If the United States were my patient: Science cannot rescue us from ourselves

It has been almost one year since a new coronavirus named SARS-CoV-2 made its presence known to us. What started off as a small cluster of unusual pneumonia cases that cropped up in Wuhan, China, soon rippled out from there, causing infections around the globe. By March, Covid-19 had been declared a pandemic and essentially shut down many sectors of society in most countries.

During that time, I’ve written several essays, including two on how I would treat the United States if it were my patient. Since finishing medical school more than 25 years ago, it is often how I look at the world. And now, while this country is paradoxically at the brink of both the very best- and the very worst-case scenarios, it may be time to check in again.

I say the very best-case scenario because we are so close to doing what, pre-pandemic, would have seemed impossible: creating, testing, authorizing, manufacturing and distributing not just one but several vaccines in an amazingly compressed timeline — certainly one of our greatest recent medical achievements. Also, we have learned so much about the virus, in real-time, and have new — and some old — medicines to treat it.

The worst-case scenario has to do with how the patient itself is doing. Increasingly frail, vulnerable and critically ill. In the beginning, the disease was localized, easier to manage with a good prognosis. As time went on, though, my patient didn’t always listen to the recommendations, and the disease spread to every state in the country.

The United States continues to hit horrific new records. On Saturday, the country topped 14,542,000 total coronavirus cases and more than 280,000 total deaths. On Friday, the country saw its highest number of new daily Covid-19 cases, more than 227,880, and more than 101,250 people were hospitalized with Covid-19, straining health care systems in many states. And this is before we’ve even felt the full effects of the Thanksgiving holiday.

For comparison’s sake, the week of May 18, the country was seeing an average of approximately 23,000 new cases a day; by the week of July 4, that number had jumped to around 48,000.

This past week has been so bad that, 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, beating out coronary heart disease.

So despite the best advice, the best care, the patient’s condition has continued to deteriorate. And instead of being localized to a few hotspots that required aggressive treatment, as was the case in July, the infection has now engulfed almost the entire patient.

The reason that’s so dangerous is that earlier in the pandemic, and even in July, there were a lot of built-in reserves and redundancies. If one part of the body is in crisis, other parts of the body can take over and do the work to keep the patient relatively stable. For example, we saw how back in the spring and summer, when one location — such as New York City or Houston — was overwhelmed, doctors and nurses came rushing in to help. Alternatively, patients could be transported out of an overwhelmed hospital to a less-strained facility in a nearby region.

Redundancies, escape hatches, reserves — call them what you will, but they no longer exist for the patient, the country. Now, state after state reports hospital systems reaching their breaking points. It’s not just that there are fewer hospital beds available, but front line health care workers and support staff — from doctors and nurses to orderlies to the hospital cleaning crews — are getting fatigued, worn out and sick themselves in ever-growing numbers. And there is no one to replace them.

For how long can the patient hang on?

Usually, when the human body is faced with a crisis situation — be it an out-of-control infection, widespread bleeding or something equally catastrophic — there are all these biological defensive mechanisms that kick into gear, tricks that the body pulls to compensate for the systems that are out of balance. These self-preservation instincts are part of the reflexive nature of our biology.

But this patient, our country, instead of compensating and trying to maintain balance at all cost, is decompensating and has shown little inclination to do what it can to keep itself from getting worse.

The IHME predicted that states would respond once we hit the threshold of 8 people per million dying, and that the country’s defense mechanisms would be triggered, leading to measures such as stay-at-home orders being reinstated.

Eight people per million dying works out to about 2,800 deaths per day — and we’re already past that. But the country’s defense mechanisms haven’t revved up on the large-scale basis needed. While many people in this country wear masks and follow physical distancing guidelines, too many still do not.

Mask wearing continues to be a political statement and is not mandatory in 15 states. Only seven states have any kind of stay-at-home orders, advisories or curfew, over which many a battle has been waged.

The outgoing Trump White House kicked off its holiday party season this week, with more than a dozen group gatherings planned, flouting US Centers for Disease Control and Prevention guidelines for size restrictions, as well as Washington, DC, restrictions for indoor gatherings. Most of us missed spending time with our families over this holiday season, and I am constantly on television reminding people of the dangers of doing so. Yet the administration itself has already been the epicenter of at least three Covid-19 outbreaks among staff and allies, and a series of events such as holiday gatherings will likely put several hundred more guests, workers and staff at risk.

That’s even as the US Surgeon General Dr. Jerome Adams issued what amounted to a plea on Fox News Friday. “To all the leaders out there, we need to lead by example over the next couple of weeks and really help people get over the finish line because, again, it’s in sight,” he said.

And the end is indeed in sight. Help, in the form of one or more vaccines, is on the horizon. This patient, our country, will survive, of course. But any imminent vaccine, while nothing short of a scientific and logistical miracle, won’t be an immediate fix. It will take time, several months to half a year, to distribute it to communities everywhere.

So, the question we have to ask ourselves is: How many Americans will we let die in the meantime?

President-elect Joe Biden told CNN’s Jake Tapper on Thursday that he will 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 for mask use, calling it “critical” to controlling the spread of coronavirus.

According to the most recent IHME model, the number of projected Covid-19 deaths could decrease by 66,000 by April 1st if 95% of people wore masks. Think about it. One of those lives saved could be your own mother’s, your elderly neighbor’s, your favorite musician’s or the next brilliant scientist’s. It could even be your life or mine.

In addition to wearing masks, we must restrict our activities and reduce capacity at certain types of businesses. A modeling study, by researchers at Stanford and Northwestern universities, shows that a small minority of places people visit account for a large majority of coronavirus infections in big cities. And it suggests that reducing the maximum occupancy in such places — including restaurants, gyms, cafes, hotels and religious establishments — can slow the spread of illness substantially.

This type of move will, or course, cause the patient a certain amount of pain—so leaders should be prepared to offer pain medications. In this metaphor, morphine comes in the form of money for those suffering, an economic stimulus.

One thing that has become clear. Our patient does not like taking small, incremental steps like those outlined by countless public health experts. Instead, the patient, our country, likes the big, hail-Mary, grand gestures. We are the quick-fix, short cut society — always hoping for the magic cures and potions, instead of leaning into the simple effective tools, which require a little more work. As a result, my patient doesn’t want to wear a mask and skip holidays with the family and friends; they just want a vaccine to hurry up and return us to life as normal.

Our human spirit has made us innovative, creative, resourceful and tenacious enough to see this dream of a vaccine bear fruit. But it’s our human behavior and biological reflexes that will dictate how deep our wounds ultimately go. No amount of science can rescue us from ourselves.

I can only hope that this country’s self-preservation instinct kicks in soon, and long enough, to get as many of us over the finish line as possible.