It’s been a while since the last Covid on the Coast letter. I had hoped that we were done, at least done enough.
We are now surfing the second wave of Covid-19. In the past week America has reported one million infections, a ten percent increase in total cases over just seven days. Friends in Europe see deaths spiking higher than in April. They are nervous.
As with everything in 2020, it’s hard to know what to think about the massive Covid-19 case increases in Europe and the US. Should we be terrified? Should we be hopeful that America is moving towards “herd immunity”? Should we be more certain than ever that Covid is a hoax since the mortality rates are far lower than in May?
Personally, I deeply want to declare this whole Covid thing ridiculous. Kids wearing masks on soccer fields and not executing throw-ins because the virus might travel on a ball kicked around a field is a little silly. I do not want to hear another commentator advising us to skip Thanksgiving with family. It feels like being warned about poisoned Halloween candy every season even though there have been almost no proven cases of candy tampering in the last fifty Halloweens.
But…sadly, sadly, sadly…as much as I want to…I can’t give into that “Covid is done!” voice quite yet.
Covid-19 remains a sneaky disease. Most diseases attack individuals. Covid-19 also attacks modern medical systems. In America’s case, it has further ruptured the social tendons that help hold us together.
We Cannot Believe Our Own Eyes and Ears
Covid-19 is just like everything in 2020. What we see with our own eyes is often not real. Or not real for many. Or is really only part of the answer.
The hospital worker surrounded by people struggling to breath knows Covid-19 is real. The guy on the street, especially in the small town with elderly relatives who live safely alone, doesn’t see any sick people. His eyes rest only on the regulations that get in the way of making a living or enjoying a normal life. To him and his family, Covid-19 is not real.
What we hear with our own ears is even more confusing. We hear voices, but we can’t make sense of all the dissonant words. Some are calling for shutdowns and isolation even though friends at restaurants and hotels have lost their jobs. Other voices poke fun of the disease even though we’re told it has killed four times as many Americans as were lost in the Vietnam War. Practically, though, that is just a couple thousand people for most states, right? Do we, personally, know even one of them?
Covid-19 does not make sense. It does not fall exactly into any familiar movie genre:
The Zombie Movie
If the virus attacked more virulently, the generation raised on zombie movies would have known what to do. Some would have grabbed their guns and retreated to well-stocked bunkers to wait out the initial waves. That is why all the toilet paper disappeared. Federal leaders would have cordoned off whole cities, built walls, and denied entry. They would have made the tough decision to sacrifice the few for the sake of the many, bargaining for time.
The Science Thriller
American “Indiana Jones” scientists were not allowed to gather data–the lifeblood of science–on the scene in Wuhan China. They weren’t able to verify the obvious, that the Covid-19 is biased towards certain groups, until months too late. America couldn’t even follow its own guidance and the detailed plans from the Bush and Obama years. Instead, it behaved like everything was happening for the first time in modern history–a very unscientific thing.
Science, writ large, is a type of army. The US Army lives on its training. America has tossed much of its scientific training aside.
The Underdog Triumph
Americans love the story of the hero who risks everything to save a single soldier, child, or parent trapped behind enemy lines. The Covid-19 Pandemic has engendered heart-warming stories about efforts to manufacture ventilators, hand-sew personal protective equipment, and deliver selfless front-line work. Thank you to everyone who contributed!!!
Still, a few months into the pandemic, it began sounding as if leaders were blaming the underdog sick for being old or fat or for living in a multi-generational home not nearly spacious enough.
Some insist that our real triumph is with Operation Warp Speed. I have listened to health experts assisting in the ambitious vaccine development program. If it ends up working to some degreee–and I think it will–we should be impressed!
Clearing roadblocks and investing in manufacturing simultaneously with Phase I testing makes the lean process guy in me super-excited. Still, it is disheartening that many started cheering loudest when $500 million checks got cut and stock prices went up. Surely they are not underdogs.
America’s Pandemic Movie is not falling neatly into any of our familiar Netflix patterns. Many of us, though, do feel certain that we haven’t yet made our way to the end of this series…and that Covid-19 feels a lot like a tragedy.
Should We Still Be Paying Attention To Covid-19?
Yes, America still needs to manage the pandemic.
We should be excited about the Pfizer and Moderna vaccines. It is interesting, though, that the initial Salk polio vaccine was trialed in 1.3 million Americans for almost a year during 1955 before being deemed successful. Even then, it took decades for America to be deemed polio free. For perspective, more than .04% of Americans suffered from the polio virus in 1952 with under .02% suffering paralysis. By mid-November 2020, around 3.4% of Americans have been reported infected by Coronavirus. More than .07% of Americans have died in less than nine months.
Russian friends report no obvious negative results from their first-to-market vaccine and are hopeful for a positive impact. Still, stories about vastly underreported deaths and Russian hospitals filled with the sick are common.
Vladimir Putin is one of the most thoughtful rulers-for-life of our generation. He has calculated the odds and still keeps himself hidden in his palatial compounds. He doesn’t take unnecessary risks. If Putin is still taking this virus seriously, American like you and I should too.
Let’s care for ourselves and our loved ones. The second Covid-19 wave is real:
- 30 US states are reporting ICU bed utilization at 70% or more, a little to a lot higher than typical. States like Wisconsin, Montana, and the Dakotas report little remaining ICU bed capacity in many counties. Studies clearly link high Covid-19 death rates to stretched hospital capacity.
The rapid rise in Covid is harming our ability to provide medical care for the non-Covid medical issues that are traditional killers. People who typically would not die are dying from diseases that are less well-treated.
Analysis of American deaths using US Census Data from March to July 2020 indicate over 225,000 “excess deaths” beyond the expected number, given historical deaths since 2014. About two thirds are explicitly identified as due to Covid-19. The remaining third are attributed to spikes in cardiovascular, Alzheimer’s, and other non-Covid diseases. These excess deaths occurred primarily in states facing significant Covid outbreaks.
- Covid-19 remains deadly. The Covid-19 mortality rate in the US is 2.2% among “observed cases” (246,214/11,036,935 as of Nov 16). This compares to a .1% mortality rate in the deadly flu season of 2017-18 (61,000/45,000,000). The elderly and those with underlying health conditions face a dire disease. There remains significant concern about the long-term negative health impacts among those who recover after hospitalization. Even with mortality rates drastically improving (NYC shows a three times step up), Covid-19 is far more dangerous than the flu.
Why Does Covid-19 Seem Less Deadly Now?
Covid-19 appears less accutely dangerous than in early 2020. No one knows for certain why. The following reasons are strong candidates:
- Covid-19 has spread to younger, more resistant groups. The growth in testing has further revealed its presence in asymptomatic individuals who were not previously being counted.
- Science/medicine has learned to treat the disease much more effectively: more restrained application of ventilation, more effective bedside care/positioning, corticosteroids/dexamethasone, blood thinners/heparin, antivirals/remdesivir (still highly debated), and other promising treatments in experimental stages/monoclonal antibodies that a very few are able to access.
- Proper PPE has been proven to work in treatment and testing facilities, minimizing infection among the medical community. There are theories that social distancing and masks are limiting the viral load that assaults many victims. Lower initial doses of virus have been shown to be less dangerous in other diseases.
- Hospitals and intensive care units are less stressed in August than in April. Peak deaths occurred in small parts of NYC, New Jersey, Massachusetts, and California where hospitals were direly taxed.
- We are more familiar with Covid-19. Familiarity breeds contempt, right?
So, What Do We Do To Keep Our Families Safe?
I’m a minimalist. Minimal rules. Minimal interference in one another’s lives. In all things moderation. Sometimes, though, the minimal level of interference is still significant.
- Protect the most at-risk. Highly at-risk individuals should remain isolated, if possible, and carefully protected. Testing can be stepped-up around them. All the following should be done, too.
- Minimize local disease spread: wash hands, use sanitizer, wear a mask around people, and avoid hand-shakes and hugs. I particularly dislike wearing a mask. Fortunately or not, mask-wearing is almost certainly protective against Covid-19, for both ourselves and our neighbors. (Mask wearing, by the way, is not deemed necessary or effective against all viruses. It is not seen as a virus panacea in the medical community.)
Japan’s government is said to have not been proactive around Covid-19. They did not test widely, unlike South Korea. They did focus on the aggressive limitation of “spreader” activities like events at gyms and night clubs. Japan’s Covid-19 infection rate remained minimal until very recently.
Typically, Japan suffers relatively more deaths from flu each year than the US. There were many reports that the Japanese flu season ended early in 2020. Many speculate that when the Japanese rapidly, voluntarily adopted mask-wearing in January, they lessened the intensity of the flu season and helped protect one another from Covid-19.
- Make group activities safer. Establish procedures to minimize exposure: keep activities outdoors when possible, limit the number of people near one another, separate by space and barriers, use quality ventilation, sanitize common surfaces, and, when indoors, carefully follow guidelines to minimize local spread. Once most of these things are done, in-person schooling, retail, and even restaurants are acceptably safe. Data strongly suggests that even travel on airplanes is low risk when everyone is masked. The few hospital breakouts in Boston over the past two months have been associated with simple breakdowns in safety measures.
- Take the darn mask off when you are outside and alone! We should get outside as often as we can. If we are alone or with our family pods, let’s take the mask off and breath deeply.
A Final Question: Do state or country-wide measures ever make sense?
Yes. South Korea and Denmark, not to mention China, pursued aggressive national measures to contain Covid-19 in early 2020. Citizens supported the efforts, and the countries benefitted from minimal infections, minimal deaths, and economies quickly returned to near-normal. The US military pursued strict masking and hygiene rules from the beginning. Following these rules, military bases have remained exceedingly Covid free.
Mid-December update: Denmark has spiked. Its cases per million are approaching the level of its neighbor, Sweden, the early proponent of “herd immunity.” Sweden has the misfortune of approaching the rate of infection found in the US, the world leader. Europe still leads in deaths per million, but the US is closing fast. The US death rate due to Covid is ten times that seen in Asia, Australia, and Africa. It is about double that of South America.
It is hard not to wonder if the coordinated management approaches in Asia and Australia have been effective. Some propose different biological factors in Asian populations than European. It is possible. But there is no doubt that the Wuhan region in China suffered immensely in the early days of the disease.
Some like to say, “That stuff would never work here.” I’m not such a pessimist. I believe people care for one another and that America’s favorite sport, football, demands similar commitment to team goals. Citizens and soldiers can work together to move the ball down the field and keep their communities safe. South Korea remains largely Covid-free today. Cases in Denmark are higher than in the spring but still far lower than those in their neighbor Sweden and other European countries.
In America now, the Covid cat is out of the bag, so to speak. We have to weather the storm as well as possible. As long as businesses are following Covid protection guidelines, they should be open to serve their communities. A lot of activities can be made safe. Some, like singing and dancing, remain challenging.
Let’s stay committed to the basics. I keep on reminding myself of this…even when the mask is making me a little crazy!
Finally, if a community sees their intensive care beds maxed out, it is reasonable to take more extreme precautions for a few weeks. Each of us should help, if we can. Covid-19 is still killing lots of Americans. Let’s work to keep our medical system functioning so we all can remain healthy.
Perhaps most importantly, let’s not allow Covid-19 to break down the ties that bind us together!
Happy Thanksgiving! [Happy Holidays!]
…from my family to yours