adults have a higher risk of severe illness then children but still very low and certainly lower than the risk of increased psychologic stress and illness and deferred medical treatment and care for the general population. Once again the goal should be to try and decrease the vulnerable populations’ exposure to the virus. If we knew in February what we know now we could have placed our entire nursing home and care center populations in private isolation wards with round the clock nursing for a fraction of the price we have paid to keep everyone at home waiting for the virus to go away.
Where do we go from here?
Initially, our kids asked how long we thought the lockdown would last. We were surprised the lockdown for two weeks occurred at all, but given the uncertainty and the dire projections, two weeks at least made some medical sense until the smoke cleared. After two weeks the lockdown became less and less about good medicine and more and more about something else. At this point, after not weeks but months of lockdown, I cannot even venture a guess when it will end as this lockdown has less to do with medicine and more to do with politics. I know what should be done from a medical point of view. Open up! Not in phases and color codes, but return to normal and put our assets into protecting our vulnerable population. No masks, no forced testing, no forced tracking of our population. And in the following months to years, figure out what went wrong. Why did we stick to our initial battle plan after the fog of war lifted and our real world information did not agree with initial models, projections and strategies? Refusing to adapt and ignoring data that contradicts models is counterproductive.
I know what I fear will happen. There will be fundamental change in our freedoms, liberties and way of life in the name of keeping people safe from the multitude of viruses that will come down the pike. We will ultimately risk life, liberty and the pursuit of happiness for the illusion of safety. I really hope I’m wrong!
*Sincere apologies to Dr. TANSTAAFL for not only misplacing this post but also posting so late today. All I can offer as an apology is that I slept way too late after spending the day yesterday ripping up carpet. Which like everything else done by the previous owners was done …. in a difficult way, which means I need to go scrape the floor now before we put down wood tomorrow. Also I need to buy putty because — seriously — who cuts the hole for the light plates way too small and then CAULKS the plate to the wall. I broke one before I realized what they had done. (And they VOTE. Let’s remember that.)
What I can promise in the future is that as soon as this round is done, I’ll go on an AGGRESSIVE writing schedule, because whatever other construction projects this or future houses need, I want to pay someone else to do it. Now I’m nearer 60 than 50, I’m way too old for this sh*t. – SAH*