COVID-19 first seemed very lethal, its spread assumed to have started here
in late February. Suspension of travel, social distancing and lockdowns
ensued by mid- to late-March due to fears of
millions of U.S. deaths, hospitals everywhere overwhelmed — a public health cataclysm.
Yet infection control rests on utilitarian principles: The greatest good
for the greatest number, not simply saving every single life. We send
first responders into life-threatening conditions, we allow driving and
even deadly cigarette smoking. Health policy rests on science, which moves
with new data.
What we know now: Data newly indicates that undetected cases of the coronavirus
spread widely in U.S.,
starting with millions of travelers from China in late December through March,
even before the lockdown.
Chinese data show it spreads fastest in close households (including nursing homes)
and by mass transit. Outdoor transmission is mitigated by air dilution
and as micro-droplets dry out.
Arguably, lockdown of untested positive “carriers” in clusters may have
promoted spread in late March and early April and was too late to stop prior to massive
spread. Those sheltering at home now represent the most common source of
New York City admissions. Responsible use of parks and beaches seems reasonable.
As we reopen responsibly, the past is prologue. Except that in the case
of the virus that causes COVID-19, there was no scientific knowledge of
it, a truly novel virus — but not a magical one. It still follows
the laws of virology, despite its highly communicable properties —
enhanced by lack of immunity.
All viral epidemics have a time
curve, even the novel flu of
2017 that infected 50 Million and killed an estimated 80,000 in the U.S. As
more get infected, the rate of infection slows. Weather is also a factor;
more people being outdoors lessens close contact.
COVID-19 has an up to-14-day incubation period from infection to noticeable
symptoms. Symptoms are absent in many, thus not detected. A similar additional
lag occurs from illness onset to death.
So the first deaths appear up to a month from infection. Rising positive
tests, hospitalizations and deaths are thus a trailing marker for current
rate of spread. Yet those lagging numbers guided lockdown rationale.
Given the high communicability, with tens of millions infected, even a
very small minority who die will add up to a terrible total number.
Most
deaths occur in the aged and those with chronic conditions. Under 40, the risk
of death is similar to the flu, under 20, it approaches 0 (unlike the flu).
Stopping school may lower spread, but that needs proof. It clusters in school kids with
more vulnerable adults.
The “greatest good” — and individual life — is
harmed by people staying away from
medical care for treatment of heart attacks, strokes, acute appendicitis, chronic joint
problems where mobility is crucial, pain, even stopping necessary
vaccinations for children. The unprecedented economic upheaval, media-fueled fear frenzy
and resulting tsunami of anxiety and depression are swamping mental health
resources. Mental disorders harm physical health.
Recalibration should take geographic as well as demographic variables into
consideration, rather than one-size-fits-all. Federal policy is too autocratic,
municipal may be too self-serving.
Small states or counties of very large ones may work best, with constant
monitoring of best hygiene and distancing practices, enforcement when
needed. America’s independent public will resist unenforceable policy
and lower trust in public officials.
One cannot prevent each and every death. Dogmatic policy may promote more
personal and socioeconomic harm and deaths than an apolitical but populationally
responsible one.
Michael Brant-Zawadzki, M.D., is a physician and a senior medical executive
in Newport Beach.
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