I haven't seen an explanation that satisfies me of what our situation is at the end of March 2020. I may have missed it; it's not possible to read everything and listen to all the reports in the media, which are overwhelmed with stories. Some articles stress parts of the following, and all of the things in this post have been said somewhere by people who know what they're talking about. However, spelling things out this way helps me get perspective. Maybe it will clarify things for others as well.
As I understand the current situation, we need to buy time by staying home, only take necessary trips for essentials such as food, and practice social distancing, so that hospitals can be adequately equipped to treat everyone who gets Covid-19. Ideally we don't ever want to overwhelm the medical services we have. [But this is going to happen now.] Until there is more understanding of this virus, effective therapeutic treatments are found, and an effective vaccine is available, our leaders -- everyone -- needs to "flatten the curve" of new cases.
A lot of us get that, but unfortunately the people in charge at the federal level are not among them. The president wants the churches full in two weeks for Easter. Covid-19 is compared favorably to the flu. After all, they say, many thousands die each year of flu. What is the problem? And then this week, some leaders have proposed that elders sacrifice themselves for their grandchildren, which met with some agreement but mostly consternation and outrage..
So here's a straightforward comparison of the flu versus Covid-19.
INFLUENZA
- A vacine is available, and millions of people get their flu shots each year.
- Many of us have immunity to some of the strains because they've been around for a while. This is called herd immunity.
- Medical professionals have protection from the flu because they overwhelmingly have had flu shots.
- When people get a serious case of flu (assuming they have access to decent health care), they receive expert treatment in first-rate hospitals, and are put in ICUs with ventilators if necessary. Hospitals are equipped to deal with seasonal, known flu strains without risk of being overwhelmed. YET...
Despite all of these advantages, people still die. So the number of cases and deaths due to influenza is dramatically reduced from what it would be without a vaccine and advanced ICU medical care.
COVID-19
- There is no vaccine for Covid-19 and there won't be for at least a year.
- Human beings appear to be extremely susceptible to it, and we don't know whether anyone has natural immunity to it. There is no herd immunity to Covid-19.
- Medical professionals have no immunity to Covid-19 and must have personal protective equipment (PPE) to avoid getting sick themselves.
- The number of Americans who can get this is in the tens of millions. Even if 95% of cases are mild, the U.S. does not have enough ICU beds and ventilators to treat 5% of millions.
- As of March 26, everyone who has caught Covid-19 and became critically ill has had access to expert care, ICUs and ventilators. And aren't a high proportion of the people who needed ICU treatment in the vulnerable group, or medical professionals who have been exposed? EVEN SO...
On March 26, the number of deaths in the U.S., despite the best treatment, is 994 on CDC's website. This coronavirus is just getting going. And NY City is about to exceed its ability to treat critical patients.
REGARDING VULNERABLE POPULATIONS, INCLUDING MOMMA
Vulnerable people - those older than 65, with compromised immune systems, with underlying conditions such as COPD, asthma, diabetes, heart problems, and obesity - are advised to be especially careful.
The best thing they can do is follow directions so they are not infected in the first place. The worst thing they can do for the country is expose themselves to this virus because they have the greatest chance of needing the ICU and ventilators. If a lot of the high-risk people get the virus they will quickly overwhelm the ICUs. If almost all the cases are not from the vulnerable groups, fewer critical cases will occur and the chance of overwhelming the hospitals decreases. Right? At least this reasoning makes sense to me.
I also think it's likely that experts will recommend that the vulnerable people should continue to stay home when governors lift the current strict stay-at-home rules. They won't be very safe for a year or so, until there is an effective vaccine, or perhaps some sort of therapy or treatment when doctors figure out more about this pandemic. We'll see....
Everyone is running some risk of a serious infection, but the odds are it will be manageable for healthy people in most cases even without hospitalization. The odds are perhaps 50-50 that the vulnerable populations will need the ICU, and yes, some of them will die no matter what. But if there aren't enough staffed ventilators, many people NOT in the vulnerable population will die unnecessarily. The humane thing to do is to give everyone a fighting chance.
REGARDING DEATH RATES
There isn't enough data yet to compare the usual influenza viruses with Covid-19 on death rates.
REGARDING PREPAREDNESS
- We were not prepared in the U.S. despite much research and planning. Most of the world was not prepared for this extreme event.
- The president is absolutely wrong whenever he says (and he repeats this frequently) that no one knew this could happen. His own administration has produced documents that anticipated this situation.
- The president continually deflects criticism, in fact, attacks those who criticize the federal response, and blames others, including the previous administration for a "broken" system he inherited. He's had three years to fix things, and he doesn't even know what his own administration has been doing. And the quote below from the March 25 briefing is an example of his apparent delight in watching everyone compete for critical supplies.
- OK, so we were not prepared in January when the world first heard about what is now called Covid-19. But it is now almost three months since the first notice. Our federal leaders should have looked at their plans by now and acted to implement recommendations in the reports. January would have been better than late March, but SOMETIME, like today they should review the plans and ACT. And the president is still not taking this seriously.
March 27, the president was quoted in a CBS news article, "Trump challenges Cuomo: 'I don't believe you need 40,000 or 30,000 ventilators'"
""I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they're going to need," the president said. "I don't believe you need 40,000 or 30,000 ventilators. You know, you go to major hospitals, sometimes they have two ventilators. Now all of a sudden they're saying can we order 30,000 ventilators.""
On March 25, President Trump said at the Corona Task Force Briefing:
"Finally, I want to provide a brief update on the critical supplies. Through FEMA, the federal government has delivered, or is in the process of shipping 9.4 million N95 respirators — think of that: 9.4 million — 20 million surgical masks, and we have others that we think are going to be delivered pretty quickly. The whole world — you know, it’s not just us; it’s not just the States. The whole world is trying to get these things — in competition with many, many countries....
"3.1 million face shields, 2.6 million surgical gowns, 14.6 million gloves, and almost 6,000 ventilators, which go to the areas of greatest needs. We sent, over the last day, 4,000 ventilators to New York...."
I don't know what the demand is for surgical gowns, gloves, masks, etc., but NY Governor Cuomo has said NY alone needs 30,000 ventilators. The PPE and ventilators will be in great demand for at least a year. The impressively large numbers -- millions of masks, and so on that the president highlights -- are also inadequate.
On March 28, Dr. Michael T. Osterholm and Mark Olshaker write in a NY Times op-ed, "It’s Too Late to Avoid Disaster, but There Are Still Things We Can Do"
"...For example, even as 3M was producing at 100 percent of its capacity (35 million N-95 masks a month), a single hospital in New York City used up more than two million masks in February, before the surge in Covid-19 cases there. And new production won’t happen for many months."
Wading through the existing documents about how to prepare for a pandemic, in particular, what should be done ahead of time to ramp up production of essential supplies and equipment, requires more than hip boots. In fact, wading isn't the best description. Federal government information is the Mount Everest of research challenges. I'll have to write several more posts about preparedness. (BTW, this obstacle is probably one of the reasons it's been so hard to be ready for such a pandemic.) The above is enough for now.
Everybody, and especially those most at risk, don't get sick!
P.S. After I wrote this today, a related article came along: "Three months into the pandemic, here’s how likely the coronavirus is to infect people." Washington Post, March 28, 2020.
