"Nothing is so much to be feared as fear.”
A journal entry by Henry David Thoreau on September 7, 1851.
The sentiment was shared nearly 300 years prior by Francis Bacon, an English philosopher, who wrote of his observation that persons with fortitude will not be shaken by adverse changes in their circumstances whereas a person who is fearful will suffer much.
Speaking only for myself but as a physician, I am concerned that the U.S. public health, political and legal response has been less than ideal during the COVID-19 pandemic -spreading fear without real solutions. There has been inconsistent messaging followed by unexecuted promises. The media have amplified misinformation and propagated fear.
These entities have used incomplete World Health Organization and CDC data with obvious selection bias and extrapolated false assumptions to the U.S. population. This narrow perspective in turn has become the foundation to drive U.S. public policy. Each official seems to be trying to out-do another without a basic understanding of data analysis or health system needs. Yes, the goal to “flatten the curve” to avoid over burdening our hospitals is a laudable goal. But at what cost and is there another way?
I remember the H1N1 swine flu pandemic in 2009. At that time, we had teenagers and 20 somethings on ventilators in the intensive care unit. However, we had enough ventilators and we did not shut down the economy, schools or require mass quarantine. Yes, we did have a flu vaccine that was approximately 30% effective that year and perhaps there may have been some latent immunity that impacted public health decision making. However, I do not accept the mortality rates estimated by the World Health Organization to date. They have provided all age mortality rates between 2 to 4% and mortality rates approaching 15% for those over the age of 80. These are pretty intimidating numbers – if they were accurate. The problem is that the testing is largely confined to those being hospitalized with the most severe illness. We do not know the actual denominator and we know that COVID-19, in many people, especially the young is asymptomatic or minimally symptomatic. So, when it was clear that we had incomplete information, I looked for better data and found it in South Korea. They tested early and often. I refer you to the website that is updated daily: https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030
As of 3/20/20, South Korea has tested 316,664 people for COVID-19 (as compared to 49,681 in the U.S) and they had 8,652 positive cases with an overall mortality rate of 1%. Under the age of 30, they have 2,914 positive and zero deaths. Under age 50, they cite exactly 5000 positives with 2 deaths. This relates to a mortality rate less than 0.2%.
What about the older population? South Korea has documented 329 COVID-19 cases in people above the age of 80 and 33 have died. This corresponds to a mortality rate of 10%. This is unfortunate and definitely a concern but not really unexpected. After all, the mortality rate now in the U.S. for viral pneumonia (including the flu) is approximately 20% for those over the age of 80.
Moving forward we need to think clearly and rationally. We need to kick politics and legal posturing to the curb. South Korea did not shut down their economy and they have been criticized for not shutting down their borders. However, they definitely got out in front in regards to testing their population and took reasonable public health measures to limit the spread.
In the coming days and weeks, as U.S. COVID 19 testing becomes more available, the number of cases will be publicized loudly, creating a fever pitch of hysteria and anxiety. Do not buy in to it. I hope that we will eventually come to understand that this virus was already out of the bag in the U.S. and that preventing the spread to some degree was futile. COVID 19 testing will be of limited value to those who are hospitalized and for those who need to care for our most vulnerable. Perhaps someday, we will get serum antibody testing to get a better estimate of the United States’ true denominator for this disease. For now, rational containment and focusing our resources on emergency and hospital capacity should be our focus.
What does this mean for you?
Keep a proper perspective and don’t buy into the fear.
Do the same things you would do to protect yourself from the flu in an unvaccinated state.
Protect the most vulnerable – the elderly, immunocompromised and those with chronic respiratory conditions.
Use PPE as appropriate.
What is my hope?
We stop spreading fear. We propagate meaningful information to the public.
We execute on promises of adequate supplies and testing.
We increase hospital capacity by discharging patients from the hospital that do not need to be there. Hospital capacity could be increased by creating stepdown units in hotels or other facilities that are staffed by generously paid caregivers. Many patients are waiting discharge from the hospital for social reasons.
For those who are at low risk for complications, we send them back to school and get back to our normal routines as soon as possible. (weeks not months). This reduces the risk of an economic catastrophe which also carries health risks.
We protect those at high risk such as those in assisted living and nursing homes with a rational quarantine protocol.
This is doable. I am proud to be associated with such a fine group of professionals and staff. Thank you for your service to Douglas County. You will continue to make a difference.
John Powell M.D.