I don’t agree with the experts so much on this.
My bottom line is that the Public Health Community deals with demographics and statistics and not individual patients. Classically there are three public health strategies to take care of a pandemic:
1. Let it run its course like Italy. Lots of deaths early on, the entire population gets naturally immunized, and the disease runs its’ course in a very short period of time.
2. What we are doing in this country — that is isolating and distancing everyone.
3. Isolate the at-risk population — the 20% of the population with comorbid conditions. This would be my recommendation.
It would save resources and divert costs to those most in need. Public Health specialists can never have enough “data”. There are two reasons for testing. One is statistical and the other is clinical. You and I had several discussions about this in the mid 90’s when you were at Eagle. Once hot spots and the cadence of the infection have been established, and pandemic has been identified, the focus should be on clinical issues. Quarantining and isolation techniques are appropriate and important.
Down the line selective and very limited retesting is important. But now the time has come to take care of sick people. If a person has a fever and a cough they should be placed in isolation. Knowing that the tests have a 20% false negative rate makes physical exam more important. If a patient has a fever and a cough and a negative test isolate. If they have a fever and a cough and a positive test isolate. When the President makes a pivot from the public health model to the clinical model he will be criticized, but he will be doing the correct thing. Flattening the curve certainly conserves resources, but it prolongs the epidemic.
Finally comparing the Spanish flu epidemic with what we are facing is a bit premature. 50 million people died in that epidemic when there were only 1.8 trillion people living in the world. Hygiene, nutritional status of patients, and even antisepsis were very different then than now. If we have 300 million people — to make calculating easier, and 80% will get infected many not demonstrating any symptoms, and 20% of our population are compromised hosts or have preexisting conditions, then 48 million people are truly at risk, and if we have a 0.01% death rate 48,000 people will die. Over the past 10 years, seasonal flu deaths have been between 20,000-80,000/yr.
Finally, we live in the greatest county in the world and we make the greatest scientists and the most creative entrepreneurs in the world. My prediction and it is not one that many other physicians agree with is that in the next 6 weeks we will deploy clinical strategies using known drugs that don’t require toxicological or pharmaceutical testing. Combinations of hydroxychloroquine — a drug I used to treat patients with malaria in the ’70s and that is now being used for Lupus and RA, and Zithromax have stopped SARs in China in 2002 and a study out of France last week shows very promising results against COVID-19.
If the government bureaucrats and regulators get out of the way and let the private sector loose, great things will happen quickly. A colleague of mine who was in China during the SARS epidemic and who commented on a post of mine below agrees with that position.
I would recommend following the disease on the John’s Hopkins Web Site. On the bottom right hand of the page is a real number, log, and new case bar graph function. Follow both the real number and log functions, and when new cases fall back below the existing cases on the log graph anticipate the approach of the mean.
Finally don’t be pessimistic for a second. When I was about 12 Dad gave me a book called “Eight Bells and All’s Well” by Admiral Dan Gallery. In the book, he describes the Ships Chaplain as having the philosophy that we pray to God on good days and bad and extra intentions and pleadings to God on the days before battle can be difficult for the person making the prayer to place in context. In other words, God is always watching over us the same way every day and when the guns start shooting knowing that one truth is what is important.
In the Catholic Mass right before the consecration of the host, we have the “Sign of Peace” proceeded by the words from JOHN 14:27, “Peace I leave with you my peace I give unto you not as the world giveth I unto you. Let not your heart be troubled, neither let it be afraid.” Fear is an irrational emotion. Concern leads to an action and in this situation action is what is called for. This will all soon be over and in a shorter time than the media is leading us to believe.
Our President is doing a great job and he is proving to be everything that I hoped he could be. Our greatest days as a people are yet to come. Keep the faith. MAGA
