Coexisting with COVID-19 and the Increasing Death Disconnect
Cheer up, homebodies; we’re surrounded by good news. You might be wondering exactly what I am referring to as our nation is currently chalking up record numbers of new coronavirus cases with each passing day. Well, it’s not the employment numbers, as last week the number of new jobless claims were almost 1.5 million. Nor is it that Congress, at long last, is making progress on addressing racial injustice as Senate Democrats have refused to even allow the Senate to debate the grossly insufficient Republican proposal, not trusting that Mitch McConnell will even allow his caucus to consider Democrat proposals to make the Republican bill more effective. No, the good news of which I speak is the success that other nations have had in containing the virus. Most Pacific Rim nations stopped the spread of the virus before it even got started and most western European nations, after a rocky start (not unlike our own), have reduced the daily number of new cases to a manageable level. Even the so-called “Shithole countries” that do not possess our medical and economic resources, have shown that the virus can be safely managed.
Then you should be asking why the United States, a nation with 4% of the world’s population, has produced 20% of the world’s confirmed cases of the virus and 25 % of the deaths attributed to it. The answer, of course, is that we have done much that has been wrong and little that has been right. First, we ignored the virus until after it had infected a significant number of persons in this country causing us to waste valuable time during which we could have procured medical supplies and other items that would be needed to fight its spread. Then we underestimated how fast and far it would spread and were slow to impose measures that would retard its progress. We also made the mistake of trying to reopen our economy before the disease was sufficiently contained, assuming that our economy would bounce back even though 70% of the population remained afraid to freely venture out of the safety of their homes. Lastly, we put our faith in the creativity of our nation’s medical and pharmaceutical industries to quickly develop a cure or vaccine that would save us from the virus. Considering the novelty of the virus, these are somewhat understandable reasons for our current dilemma. What is not so understandable is why we have consistently ignored not only the advice of the nation’s public health experts, but also the successful efforts employed by other nations in combatting the virus.
Perhaps the most important things we have learned about the virus are that (a) the vast majority of transmissions take place through the air on microscopic moisture droplets expelled from the mouths of infected persons and (b) many infected persons are asymptomatic or are simply yet to experience the ill-effects of the virus and do not even realize that they are transmitting it. Thus, the most effective ways of preventing the spread of the virus is to limit social contact and to wear a face mask. While there was a serious shortage of face masks in March and April, that is no longer the case. Thus, it was extremely upsetting for me to listen to a video of a public hearing in Palm Beach County called to consider imposing a mandate to require the wearing of face masks in public places where social distancing is not possible.
The arguments that were voiced in opposition to the measure ranged from the frivolous to the absurd. One woman argued that she would not be able to breathe if she had to wear a mask, apparently oblivious to the fact that hospital workers wear their masks throughout their entire work shifts which frequently last as long as twelve hours. Another person argued that it would interfere with God’s design of the human body. A third argued that such a requirement would violate her right of free speech. I was really puzzled whether this argument was referring to the fact that it is difficult to speak while wearing a mask or whether it was an assertion that wearing a mask was a political statement. One individual even questioned the intelligence of the County Commissioners for considering a proposal recommended by virtually every public health official in the country.
I would be comforting to think those who voiced these arguments were simply representatives of that small segment of our society that stands in opposition to every government mandate which they find inconvenient. Unfortunately, these views are held by many of the nation’s leaders including governors who have not only been unwilling to impose such requirements, but also to even allow city and county governments within their states to do so. Of, course, much of the problem lies with our own President who refuses to wear a mask in public and has let it be known that he considers that wearing a mask is a statement of disapproval of his leadership. As a result, at his recent rallies in Tulsa and Phoenix, the vast majority of those in attendance were without something covering their faces. Thus, you can add to our list of failures a lack of responsible leadership.
The countries that have enjoyed the greatest success in combatting the spread of the virus are the ones that responded immediately. This mostly describes the nations of southeast Asia that have experienced serious problems with other respiratory diseases such as SARS and MERS. They understood the importance of taking immediate action to limit the spread of the virus before it worked its way into the bodies of a large number of individuals. The success of the San Francisco Bay area in suppressing the spread of the virus can be attributed to the foresight of its public health officials who recognized that, because of the constant interaction between the area’s own Asian population and China, it would not be long before the virus would find its way into their communities.
The peoples of southeast Asia also not only understood the importance of wearing face masks, but also had them readily available and were accustomed to wearing them. In the United States, the use of face masks had been largely limited to medical personnel, miners and construction workers. Thus, face masks were only available in limited quantities; and those that were available had to be reserved for use by medical personnel. This, in turn, created yet another problem, prompting those taking the lead in fighting the spread of the virus to downplay the importance of wearing face masks in order to avoid a panic among the general public. Thus, the nation came to believe that face masks were not necessary to prevent the disease from spreading. To make thing worse, public health officials emphasized the importance of constantly washing your hands, giving the misimpression that the virus was primarily spread by touching a person or object bearing the virus.
The United States was not alone in making these errors as the virus traveled to western Europe where it also spread rapidly before it was transported New York City which quickly became the epicenter of the disease by early April. Whereas the countries of southeast Asia anticipated the spread of the virus and were able to keep it in check as it began to infect their citizens, those in western Europe didn’t focus on the virus until it had already infected a few thousand of their citizens, making contact tracing difficult, if not entirely unfeasible. Those countries had little choice except to close their borders and shutter their non-essential businesses in an effort to impede the virus’ further spread.
While we in the United States took similar measures, there were a few important differences. Perhaps most importantly, the countries of western Europe had a “socialized” public health systems which place a heavy emphasis on disease prevention. As such, their medical facilities were better equipped to handle the type of onslaught of patients associated with epidemics and pandemics. Secondly, most of their leaders heeded the advice of their medical experts and imposed greater restrictions on business and social activities. These restrictions were mandatory and not simply recommendations as they were in many of our states. In addition, the European countries kept their restrictions in effect for over two months until the spread of the virus had been reduced to the point that persons who had come in contact with someone infected with the virus could be traced and quarantined. As a result, the countries within the European Union are currently experiencing only approximately 2,000 new confirmed cases each day. In the United States the average daily increase in the number of confirmed cases has been 20,000 over the past few weeks and that figure has risen to over 40,000 during the the past week.
Even though the increase in the daily increase in confirmed cases has risen to a frightening level, the daily increase in the number of deaths from the virus has not risen dramatically. In fact, it has fluctuated between 400 and 900 per day for the past two weeks. This is a much lower rate of deaths than were experienced in April as the virus was wreaking havoc in and around the New York City metropolitan area. In addition, back then there was a roughly three-day lag between a noticeable movement in the daily number of new confirmed cases of the virus and the daily movement in number of deaths. Both of these seeming disparities can be explained.
In April, there was a serious shortage of test kits for the virus. Thus, the only people who were being tested for the virus were those who were experiencing serious symptoms and had checked themselves into a hospital. By the time these individuals were being tested they were already quite ill with the result that those who died generally did so only a few days after they had tested positive for the virus. Today, testing for the virus is more widespread with the result that the virus is frequently being discovered even before the infected persons experiences any symptoms of the disease. This, in itself, explains why there is currently a much longer time lag between changes in the daily rates of new confirmed cases and changes in the daily death figures. It also helps explain why the percentage of persons dying from the virus seems to be dropping. In the beginning the only people who were being tested were already experiencing serious symptoms. Now positive tests are identifying people who may never experience any adverse symptoms from the disease.
There is also a qualitative difference in the people who are testing positive today from those who tested positive for the virus in March and April. Today, the average age of an individual who has tested positive for the disease is approximately 35 years-old, compared to almost 65 years-old for those who tested positive in the early months of the pandemic. That age differential itself accounts for most of today’s lower death rate as the virus is much more lethal to persons 60 and older.
It is also important to understand where the various hot sports for the disease were in March and April and where they are now. At the beginning of the pandemic, most of the deaths were occurring among residents of nursing homes and long-term care facilities. Once that became apparent, greater measures were undertaken to prevent the spread of the virus in those facilities. Now disease hotspots tend to be meat processing facilities where the average workers age is roughly 40.
There is yet another factor that helps explain the recent lower rate of death. In the beginning, COVID-19 patients in serious condition were placed on ventilator systems that forced air into their lungs. The death rate among patients receiving this procedure was about 80%. It was soon discovered that the use of ventilators was causing damage to the patient’s lungs and doctors began reducing the pressure of the ventilators and increasing the level of oxygen going into the patient’s lungs. Doctors have also begun experimenting with certain therapeutics which seem to also be helping recovery rates. While many Americans are holding out hope that a vaccine or therapeutic will soon be on the market to combat the virus, both of those possibilities could still be many months, if not years, away. At least one epidemiologists has reported that antibodies for the virus have a limited ability to prevent the recurrence of the disease which means that a vaccine that would remain effective for more than a few weeks may never become available.
Thus, in the last five months has taught me how to coexist with COVID-19. This includes wearing a face mask in public, severely limiting both the duration and distance of my indoor contacts with others and practicing good hygiene. I still don’t dine in restaurants, but now I do feel comfortable shopping in supermarkets, drug stores and other retail establishments where everyone wears a mask and efforts are made to keep people apart. I remain reluctant to ride in a vehicle (car, train, airplane or bus) with strangers and to invite service personnel into our home. When necessary, these inhibitions can be overcome with a healthy use hand wipes and other disinfecting agents. I do miss concerts and theatrical performances and will likely not be attending them even when they do resume. On the other hand, I didn’t need the pandemic to convince me not to attend Mets games.