So the first thing to understand is that the novel COVID-19 coronavirus is not the zombie apocalypse. The fate of the human race will not be left in the hands of an elite team of exceptionally good looking epidemiologists who traverse the globe in search of life saving antibodies residing in the blood of a specific Wuhanese bat. The novel coronavirus is probably more comparable to a very bad flu…and unfortunately, whether you realize it or not, that means it is very serious.
Generally our ability to assess risk kinda sucks. It is why we tend to spend our days worrying about our children getting kidnapped at the local park by an evil clown living in an unmarked white van rather than take the extra time to make sure their car seat fits correctly or our backyard pool is safeguarded.
For the young and healthy, many folks think it’s no big deal to skip this year’s flu shot- ignorant to the fact that in the hospital down the street someone like them is critically ill, dying from influenza. Over the last five years I have personally seen at least a dozen completely healthy unvaccinated 20-40 year olds die from the flu. In 2020, in the United States alone, about 16,000 people have died from the flu, 250,000 have been hospitalized for it, and 29 million have contracted it. It’s a serious disease that we often perceive as not that big a deal.
The actual statistical risk of something bad happening often really doesn’t guide our actions. Even if an activity is safe, often we think it’s dangerous and vice versa. What dictates our behavior it how we perceive that risk.
Right now, we have no idea how to perceive the risk of contracting the COVID-19 virus and it is freaking us out. This muddled perception of our risk is causing and will cause a lot of disruption.
The mortality thus far of the COVID-19 is said to be about 2 percent. That would put it on par with the 1918 Spanish flu. That pandemic wiped out 2-3% of the world’s population. Two percent of the world is 150 million people. That’s an insane number. Now this mortality data comes from one limited study in China. Now I trust data from China about as much as I trust an email from a Nigerian Prince letting me know about a “golden investment opportunity”. Also the virus has only been around for a very short time. So we really don’t know.
Most of the folks who seem to be dying tend to be elderly and have co-morbidities. It seems like 80% of people with COVID-19 have symptoms equivalent to a mild cold. You might never even know you had it unless you are tested. Very likely we have vastly undercounted the number of mild and asymptomatic people that have the disease. This would mean a much larger percentage of folks make it through a COVID-19 infection ok, and far less than 2% of patients actually die.
It is precisely because the majority of people only have minimal symptoms that this disease is destined to fully infiltrate the United States. We cannot build a wall to keep it out; we cannot isolate ourselves for too much longer before this virus will spread into our communities. All we can do is try to delay its arrival, hopefully long enough to get through flu season and work on a vaccine or other treatments.
Right now, many of us think the virus itself is going to be our biggest problem. But I don’t think that is the case at all. Odds are most people will not only survive, but will barely get sick. Make no mistake, people will die- possibly people we know. However, how we perceive the outbreak might ignite far more life altering ramifications.
When COVID-19 truly infiltrates our community, will we believe that we are at constant risk and totally freak out? Or will we think the whole thing is overrated and not a real threat to us? Will we shut down life in order to prevent one infection? or one lawsuit? I believe, almost certainly, our reaction will be more deleterious than the virus itself.
My guess is first and foremost the Trump administration will continue to try to build a wall around this virus. They will try to isolate us (Americans) from them (virus people). This may delay the spread of COVID-19, but it will eventually fail. The virus is just not virulent enough to track; if people died instantly it would actually be easier to stop. It is also quite contagious and can likely present in and be passed on via almost asymptomatic people.
But there is almost no way we will accept that reality right away. We might then attempt what China has been doing: isolate and separate people. I have a friend in Shanghai whose family has basically only left the house to pick up groceries in the last month. Schools will close, people will stop showing up to work, no one will go out to eat, people will cancel vacations, NBA games will be played with no fans in the arena. Life as we know it would pretty much be put on hold while we try to figure out what is going on.
But the virus itself will also affect our lives even for those of who do not get it.
Hospitals will be crowded with COVID-19 patients sucking up resources and gobbling up supplies that cannot be easily replaced. All elective surgeries will be cancelled and people with other medical problems will get sub-optimal care because everyone is so busy dealing with COVID-19 patients. It will not be a good time to get hit by a truck, have a heart attack, or deliver a baby.
As a critical care doctor, I can imagine an ethically crippling scenario: running out of ventilators. There is a limited number in any hospital and a true pneumonia pandemic would overwhelm that supply. What happens when two patients arrive in respiratory distress, a 30 year old mother and an 80 year old man… and you only have one free ventilator? Who gets it? I bet you would say the 30 year old mother. That’s not a too crazy an ethical hypothetical. Now what about if there are no free ventilators but there is a 90 year old sick man intubated on ventilator but has very little chance of surviving for the next week? What would you do? Could you approach a family to ask them if they wouldn’t mind letting grandpa die a little early so this other women could survive? Imagine leading a loving family into a room to ask them to make this sacrifice so you don’t have to bring a different family into the same room to tell them we just don’t have the resources to save your wife and mom. I don’t think we have ever faced questions like these in the United States on any sort of scale. The US health care system is modeled on the cultural edict of maximum treatment for everyone and we almost always find the resources if we need them.
Now you can easily envision these crazy situations lasting a few weeks- no big deal. But what about a few months or six months? A year? Not going out of the house for months, your kids stuck at home, long lines at the grocery store to pick up whatever is available is a tough reality to truly digest. It sounds pretty bad. On the other hand, it could be a golden opportunity to get through all of the Netflix shows you’ve never had the time to watch.
This level of societal disruption today seems hard to truly conceive and hopefully it just won’t happen. But on Sept 10, 2001 you never would have thought someday you would be taking your shoes off at airport security, throwing away full bottles of water as if they were filled with plutonium, and entering a giant cylinder to put your hands in the air like you are being mugged. I am not saying life as we know is about to profoundly change, but we need to at least recognize that it is possible. Life altering pandemics are not mythical events- they have occurred before.
The good news is this disrupted state of living will only last so long. At some point the consequences of staying home from work and putting a hard pause on living life will outweigh the fear of contracting the disease. We will someday return to living. But at the same time, for some people it’s going to bad.
It almost sounds like I am fanning the suffusing flames of an impending Armageddon. Well I am not. We cannot afford to retreat into a metaphorical panic room. I am instead sounding a wake up call that we must mentally prepare for the challenges we are likely to face over the coming months. There will be people out there taking advantage of our fear and circulating rumors. We will look to buy false security and false treatments-kind of like the ubiquitous masks that do nothing to protect you from the virus. Honestly we all know what we should do to not catch a virus from someone else. This time we just have to actually do it.
Be safe out there folks, and get ready, cause it could get a little nuts. When you watch TV and the media frenzy truly ignites, pause, and take a deep breath (not near someone coughing) and remember how our incorrect perceptions often misguidedly motivate our actions. Then get up, go to the sink, and wash your hands. It’s going to be ok.