But when our leaders - the president, the governor, some state senators - start to agitate for reopening businesses, lifting the shelter in place, returning to normal, I get a swift, white hot, boiling shot of cortisol and adrenaline that shoots from my limbic system right into my bloodstream, sending my heart pounding, my pulse racing, and my temples throbbing while I hyperventilate. You get the picture.
And yet on some deeper level less connected to my amygdala, I know and acknowledge that we can't stay in self-imposed quarantine for a year to 18 months. That's not realistic and the economic hardship and pain that will cause is a valid concern too. Yes, we do have to balance public health and the economy. We cannot live without paying rent and bills. We cannot live without people willing to provide services like manufacturing, selling, and delivering the goods we need even while some of us have had the luxury of huddling in our safe spaces. Somebody has already been out there every day making it possible for us shelter in place. They've been taking risks for the rest of us.
Yet, when some of our leaders privilege the economy over public health and safety it sounds offensive. When they talk about acceptable numbers of deaths and acceptable risk, it raises my hackles. Whose risk? Whose death is acceptable? Who do you want taking that risk for you? And do you know the value of life, or just the price of commodities?
Right now, it's appropriate for the federal government, the states, and the municipalities to be starting the long range planning for a reopening. But we need transparency and criteria for when all that will happen. Too often, the focus seems to be shifting to arbitrary timelines and calendar dates divorced from data.
So, it might be helpful to talk about what was our goal when we all went into quarantine. What did we hope to accomplish?
We were told it was to flatten the curve. In Wuhan, China, where the novel coronavirus first emerged, it caused pandemonium (same root as pandemic?). The virus spread like wildfire, overwhelming hospitals, creating shortages of ICU beds, medications, and all important ventilators. Patients were dying as much from shortages of supplies and medical personnel to care for them as from the actual virus. And doctors and nurses began to succumb because of lack of personal protective equipment (PPE).
Then Covid-19 spread to Italy to a prosperous region in the North. Unlike China, which for a long time kept a clamp on news about how bad the epidemic was, in Italy we got a full, unvarnished look at how coronavirus raced through the population, creating shortages of lifesaving equipment, ravaging people, bringing down medical staff. In Italy, we witnessed the sight of streets choked with coffins and frank discussions about rationing ventilators. Triage became the word of the day as bioethicists wrestled with criteria for deciding who lived and who would be allowed to die.
That's when the rest of the world came up with the strategy of sheltering in place to stop this highly contagious pathogen from spreading so quickly. China was the first to use draconian lockdowns, forcing their people to stay at home until new infections stopped rising. Italy did the same as the only solution to stop the steady march of corpses to coffins to graves.
Plotting the graphs of rising death rates and rising new infection rates, the goal became to flatten out that line on a graph by reducing new infections. The object was to keep the rate of infection low enough that hospitals would not become so overwhelmed they couldn't care for patients or run out of lifesaving equipment. It was never to eliminate all virus cases, it was to keep the number of patients low enough to make hospital treatment manageable.
Once the rate of infection was flat for a couple of weeks, the goal would be to begin to restart life and get people back to school and work. With more testing and contact tracing, public health officials hoped to be able to monitor how well that was working. And with vigilance, they'd watch for any uptick in new infection and move quickly to re-shut school and business until it went back down. That, of course, meant halting startups, shutdowns, restarts, hope, disappointment, and maybe more hope.
It wasn't perfect. And it wouldn't guarantee anybody real safety. After all, even with robust testing, by the time you have the positive test, it may be too late for your personal health and
safety, even if your uninfected coworkers are still safe from you and the hospital still has the capacity to treat new cases. The biggest drawback, after all, is we still don't have any effective drug or treatment for those already sick. The best medical experts can offer is supportive therapy to keep the patient as comfortable as possible and to treat symptoms while the patient rides out the infection, hoping their immune system will kick in and fight the virus off. Ventilators, after all, don't kill viruses, they breathe for a patient whose lungs have been infected until the patient's immune system fights off the virus and recovers. Or doesn't recover. Ventilators treat symptoms. They don't kill viruses. About half the patients who go on ventilators don't recover. But without a ventilator, many more of those patients would die.
So, a second goal - or more a second hope - began to emerge. That is buying time. Some medical experts hold out hope of developing a vaccine in about a year to 18 months. Other researchers are racing to find an antiviral that can treat the actual pathogen. We already have antivirals and the very controversial antimalarial, hydroxychloroquine, which showed some promise in a very small clinical trial. Of course, more and better clinical trials need to be done. But it is possible to have one or even several medications that can treat and slow down the virus within several months, maybe even by the summer.
Hospitals, universities, and private labs all over the globe are sharing information and working cooperatively to find new medical treatments for the novel coronavirus. Meanwhile, testing capacity is finally ramping up. All that might be worth waiting for.
I know it's unrealistic to talk about waiting until the middle or end of 2021 to get back to normal. And I know our cratering economy is harming a lot of people. My husband, as part of his jobs, is on calls all the time about the astronomical unemployment rate. One day a few weeks ago, we went into DC so he could sign hundreds of emergency checks for unemployed union workers. So, we are cognizant of effects on the economy and the human toll that takes too.
But might buying some time for a an effective treatment be worth the extra sacrifice if what we are talking about is a few months?
In Part 2, I will talk about what a roadmap to reopening should look like
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