With President Trump, members of his administration, and other politicians shoving back against public health officials’ recommendations on when to get Americans out of their homes and returning to work, the ultimate decision may be up to individuals: Do we give up the existing physical-distancing guidance? Or not?
The data on Covid-19 infections and deaths is still building, but it may be worth reviewing what is known about the disease, whom it afflicts, and how.
Based on the deaths of those diagnosed with the novel coronavirus, it has been deadlier for men than women. It is taking a terrible and disproportionate toll among African Americans, with Latinos afflicted at high rates, too.
Contrary to myth, Covid-19 infections don’t exempt the young, with patients between the ages of 20 and 50 making up a big chunk of those with cases serious enough to require hospitalization. It also is true, though, that Covid-19 fells older people hardest, particularly if they have underlying conditions.
The building evidence doesn’t seem to buttress arguments that “safer” groups exist and individuals in them should go back to work and socializing pronto, while others safeguard themselves by staying at home.
The disease has killed very young patients. But Covid-19 has not, so far, attacked infants and children with the severity, say, that the seasonal flu has in recent times.
The infection appears to take time to develop after individuals are exposed to it, with experts expressing big worry about Covid-19’s asymptomatic spread, meaning those with no fever, no cough, no aches and pains, nor other signs of distress may walk around for days infecting many others before they finally turn sick themselves.
Covid-19 seems to enter the body through the nose and mouth, particularly when people spread the virus from their hands to the face area. This is why face masks and robust hand washing, along with physical distancing among us all, have become public health officials’ big recommendations for “bending the curve,” or stretching out the time the number of cases grow, so the health system doesn’t get overwhelmed.
The coronavirus attacks the lungs, and, in more severe cases, appears to go deep in the respiratory system. This can trigger an excessive immune response, which, in many patients, seems to significantly worsen their condition and lowers their chances of the body battling back the infection.
When patients’ respiratory systems reach high levels of distress, doctors have tried to assist their breathing with mechanical assistance — though greater clinical experience is suggesting this step may be occurring too early. It also may not help as many patients survive as medical teams would wish. Ventilators also continue to be in high-demand, and, in hard hit areas, they are in short supply.
The breathing distress that patients suffer due to Covid-19 also may be putting excess demand on their hearts and circulatory systems, some reports suggest, with cardiologists also asking if the coronavirus may be attacking not just lung but also heart tissue.
If patients survive the novel coronavirus’ onslaught, they may be vulnerable to other diseases, and their weakened condition may cause significant challenges with existing, underlying conditions. The process of getting patients off mechanical breathing supports is slow and can be unpleasant. Recovery from a Covid-19 infection isn’t fast or easy, with patients requiring costly and extended stays in the hospital or special nursing facilities.
Patients have come forward to tell about their infections, less severe and not requiring hospitalization but home stays. They have said that their Covid-19 cases have been worse than a bad cold or difficult flu, with bouts of sapping fever, aches and pains, and racking coughs compounded by shortness of breath that doesn’t go away easily or quickly.
The inequities and disparities in the U.S. health care system have been magnified exponentially by the coronavirus pandemic. Critics long have assailed the system for its poor care for African Americans and Latinos (particularly those who are immigrants or newer to the country). They toil at jobs with lower pay, meaning they have less access to health care. Their job and difficult lives may leave them with greater disability and more underlying conditions, for which they get less preventive care or needed treatment. Their current financial situation is less likely to allow them to skip work, stay at home, and avoid the close contact that has spread Covid-19.
Public health leaders have fought critics over the collection of infection data with information on patients’ race and economic standing. Controversies continue to flare over whether rich, white Americans get greater access to testing and treatment for the coronavirus than do poorer communities of color, which also often are more densely populated and already struggling with poverty’s ills.
In making their individual decisions about their lives and safety, Americans also may be significantly affected by the health decision making of their state and local leaders and the geography of where they live and work. Some states have leaders who have declined to put in place rigorous protective measures with urgency. This may mean that their people may work and play a bit longer but that their Covid-19 toll, in disease and economic terms, may be greater and longer lasting. But even in states with heavy-duty actions in place, facilities and medical supplies may not be sufficient, and forecasts on the infections’ peak not only vary by place to place but may be too high or too low as to needs and demands.
If this much known information on the pandemic isn’t persuading you, welcome to the big challenges confronting public health officials and politicians as they seek to determine the next steps for us all, especially as the world lacks for now a demonstrated, effective treatment for the disease or a vaccination to prevent it.
Medical scientists are rolling out not only more tests — both to detect current and past infections — and task forces at all levels of government and medical science may be planning how better to track and isolate those with Covid-19, so many more people may leave the shelter of their homes.
Does this happen in May or later? How sound are the tests on which so many plans rely — and how good is other evidence underlying the stark choices facing the nation? Will normalcy return in trickles rather than in a flood?
There’s also this to consider: Expert forecasts see a speedy lifting of the states’ stay-at-home measures, say, within 30 days of their issue, resulting in a Covid-19 death toll of 200,000, the New York Times reported.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the benefits they can get by staying healthy and out of the U.S. health care system. The coronavirus threatens to swamp our health resources, which, in their better times, already had notable problems with infections acquired in hospitals, nursing homes, and other medical care giving facilities, as well as major challenges with medical error and misdiagnoses. That said, at this difficult moment, we need to support doctors, hospitals, and public health officials as they marshal science, evidence, and facts to battle the global menace of Covid-19.
If experience teaches us much about pandemics, they do run a course. The price for this may be too steep for a country like ours to return to work, while watching too many loved ones, friends, and colleagues get sick or die. We’ve watched others make some sketchy decisions about health care in this country, on which we spend more than $3.7 trillion annually — and for a system that looks itself all too fragile at this moment. In better days, here’s hoping we collectively find much more energy to support not just the health system but real resources and investment in public health, including to reduce unacceptable disparities of multiple kinds. We also need to remember, toward the November election, how various elected officials rose — or didn’t — to meet this crisis. We’ve got tough thinking and acting in the days ahead for our individual, loved ones and the nation’s well-being.
