So yesterday I went to an ICU meeting about the impending COVID-19 explosion sure to hit the hospitals en force in Los Angeles in the next week or so. I think I now know what it must be like to be told you are about to be deployed to a war zone. It is without a doubt going to be the worst medical disaster I will see in my medical career. I have no doubt we will be overwhelmed, our standard of care for our patients will drop, and people will die in the next few weeks who may not have died a month ago. Many of those will be people who do not actually have the coronavirus, but fall through the cracks of an overwhelmed health care system. The hospital will just be so overrun with the COVID-19 patients, that the guy with the stroke or heart attack is going to suffer.
I am actually impressed that life has effectively been put on hold here in the US. Sports seasons are over, schools are cancelled, and many people are working from home. We have all heard of socially isolating in an attempt to decrease the risk of everyone getting sick at once and overwhelming the health care system. There are still a lot of folks who think all of this is probably simply an abundance of caution. They don’t think things can really get that bad. They can’t yet see it for what it is.
Even so, many folks have jumped on the bandwagon and are ready to hunker down, wash their hands, and limit their interactions with others. They buy lots of toilet paper- hopefully mostly because others are buying toilet paper and not because there is an “unspoken of” GI disease also infiltrating our society. I went to a store yesterday and there was a security guard in the toilet paper aisle. I never thought I would see that. I kinda wish I bought that bidet I’ve always coveted.
Everyone is waiting with anticipation for the bomb to drop.
Right now, on TV, we are looking for people to blame for our unpreparedness. “Why don’t we have enough COVID-19 tests? The Trump administration has failed us! If we just had enough tests, that would make the difference. Thats what the South Koreans did. Only then can we truly contain the virus.”
Although I agree more tests would be helpful, I don’t think that is what is going to make the difference.
The current available COVID-19 test has a false negative of at least 30%. That means thirty percent of time a person will actually have the COVID-19 virus and the test will say they do not. 30 percent. That is not a great test. Also, the test takes 3-4 days to come back. People are coming to the ER with mild symptoms, hoping to get tested. But a negative test really doesn’t tell you anything if you are mildly sick. There is no medicine to treat it. You really just need to go home and self quarantine so you don’t pass it on. That is all you can do. If you deteriorate, come back to the hospital and get treated. Since this virus has already infiltrated our communities, testing is less useful. We can no longer use testing to help isolate and contain it. We have to assume we are positive if we have symptoms and just act accordingly.
All we have is social distancing…
I think there is a major misconception of why we are doing all the social distancing. If you are young and healthy, you are not avoiding contact with others primarily to protect yourself. Although don’t believe the myth healthy people cannot get very very sick, because they can, albeit rare.
We need to social distance ourselves to protect other vulnerable folks in our society. The social distancing and precautionary measures work more on a societal level, than an individual level. Even if you catch COVID-19 and you don’t know it, your social isolation helps you not unwittingly pass it on to others who are at risk. Staying at home both simultaneously helps you not contract the virus and not transmit the virus. If done effectively, over time, the COVID-19 prevalence will wane.
Right now we are amped up and running at full speed, sweating anticipatory angst. We await the explosion to come. But little do we realize we are not racing a 100 meter dash, but rather are running an ultramarathon. Soon enough, many of us, who are not healthcare workers, may conclude that the risk has been overstated. After weeks of no NBA games, working from home, and the kids staying out of school, we will collectively go stir crazy. There will be reports in the media of people dying, but most people’s true life experience will be something very different. They might not know anybody who got very sick or died. If surrounded by only certain types of people, the crisis could conceivably seem like a myth. They might only see their 401K depleted and a shortage of soap. People may then conclude the virus is not relevant to them.
Which leads us to make a choice.
The people vulnerable to this virus best hope will be the continued social distancing by the “less vulnerable” of our society. At some point the virus will be less prevalent. I have read this could take a minimum of 8 weeks, maybe longer. If a majority of us don’t participate, it won’t work or will take longer.
So, are we going to act only in our own self interests, consistent with American cultural tendencies, or will we make a sacrifice for the benefit of the vulnerable of our society?
I have no idea what is going to happen. But I think it is important to spread the word to healthy people bunkering down in their home, that the reason they should do so is not so much to protect from a viral menace stalking them, but rather to protect someone else- someone vulnerable.
The question is: Do we actually care to protect the vulnerable? And if so, do we believe our actions can make a difference?
It might be hard to accept we actually have a personal responsibility to save other people- even more so when you will never know who is being saved by your actions. I mean, what can one person do? And it’s not like you will see a tangible result from your actions. In fact, if it works, history might incorrectly judge us as overreacting to a risk that was overblown.
Maybe think of it as you might an election. One vote may not matter- but all the votes counted together at the same time can change the destiny of our nation.
I have an idea to make the concept more relatable and maybe something that can give you stamina when the sacrificing inevitably gets really hard and the benefits of said sacrifice seem obtuse: Choose an actual vulnerable person for whom you will maintain your effort of socially distancing. Maybe choose your 80 year old grandmother, or your cousin with kidney transplant on immunosuppression, or maybe for your friendly neighbor on chemotherapy? And if for some reason, you have no friends or family and you can’t think of anyone, maybe just do it for 79 year old actor Sir Patrick Stewart. Whenever you are thinking about getting lazy in you social distancing efforts, remind yourself “I am doing this for Captain Picard.”
I have had many reasons to doubt in the last few years, but in the end I actually have faith in Americans. When someone is in trouble, and we allow ourselves to really recognize it, Americans can be the most generous and helpful people on the planet. Democrat or Republican, when we temper our fears, and allow ourselves to imagine a solution, we are a people that prefer to run toward a problem rather than away. I know this may seem like a hokey exaggerated rally cry spouted by politicians during troubled times, but I actually believe it. I am going to choose to not be cynical.
Soon most people will understand that the world wide reaction to this pandemic is not an overreaction. We really have all unwittingly been drafted into a war and we must each do our part- not just for ourselves, but for everyone. Maybe all you can do is stay home. But if you can do more, please do. Consider helping your neighbor who is a nurse working in the hospital, who needs help with watching her kids out of school. Maybe you know a lonely elderly women is afraid to go to grocery store and you can pick her up some food and tell her it’s going to be ok? Maybe your apartment mate has run out of toilet paper and you stocked up early? For God’s sake give him a ply for all of us! Ironically social distancing is something that really cannot be achieved alone.
And if you a part of the vulnerable population, have faith. We got your back.