The unchanging red light

Ira Lacher: “Drastic measures” to address novel coronavirus “need to be carefully weighed for their presumed benefits vs. their unintended consequences.” -promoted by Laura Belin

We’ve been hearing a lot lately about “flattening the curve” as it pertains to dealing with COVID-19. The premise is to keep down the number of patients needing hospitalization because America lacks the beds to treat them.

Health experts agree that doing so can reduce the number of severe cases. “If you don’t have as many cases coming to the hospitals and clinics at once, it can actually lower the number of total deaths from the virus and from other causes,” says Dr. Howard Markel of the University of Michigan, who has studied epidemics. “And, importantly, it buys us time for university and government scientists, and industry, to create new therapies, medications and potentially a vaccine.”

But it can also mean extending the disruption of virtually everyone’s life. And that’s not going so well with one of my neighbors.

“If I get the disease, I’ll get sick for a while and then recover,” he says, and he’s right, according to the World Health Organization:

“For most people, COVID-19 infection will cause mild illness; however, it can make some people very ill and, in some people, it can be fatal. Older people, and those with pre-existing medical conditions (such as cardiovascular disease, chronic respiratory disease or diabetes) are at risk for severe disease.”

He and others like him feel they are being forced to bear the brunt of a massive failing in public policy: a severe deficiency in our health care. Which is not an accident. For years, hospitals have intentionally reduced the number of inpatients and the beds to treat them.

A report published in 2015 in Orthopedic Reviews concluded that when Medicare started expanding coverage to pay for “ambulatory procedures,” which are less costly than inpatient services, hospitals started admitting fewer patients. Then, they pared beds because they had fewer patients using them.

So now, America has fewer than three hospital beds per 1,000 people, and fewer than 45,000 intensive care unit beds. “We would need 200,000 for a moderate outbreak,” Aaron E. Carroll, a professor of pediatrics at the Indiana University School of Medicine, wrote for The Upshot in The New York Times.

This is why public health officials are imposing restrictions on mass gatherings before they have to use a heaver iron to flatten the curve. Such as mandating mass quarantines. We have some indication of what those can impose.

In 2003, Toronto instituted such as quarantine to quell an outbreak of severe acute respiratory syndrome (SARS) — a far more proportionately lethal coronavirus than COVID-19. A study found that many of those quarantined exhibited a “quite significant level of psychological distress,” according to Dr. Laura Hawryluck, a coauthor of the study. Those included anxiety, isolation, anger and trouble sleeping, including nightmares. The study concluded:

“Our data show that quarantine can result in considerable psychological distress in the forms of PTSD and depressive symptoms. Public health officials, infectious diseases physicians, and psychiatrists and psychologists need to be made aware of this issue. They must work to define the factors that influence the success of quarantine and infection control practices for both disease containment and community recovery and must be prepared to offer additional support to persons who are at increased risk for the adverse psychological and social consequences of quarantine.”

This is because humans are social animals, Drs. Shoba Sreenivasan and Linda E. Weinberger point out in Psychology Today. They note that technology, such as teleworking and online schooling, are inadequate substitutes.

“Fundamentally, it doesn’t matter how technologically sophisticated we become,” they write; “emotional connectivity remains a core part of being human. We need each other—maybe not in the ways that characterized us evolutionarily, but for a need that remains essential for psychological survival.”

Current curve-flattening measures — restricting mass gatherings, calling off spectator sports and other mass recreation, canceling school and religious services, and imposing work-from-home edicts — are relatively inconsequential. Unless they persist. Then, we are bound to be faced with the familiar frustration of waiting for an interminably long red light to change, or a line to move. The longer we wait, the greater our frustration, and the urge to do anything to break out — especially when we see someone else do it.

Drastic measures need to be carefully weighed for their presumed benefits vs. their unintended consequences. Otherwise, as my next-door-neighbor put it, “I feel I’m being punished for being young and healthy.”

Top image: Photo by Alex Veresovich, available via Shutterstock.

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  • The small silver lining...

    …to this gigantic rolling disaster would be if the Chinese government finally decided to seriously enforce their own laws against the illegal trafficking and marketing of wildlife, especially rare species. Pangolins, which are globally endangered largely because of the Chinese market for them, are a major suspect as scientists look for the original source of the coronavirus.

    There is nothing good about the Chinese black market for wildlife products except that it enables some people to make money. But so did child labor in this country. The wet markets that include illegal wildlife are a severe ongoing threat to human health because they provide ideal situations for pathogens to jump from wild animals to people (like SARS also did). Even one such jump, as we are learning the hard way, can be a catastrophe.

    Chinese wildlife marketing is not only driving species around the world toward extinction and threatening human health, but also involves considerable cruelty. Many Chinese health experts, conservationists, and ordinary citizens have been fighting against illegal wildlife trafficking in their country for years. It’s time for Beijing rulers to listen to their own people. And wouldn’t it be nice if our former governor did what he could, little as that might be.

  • On Covid-19

    Surely everyone understands the sentiments expressed in this piece. It raises some valid points. The unfortunate consequences of people being more socially isolated are not insignificant, and will grow worse over time.

    Still, I disagree with and reject the notion that drastic measures are perhaps not worth it here, if that was the intent of the piece.

    It is true that the vast majority of people who contract Covid-19 will get out of it very much alive and well and ready to rock ‘n roll.

    That should not be the take-away point here.

    The math behind the highly contagious nature of Covid-19 coupled with, say, merely a 1% death rate projects a very high number of deaths in a very short period of time for concentrated populations who choose not to take drastic measures in time. See Italy. See Spain.

    The psychological health of the doctors, nurses, and support staff in health care settings are those for whom we should be the most concerned about and supportive of in that regard. Again, see Italy. See Spain. Read accounts from the health care front lines there.

    Researchers who have been studying Covid-19 have learned that an asymptomatic person may be shedding the virus for a week before the onset of symptoms.

    “I feel I’m being punished for being young and healthy.”

    There is another way to think about this:

    “I may be saving lives.”

    Anyway, that is my two cents worth. Not trying to be a dick. Just a different point of view.

    • I don't speak for the author

      but I don’t think his intent was to discourage the social distancing measures. My viewpoint aligns with yours: almost anything we can do to flatten the curve is worthwhile.

      One challenging part: like other lifesaving policies (such as the 55 mph speed limit), the lives we save will be invisible. You won’t be able to point to any one person and say, that person would have died if not for social distancing. So critics may dispute the benefits.