COVID Contentions

My mind last night was greatly excited.  Just prior to going to bed, I was looking through my Facebook feed.  I am well aware that there are a wide variety of opinions to be found in its pages and I feel like I am good at skipping across radical views or positions that are meant to simply inflame.  My concern came from a fairly pervasive theme voicing the concern that the response to the COVID-19 pandemic has been overly aggressive.  I feel the strong need to share my voice from my perspective as a physician, one who has been trained to not only treat a specific patient that presents for care but to also consider the broader context of the community in which we all live.  I would like to illustrate the concerns that I have seen expressed and address each, one at a time starting with the least rational and moving to the more reasonable.

1. COVID-19 is a hoax and was invented as a political scheme from the left to make sure that Pres. Trump is not reelected.  I am not sure how to even respond to this. In medical studies, mortality is considered the ultimate “hard endpoint,” because “dead is dead.”  It is not left up to interpretation.  This is a world wide pandemic affecting all nations.  No one can “fake” this news.

2. COVID-19 is truly not worse than seasonal influenza.  The response to the virus has been manipulated for political gain.  This is the more reasonable conclusion from the first example.  I don’t buy it either.  I have seen recent claims that the CDC is reporting that the hospitalization rate is leveling off and that those over 65 have the highest rate of hospitalization, similar to the rate of such hospitalization during a high severity flu season.  I went to the CDC site and did not find evidence to support this claim. I even downloaded the whole 42 detailed summary and reviewed the whole document.  What I did find is that in the summary it says that influenza illness is tapering off and in the next sentence it says that SARS-CoV2 infections remained similar (not to influenza but to the previous week's SARS-CoV2) or decreased.  There was not anything to link those two statements.  They did include the following graph showing mortality from any respiratory condition now compared to the last two years.  It is easy to tell that the numbers are much higher currently than past years.

3. The death rate from COVID-19 is so low that it does not merit the drastic measures that are currently employed.  This argument is more of an opinion.  We all place value on life itself but also on livelihood.  Where one person may draw such a line will be different than another’s.  I just want to  make sure that the information that one is basing their conclusion on is based in fact.  Looking at the numbers here in St. Louis, projections were made as to how many cases we could expect having learned from the experience from New York, Washington State and around the world.  In the following graph the upper (gold) line is the worse case scenario if no social distancing was performed.  The lower (grey) line was the best case scenario. The light blue line is the actual cases over time.  Prior to March 30th when widespread stay at home orders were put in place, the trajectory of our cases was worse than what was being predicted in the worse case.  Since isolation mandates have been enforced the curve has indeed flattened, even more than thought possible. Though they have flattened, the number of cases has not yet clearly decreased.

This does not mean that the disease is not as severe as it was thought to be but is rather a reflection of how well the social isolation has been working.  This is exactly what we hoped would happen.  What we are doing is saving lives and is keeping the health care system from being completely overrun, which would happen in the worse case scenario.

An appropriate question is to ask, “Is this the only way to achieve the same outcome?” How can we mitigate against this virus and yet keep the country open?  I may go into this in more detail in future blog posts but the short answer is only through aggressive testing and contact tracing.  If we can effectively quarantine those who have the virus or who have been exposed to it, we don’t have to quarantine everyone else.  Until our capacity to do so is ramped up, societal closure is the only option.

4. Because of mass quarantine Measures, we are weakening our immune systems which makes the pandemic worse.  There are diseases where it makes sense to “just get it over with” so that you will be immune.  My generation’s parents routinely had “chicken pox play dates.”  Mothers would bring all of their children to the neighbor’s house so as to inoculate them all at once.  It was bad for a bit but then the family didn’t have to go through it again.  COVID-19 is not such a disease.  The mortality rate is far too high.  Also, the whole population is naive to the virus.  Everyone’s immune response will be impaired due to never having seen the virus before.  I would love to be an asymptomatic carrier who is now immune but that can’t be guaranteed.  An effective vaccine would be a game changer but that can’t be counted on.  Prevention remains our best option.

Having a difference of opinion is not a bad thing. I find myself changing my mind not infrequently. The key is that we base our opinion on the most accurate knowledge possible. I have no problem disagreeing with someone if they can sincerely tell me why they feel the way they do. I have such discussions with my patients in regards to influenza vaccination all the time. Many of them do not want to receive the vaccination. I will let them know my feelings and explain to them my reasoning. Many will then accept the vaccine. Some do not. That is all right with me as long as they understand my thought process. I am only satisfied when someone’s opinion is based on logic and accurate information.