If the United States were my patient: We aren’t ready to celebrate yet
Back in the middle of May, I wrote an essay titled “If the United States were my patient,” pondering what it would be like if the United States were a flesh-and-blood person who had gotten sick with an ongoing infection.
Seven weeks later, as we approach the patient’s birthday — July 4th — I thought it would be a good time to check in and see how the patient’s doing.
It turns out the answer is: not well at all.
In fact, with daily infection rates breaking records on many days during the last couple of weeks, we are arguably worse off today than at any point earlier in the pandemic. Consider: This week, 15 states saw their highest seven-day averages, and the country is seeing around 50,000 new cases a day. We have less than 5% of the global population, but about 25% of coronavirus cases and deaths. Several states, including Texas and Arizona, are on the verge of having recently infected patients overwhelm hospital capacity.
As a doctor, I’m frustrated. I feel our patient’s deterioration didn’t have to happen and there were many unforced errors.
I really thought that we’d be having a different conversation in the country at this point; I thought that along with the fireworks, we’d be celebrating the progress we’ve made so far. Instead, I have to say to the patient, “The infection has returned with a vengeance. It has spread and risks tipping out of control in some parts of your body.”
And I’m worried — worried that we’ll get to the point where the existing treatments that we have, the medicines we carry in our little black bag, are no longer going to be effective and we will have to resort to the big guns, the more aggressive measures.
But at the same time, I still hold out some hope; we still have a little bit of time to turn the situation around, to restart our medicine, take it faithfully –but we can’t afford to waste another minute.
The best care, the best advice
“If the country, like the human body, were to get sick or infected, it should seek the best medical guidance and follow it, as hard as that might be,” I wrote back in May.
Well, throughout the illness, this patient has had the benefit of excellent medical care. This country is home to some of the most creative minds, finest doctors and most experienced public health officials the world over. And they, along with equally talented international researchers, jumped into action, trying to decipher the genetic make-up of the virus, learning how it spreads and how to mitigate that spread, discovering all the ways the disease manifests, figuring out how to treat symptoms and desperately trying to develop a vaccine that will prevent new cases of infection in the future.
But after a few short weeks of following doctors’ orders, our patient — our country — has chosen to turn its back on the advice of these health experts. It didn’t like what the doctors were saying and it stopped taking the prescribed medicines because they were unpalatable.
Some of the prescriptions, like social distancing and curtailing our daily activities, tasted bad and were hard to swallow. Others, like wearing a face mask, created a bit of physical discomfort and a lot of political friction. And the most aggressive medicine of all, the stay-at-home orders, triggered never-before-seen mass layoffs across many sectors of the economy and the fallout just rippled outward from there. In other words, very real pain.
But difficult as it was to put the patient in a medically induced coma with the stay-at-home orders in order to get the infection under control, it appeared to have worked.
When I first wrote the piece, just before Memorial Day, the time of another national holiday, it looked like the patient was moving in the right direction. Infection rates had significantly dropped in some of the hardest hit areas, like Michigan, Massachusetts and New York, and were holding steady in much of the country.
Stopping treatment too soon
I worried back then about stopping the medicine too early — and that is exactly what happened.
The patient was brought out of the medically induced coma too quickly and chaotically, with every state doing its own thing. Some states reopened immediately, while infection rates were trending up (I’m looking at you, Georgia), while other states, and some cities waited a bit longer. But few, if any, states met all of the so-called “gating criteria” for reopening set by the White House and the CDC.
In addition to acting too soon, these re-openings were often accompanied by a flouting of rules, a lack of social distancing and a growing refusal to wear masks by a loud minority. We’ve all seen the photos of packed beaches, crowded bars, protests in favor of reopening, and presidential press briefings with officials crowded together behind the podium, and few, if any, wearing a mask.
It’s as if our patient had just shrugged after waking up and said, “That was a weird nightmare. Glad it’s over,” before popping out of bed and walking out of the hospital. But the infection was still smoldering under the surface.
Like Cassandra, predictions were ignored
Since then, health expert after health expert tried to remind us that this pandemic is not gone. Not only that, it will be here with us for the foreseeable future. But there is no unifying directive or plan of action from the White House. States are responding independently of each other. And so the patient continued to go about its business, often oblivious to the danger.
People in parts of the country continued not to social distance and the war against mask-wearing became even more vocal and entrenched, with the President, his vice president and other elected officials refusing to model the very behavior that health experts recommended: Wear a mask and stay 6 feet apart. For a time, the governors of some states, including Arizona and Texas, even blocked local officials from enacting mask mandates within their cities and counties.
But thanks in no small part to the alarming rise in cases, we may have hit a turning point this last week. Nearly two dozen states have paused or rolled back reopening efforts. The governors of a handful of holdout states — including Texas, Oregon, Pennsylvania and Kansas– issued mask mandates. Some in the GOP and the vice president have started donning a mask. Even President Trump recently said he’s “all for masks.” And government health expert after government health expert — including the White House Coronavirus Task Force’s Dr. Anthony Fauci and Dr. Deborah Birx, the CDC’s Dr. Robert Redfield and Health and Human Services Secretary Alex Azar — repeated the same mantra: Wear a mask. Embrace universal face coverings.
Is it too late?
As I have said repeatedly, this coronavirus is not hardy and because of that, small spoonfuls of medicine can go a long way. It doesn’t travel far, so staying 6 or 10 feet apart can help. With good air circulation, it disperses quickly, so don’t congregate in indoor spaces. And wear a mask — that’s a big one. Studies have shown it can reduce transmission to others while also protecting the wearer. Even bandanas, even paper surgical masks work better than nothing.
In fact, modelers at the University of Washington’s Institute for Health Metrics and Evaluation project that if 95% of people wear masks, about 24,000 lives could be spared by October.
If we can get our patient to stick to these small steps — these tried and true public health measures that have worked in places like South Korea — the number of daily infections can be slowly cut down to manageable levels. And then we can start containment efforts, like contact tracing and isolating potentially infected people.
But we’re not even at that stage yet, and it is just not possible to talk about containing the virus when there are 50,000, or even 10,000, new infections per day. In order to do that, we need to get the country closer to one in a million people becoming infected per day. That’s just over 300 new infections a day — not 50,000.
And that brings me to another point: We need more testing, not less. It is the only way to see how the patient is doing, to see if the infection is retreating or spreading. Testing in many parts of the country is still hard to come by; components of the test are sometimes in short supply and results are slow to arrive. And now that more people want to be tested, the testing sites in some of the new hotspots are crowded, with long lines. This will further increase the wait for results as labs strain to keep up. We need mass access to a rapid, easy and inexpensive test that can give result in minutes, not days, so testing can be done more easily and results returned more quickly.
Things will get worse before they get better
Make no mistake, the patient will feel worse in the coming days until the medicine begins to work, until the public health measures that are once again being put in place have a chance to do their job. And the patient might still require aggressive treatment in some places — we may see certain areas of the country partially shut down again.
In the spring, everyone made great personal and economic sacrifices in trying to flatten the curve. Nobody wants to lose that progress and nobody wants to go back to the coma again.
But we have to act now, as one nation, indivisible and with one guiding voice. That would be a great birthday gift for our patient.
