I say the best case scenario because we’re so close to doing what would have seemed impossible before the pandemic: creating, testing, licensing, manufacturing, and distributing not just one vaccine but several vaccines in an incredibly compact time frame – certainly one of our greatest modern medical achievements. Also, we’ve learned a lot about the virus, in real time, and have new drugs – and some old ones – to treat it.
The worst-case scenario has to do with how the patient performs himself. Weakness, weakness and disease are increasing dangerously. Initially, the disease was localized, and easier to manage with a good prognosis. Over time, my patient did not always listen to recommendations, and the disease spread to every state in the country.
For the sake of comparison, in the week of May 18, the country was seeing an average of 23,000 new cases per day; By the week of July 4, that number had jumped to around 48,000.
Last week was really bad, according to one calculation from the Institute for Health Metrics and Evaluation at the University of Washington, Covid-19 was the leading cause of death in the United States, outperforming coronary heart disease.
So despite the best advice and the best care, the patient’s condition continued to deteriorate. Rather than being localized to a few hotspots requiring aggressive treatment, as was the case in July, the infection has now almost completely engulfed the patient.
The reason this is so dangerous is that earlier in the pandemic, and even in July, there were a lot of built-in and redundant reserves. If one part of the body is experiencing a crisis, other parts of the body can take over and do the work to keep the patient relatively stable. For example, we saw how in the spring and summer, when a location – like New York City or Houston – was overwhelmed by work, doctors and nurses rushed to help. Alternatively, patients can be transferred from an overcrowded hospital to a less stressful facility in a nearby area.
Excesses, Ports, Reserves – Call them whatever you like, but they no longer exist for the patient, the country. Now, country after country reports of hospital systems are reaching breaking points. Not only are there fewer hospital beds available, but front-line healthcare workers and support staff – from doctors and nurses to hospital cleaning staff – are being stressed, overworked, and sick in ever-increasing numbers. And there is no one to replace them.
How long can the patient hold?
Usually, when the human body faces a crisis situation – whether it’s an uncontrolled infection, widespread bleeding or something equally catastrophic – there are all these biological defense mechanisms in motion, and the tricks the body pulls in compensating for imbalanced systems. Instincts of self-preservation are part of the reflexive nature of our biology.
But this patient, ours, instead of compensating and trying to maintain balance at all costs, does not compensate and shows little inclination to do what he can to prevent himself from deteriorating.
The IHME has predicted that countries will respond once we reach the threshold of 8 people per million who die, and that the country’s defense mechanisms will be operational, leading to actions such as returning stay-at-home orders.
Eight people die for every million people around 2,800 deaths per day – and we’ve already passed that. But the country’s defense mechanisms have not been accelerated on a large scale required. While many people in this country wear masks and follow physical distancing guidelines, many still do not.
Wearing a mask is still a political statement and not mandatory in 15 states. Only seven states have any kind of stay-at-home orders, warnings or curfews, over which many battles have been fought.
The outgoing Trump White House kicked off the holiday party season this week, with more than a dozen group gatherings planned, violating U.S. Centers for Disease Control and Prevention guidelines for size restrictions, as well as Washington, D.C. restrictions on indoor gatherings. Most of us missed spending time with our families this holiday season, and I watch TV constantly to remind people of the dangers of doing so. However, the administration itself has already been the epicenter of at least three outbreaks of Covid-19 among employees and allies, and a series of events such as holiday gatherings is likely to put several hundred guests, workers and employees at risk.
That’s even when US Surgeon General Dr. Jerome Adams issued what amounted to an appeal on Fox News on Friday. “To all the leaders out there, we need to lead by example over the next two weeks and really help people cross the finish line because, once again, is on the horizon,” he said.
Indeed, the end is in sight. Help, in the form of one or more vaccines, is on the horizon. This patient, our homeland, will of course survive. But any imminent vaccine, although nothing short of a scientific and logistical miracle, will not be an immediate solution. It will take anywhere from several months to half a year to distribute it to communities everywhere.
So, the question we must ask ourselves is: How many Americans are we going to let die in the meantime?
President-elect Joe Biden told CNN reporter Jake Tapper on Thursday that he would ask Americans to commit to 100 days of wearing masks as one of his first acts as president. On Friday, the US Centers for Disease Control and Prevention strengthened its recommendations on the use of masks, describing them as “critical” to controlling the spread of the Corona virus.
According to the latest IHME model, the projected death toll from Covid-19 could fall by 66,000 by April 1 if 95% of people were to wear masks. think about it. One of those saved lives could be your mother, your elderly neighbor, your favorite musician or the next wonderful scientist. It could be your life or my life.
In addition to wearing masks, we must restrict our activities and reduce capacity in certain types of work. A model study, conducted by researchers at Stanford and Northwestern universities, showed that a small minority of places people visit account for the vast majority of coronavirus infections in major cities. He notes that curbing the maximum occupancy in such places – including restaurants, gyms, cafes, hotels, and religious institutions – can significantly slow the spread of the disease.
This kind of movement will cause the patient a certain amount of pain – so leaders must be prepared to offer painkillers. In this metaphor, morphine comes in the form of cash for those suffering, an economic catalyst.
Our human spirit has made us innovative, creative, resourceful, and persistent enough to see this pollen dream bear fruit. But it is our human behavior and biological reactions that will ultimately determine how deep our wounds will be. No amount of science can save us from ourselves.
I can only hope that the instinct of self-preservation begins in this country soon, and long enough, to get as many of us to the finish line as possible.
Andrea Kane of CNN Health contributed to this report.
“Alcohol scholar. Twitter lover. Zombieaholic. Hipster-friendly coffee fanatic.”