Seven weeks later, as we approached the patient’s birthday, July 4, I thought it would be a good time to check in and see how the patient was doing.
It turns out that the answer is: not good at all.
In fact, with daily infection rates breaking records on many days over the past few weeks, we could be worse off today than at any other time before the pandemic. Consider: This week, 15 states posted their highest seven-day averages, and the country is seeing around 50,000 new cases per day. We have less than 5% of the world population, but around 25% of coronavirus cases and deaths. Several states, including Texas and Arizona, are on the verge of having newly infected patients overwhelming hospital capacity.
As a doctor, I am frustrated. I feel that the deterioration of our patient did not have to happen and there were many unforced errors.
I really thought we would have a different conversation in the country right now; I thought that along with fireworks, we would be celebrating the progress we have made so far. Instead, I have to tell the patient, “The infection has returned with a vengeance. It has spread and is at risk of losing control of some parts of its body.”
And I am worried, worried about getting to the point where the existing treatments we have, the medicines we carry in our little black bag, will no longer be effective and we will have to resort to large firearms, the most aggressive measures.
But at the same time, I still have some hope; We still have a little time to change the situation, restart our medication, take it faithfully, but we cannot afford to lose another minute.
The best care, the best advice.
“If the country, like the human body, becomes ill or infected, it should seek the best medical guidance and follow it, however difficult it is,” I wrote in May.
Well, throughout the illness, this patient has had the benefit of excellent medical care. This country is home to some of the most creative minds, the best doctors, and the most experienced public health officials from around the world. And they, along with equally talented international researchers, sprang into action, trying to decipher the genetic makeup of the virus, learning how it spreads and how to mitigate that spread, discovering all the ways the disease manifests, figuring out how to treat it. symptoms and desperately trying to develop a vaccine to prevent new cases of infection in the future.
But after a few weeks of following the doctors’ orders, our patient, our country, has decided to turn his back on the advice of these health experts. He did not like what the doctors were saying and stopped taking prescription drugs because they were not tasty.
Some of the recipes, like social distancing and reducing our daily activities, tasted bad and were hard to swallow. Others, like wearing a face mask, created a bit of physical discomfort and a lot of political friction. And the most aggressive medicine of all, orders to stay home, triggered massive layoffs never before seen in many sectors of the economy and the consequences simply spread from there. In other words, very real pain.
But as difficult as it was to put the patient into a medically induced coma with orders to stay home to control the infection, it seemed to have worked.
When I wrote the piece, just before Memorial Day, the time of another national holiday, it seemed like the patient was moving in the right direction. Infection rates decreased significantly in some of the worst affected areas, such as Michigan, Massachusetts, and New York, and remained stable in much of the country.
Stop treatment too soon.
Back then I was concerned about stopping the medication too soon, and that is exactly what happened.
The patient was pulled out of the medically induced coma too quickly and chaotically, with each state doing its own thing. Some states reopened immediately, while infection rates were increasing (I’m looking at you, Georgia), while other states and some cities waited a bit longer. But few, if any, states met all of the so-called “activation criteria” for reopening set by the White House and CDC.
In addition to acting too soon, these reopens were often accompanied by a breach of the rules, a lack of social distancing, and an increasing refusal to wear masks by a noisy minority. We have all seen photos of crowded beaches, crowded bars, protests in favor of reopening, and presidential press meetings with crowded officials behind the podium, and few, if any, wearing a mask.
It is as if our patient had shrugged after waking up and said, “It was a strange nightmare. I’m glad it’s over,” before getting out of bed and leaving the hospital. But the infection was still burning below the surface.
Like Cassandra, the predictions were ignored
Since then, health expert after health expert has tried to remind us that this pandemic has not disappeared. Not only that, it will be here with us for the foreseeable future. But there is no unifying directive or White House action plan. States are responding independently of each other. And so the patient continued his affairs, often oblivious to danger.
People in some parts of the country continued without distancing themselves socially, and the war on wearing masks became even more vocal and entrenched, with the president, his vice president, and other elected officials refusing to model the behavior that health experts recommended. : Wear a mask and stay 6 feet away. For a time, the governors of some states, including Arizona and Texas, even blocked local officials from issuing mask mandates within their cities and counties.
It’s too late?
As I have repeatedly said, this coronavirus is not resistant and therefore small tablespoons of medication can be very helpful. It doesn’t travel very far, so staying 6 or 10 feet away can help. With good air circulation, it disperses quickly, so it does not congregate indoors. And wear a mask, that’s a big one. Studies have shown that it can reduce transmission to others while protecting the user. Even bandanas, even surgical paper masks work better than anything.
In fact, modelers at the University of Washington Institute for Health Measurement and Assessment project that if 95% of people wear masks, around 24,000 lives could be saved in October.
If we can get our patient to stick to these little steps, these tried and true public health measures that have worked in places like South Korea, the number of daily infections can slowly drop to manageable levels. And then we can begin containment efforts, such as contact tracing and isolation of potentially infected people.
But we are not at that stage yet, and it is simply not possible to talk about containing the virus when there are 50,000, or even 10,000, new infections per day. To do so, we need to bring the country closer to one in every million people who become infected every day. That’s just over 300 new infections a day, not 50,000.
And that brings me to another point: we need more evidence, not less. It is the only way to see how the patient is doing, to see if the infection is retracting or spreading. Testing is still difficult in many parts of the country; Test components are sometimes scarce and results are slow to arrive. And now that more people want to be tested, test sites at some of the new hot spots are crowded, with long lines. This will further increase the wait for results as labs strive to keep up-to-date. We need massive access to a quick, easy and inexpensive test that can give results in minutes, not days, so tests can be done more easily and results returned more quickly.
Things will get worse before they get better
Make no mistake, the patient will feel worse in the coming days until the drug begins to work, until the public health measures that are being implemented again have a chance to do their job. And the patient may still require aggressive treatment in some places; We may see certain areas of the country partially closed again.
In the spring, everyone made great personal and financial sacrifices trying to flatten the curve. No one wants to lose that progress and no one wants to go back to a coma again.
But we have to act now, as a nation, indivisible and with a single guiding voice. That would be a great birthday gift for our patient.
Andrea Kane contributed to this story.
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