A Brave or Terrified New World?

Dear Readers,

As you know, it has been quite some time since I posted my last blog.  But due to the recent events that have so dramatically changed our nation, states, local communities, and family and professional lives, I’ve been highly concerned that so many have lost sight of the evidence–or have actively sought to obscure the evidence that is being acquired due to personal and political agendas rather than concern about the health, well-being, and safety of the American people.  Again, as I’ve stated in my blog’s tag line since day one, isn’t it “all about the evidence,” so that the American people receive the accurate information they deserve vs. misinformation and misguided falsehoods that do not provide, but instead conceal, the truth?

“Facts do not cease to exist because they are ignored.” 

― Aldous Huxley, Complete Essays 2, 1926-29

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

“The charm of history and its enigmatic lesson consist in the fact that, from age to age, nothing changes and yet everything is completely different.”

  ― Aldous Huxley

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The words of Aldous Huxley, the author of the classic dystopian novel “Brave New World,” were certainly prescient and relevant today.  This is not the first occasion where the world has witnessed global transmission of a potentially deadly infectious disease.  After all, most of us remember hearing about the 1918 influenza pandemic, which is considered the most severe pandemic in history.   And sadly, at that time, certain public officials repeatedly told half-truths or lied—where they were assisted by the press—though for some different reasons than we’re seeing today.

A History Lesson

The 1918 pandemic was also known as the “Spanish flu,” which  is thought to be a misnomer, since its origin is still unknown.  However, theories suggest that it may have first occurred in China, the United States, the United Kingdom, or France.

The virus that caused the pandemic was found to be an H1N1 virus containing genes that probably originated in birds (and is therefore known as a “zoonotic” virus).  The pandemic is thought to have caused the deaths of more people in absolute numbers than any other disease of all time.  The number of deaths has been repeatedly revised by researchers and epidemiologists—and every revision has been higher. 

Per the Centers for Disease Control (CDC), it’s estimated that approximately 675,000 deaths occurred in the United States.  In addition, a 2002 epidemiologic study estimated that globally, the death toll was between 50 and 100 million people.

Unlike with our current coronavirus pandemic, during the 1918 influenza pandemic, mortality was highest in children younger than 5 years of age and adults aged 20 to 40 years—and, as with our current pandemic, adults 65 years of age and older.  The CDC notes that the high mortality rate in otherwise healthy people (including those aged 20 to 40 years) is considered a unique characteristic of the 1918 influenza pandemic.  It’s estimated that the mortality rate was greater than 2.5%.  (It’s only possible to estimate, since there was not the capacity for detailed record-keeping for testing and diagnoses of infectious diseases as there are today.  Thus, such estimates must rely on comparing actual mortality to a baseline mortality level that would typically have been seen without influenza.)

Nearly 15 years ago, in 2005, the Institute of Medicine held a US forum on Microbial Threats, and a workshop summary was published by the National Academies Press (US), entitled “The Threat of Pandemic Influenza:  Are We Ready?  In the first chapter, “The Study of Influenza,” the editors (Knobler SL, Mack A, Mahmoud A, et al.) noted that “…the world is vulnerable to the next pandemic, perhaps even more than in 1918, when the pace and frequency of global travel was considerably less than today.  As the contributors to this chapter demonstrate, there is still much to be learned from past pandemics that can strengthen defenses again future threats.  The chapter begins with a review of the events of 1918, the lessons they offer, and the historical and scientific questions they raise. It describes the epidemiology and symptomology of that deadly viral strain, limited efforts toward prevention and treatment, and the resulting social disruption and its exacerbation by the actions of public officials and the media.”  (The emphasis is mine.)

Back in 1918, how did our country react?

“The first casualty when war comes is truth.”

Per the editors, “In the United States, national and local government and public health authorities badly mishandled the epidemic, offering a useful case study.”  (Again, the emphasis is mine). 

They stressed that the context of current events at that time was critical.  The United States and every other country at war took steps to try to control public perception and to prevent hurting morale.  Therefore, at first, the press in those countries did not report the outbreak.  (In contrast, the press in Spain, which was not engaged in the war, did report the outbreak.  As a result, it is thought that that is the reason the pandemic was referred to as the “Spanish flu.”)

In 1917, a senator from California, Hiram Johnson, famously (or infamously) stated “The first casualty when war comes is truth.”   In fact, the federal US government passed a law stating that to “utter, print, write, or publish any disloyal, profane, scurrilous, or abusive language about the government of the United States” was punishable by 20 years in jail.  In other words, Americans could be jailed for criticizing the US government—even if people were speaking the truth.  The government also engaged in a propaganda campaign, where one of the architects noted, “The force of an idea lies in its inspirational value. It matters very little if it is true or false.”

What Were the Consequences? 

There certainly were not positive effects.  The majority of officials in local regions repeatedly lied or told half-truths with the goal of preventing damage to morale and the overall war effort.  “They were assisted—not challenged—by the press, which although not censored in a technical sense cooperated fully with the government’s propaganda machine.”

As the outbreak spread from one town or city to another, most officials would urge the public not to be concerned and that public health efforts would prevent them from being affected.  They also repeatedly emphasized at first that the outbreak was not the Spanish flu, but simply “ordinary influenza”—and later that the “worst of the flu is behind us.”

For example, Chicago’s public health commissioner stressed that he would do “nothing to interfere with the morale of the community … It is our duty to keep the people from fear. Worry kills more people than the epidemic.”

This in fact became a nationwide mantra: i.e., that “Fear kills more than the disease,” and a popular periodical, Literary Digest, echoed the sentiment by emphasizing that “Fear is our first enemy.”

Officials in various towns and cities closed schools, houses of worship, theaters, and many other public places.  Some ordered everyone to wear masks, to avoid shaking hands, and to stay indoors.  Libraries stopped lending books.  In addition, regulations were passed that banned spitting.  

A sign in the Philadelphia Navy Yard warning against the Spanish flu, noting that there were 1,500 cases in the yard alone and 30 deaths.
~Everett Collection

While imposing such measures, some community officials continued to provide reassurances, stressing that “there is no need for panic or alarm.”  Yet despite these false reassurances, a rapidly increasing number of people witnessed the excruciating deaths of their spouses, children, brothers, sisters, grandparents, neighbors, and friends.  The disconnect between what they were repeatedly hearing from officials and echoed by the media completely destroyed any sense of trust and credibility, escalating fear and transforming into panic.  Most would agree that throughout history, America has been about neighbors helping neighbors.  Yet in 1918, due to all the factors above, many of those who had not yet become infected by the virus were simply too frightened to go anywhere near those who were ill.

What Lessons Were Learned?

Fast forward to the world we live in today.  What lessons, if any, have we learned about how to best handle the pandemic that we’re now facing?  First and foremost, it’s critical that our government officials and the media maintain (or improve) their credibility.  The American people deserve the facts, which must be based on evidence.  There should be no down-playing of reality, no false reassurances, no sensationalizing that the “sky is falling,” and no “reporting” that is given through the lens of opinion and bias versus objective truth-telling:  i.e., what we know, what we do not yet know, and all efforts that are taking place to determine those answers to develop evidence.

As discussed above, during the 1918 pandemic, many officials in local regions repeatedly told half-truths or lies in an effort to prevent damage to morale and the country’s war effort.  They were not challenged by the press; rather they were assisted by the press, which cooperated fully with the government’s propaganda.

And today, what are we seeing instead?  Many would argue that rather than bringing critical information to the American people, the popular media is again proprogating false information—but this time, it is not doing so in an effort to help prevent fear and panic.  Rather, it appears to many that their mission is to thwart the Trump Administration’s efforts and that they are much more concerned with pressing a political agenda than accurately keeping Americans informed about the global pandemic.   In fact, to some, it appears that the media is downright dismissive of crucial steps achieved to date concerning the pandemic through efforts of federal officials and private industries coming together to fulfill critical needs.  Just to name a few examples, these include the following:

  • Reduced restrictions on telehealth services
  • Eased Department of Transportation hour-of-service regulations for commercial truck drivers who are transporting emergency relief,  including testing equipment, necessary medical supplies, hand sanitizers, disinfectants, and food for emergency restocking of stores
  • The Trump Administration’s coordination with the National Association of Manufacturers that will enable up to 40 companies to produce ventilators, test kits, gloves, protective suits, and vital-sign monitors
  • Reduced Food & Drug Administration (FDA) regulations on distribution of test kits

A medical staff member using test systems for the diagnosis of coronavirus. (AP)

  • Eased restrictions on states, allowing them to take responsibility for test kits developed and used by labs within their state borders
  • Allowance of licensed, healthcare professionals to work in states other than where they were certified
  • The private company “MyPillow,” shifting 75% of its production to manufacturing cotton face masks for healthcare workers
  • Reduced restrictions enabling some US and European distilleries to add hand sanitizer to their product ranges

Public Opinion?

It has come to the point where many Americans strongly believe that the popular media is in complicity with Democrat politicians.   In fact, in a Gallup poll released on March 26th, 2020, when participants were asked whether they approve or disapprove of the way a number of US leaders and institutions have responded to the coronavirus outbreak, “Every single group or individual listed in the poll had a higher approval than disapproval rating, save one: the news media. A mere 44 percent of respondents said they approve of the way that the media has handled the COVID-19 crisis, while 55 percent disapprove.  Contrast that with what the poll reported on the public’s opinion on President Trump:  Sixty percent approve of his response, and 38 percent disapprove.  Vice President Pence had even higher ratings, with 61 percent approval compared to 32 percent disapproval.  Several institutions included in the survey had extremely favorable ratings.  Eighty-eight percent of respondents said they approve of the job that hospitals in the US are doing, for instance, and only 10 percent disapprove.  More than 80 percent approve of the response from their state government, their employer, and their child’s school or day care. Even Congress is above water with the American public, with 59 percent approval and 37 percent disapproval. Only the news media was under water, and that’s not terribly surprising.  It’s worth noting, though, that when Gallup posed the same questions to respondents broken down by party affiliation, it’s clear where much of the disapproval of the media is coming from: Sixty-one percent of Democrats said they approve of the media’s job, while just 25 percent of Republicans said the same.”

Lose-Lose Situation?

Those Americans who believe that the popular media is in complicity with Democratic politicians point to several recent examples, including the below:

  • Through much of his presidency, many in the media have repeatedly criticized President Donald Trump and his Administration for not holding regular press briefings.  Yet now that he, his advisors, and public officials, such as Dr. Anthony Fauci, are currently holding daily press briefings to keep the public informed of all developments concerning the pandemic, many in the media say that he should “just stop.”  Witness just a few examples:
    • One recent headline in The Washington Post: “Trump, as usual, is just making things worse.”
    • KUOW Public Radio (Washington State) tweet:  “… we will not be airing the briefings live due to a pattern of false or misleading information provided that cannot be fact-checked in real time.”  In response, some would ask, “Why are we supporting public radio with our tax dollars, so that they can decide not to bring the facts about the pandemic to the American people?” 
    • Rachel Maddow:  “I would stop putting those briefings on live TV, not out of spite, but because it’s misinformation.”
Video Image Screenshot
  • Update: Disturbingly, in an article by Chantal Da Silva posted this morning (3/31/20 at 4:09 AM EDT) by Newsweek, “Over 120,000 Sign Petition Calling for End to Live Coverage of Trump’s Coronavirus Briefings.”

What about the nature of many of the questions posed to President Trump during those daily press briefings?   Despite the above, regardless of one’s political views and perspective concerning President Trump’s demeanor, it’s difficult not to agree that the tone of much of the questioning is disrespectful, opinionated, sensationalized, and crafted with a “gotcha,” blame game mindset and fear-mongering intent, rather than directed at obtaining the facts and keeping the American people informed.  Again, here are just a few examples of such questions from the Washington Press Corps:

  • White House NBC News Correspondent, Peter Alexander: “Is it possible that your impulse to put a positive spin on things may be giving Americans a false sense of hope by misrepresenting the preparedness right now?” (The question was in regard to the study of investigational medical treatments for Covid-19.)   The President’s response: “Such a lovely question … ‘Look, it may work and it may not work … I feel good about it, that’s all it is, just a feeling.’”
  • Alexander was not done, however:  “What do you say to Americans who are scared, though, I guess.  Nearly 200 dead, 14,000 who are sick.  Millions, as you witnessed, who are scared right now.  What do you say to Americans who are watching you right now who are scared?”  What was clear to all who have seen this press briefing, including President Trump (with the exception of the other reporters who piled on to support their colleague), was that Alexander was far more concerned about bringing attention to himself, “scoring a point” for his political agenda, and using scare tactics to grab a headline, rather than taking the time to ask a genuinely important question to obtain critical safety and medical information to help keep the American people further informed.
  • What was the President’s response?  “I say that you’re a terrible reporter, that’s what I say.  I think that’s a very nasty question, and I think it’s a very bad signal that you’re putting out to the American people.  The American people are looking for answers, and they’re looking for hope.  And you’re doing sensationalism …”
  • When an Associated Press (AP) correspondent, Jill Colvin, then jumped to Alexander’s defense, asking “Do you really think, you know, going off on Peter, going off on a network is appropriate when the country is going through something like this?,” the President responded as follows:
  • “Oh, I think it’s a good message because the country has to understand that there is indeed, whether we like it or not, and some of the people in this room won’t like it, there’s a lot of really great news and journalism, and there’s a lot of fake news out there, and I hear it all and see it all, and I understand it all because I’m in the midst of it …  I know that and I call Pete—I call Peter out, but I call other people out, too. This is a time to come together, but coming together is much harder when we have dishonest journalists.  It’s a very important profession that you’re in. It’s a profession that I think is incredible.  I cherish it, but when people are dishonest, they truly do hurt our country.”
  • How about this question from an unnamed “reporter” at another daily press briefing:  “How many deaths are acceptable?”  President Trump’s response:  “How many?!  None.  Okay.  How many deaths are acceptable to me?  None.  Okay, if that’s your question.”
  • Here’s the perspective of Glenn Beck on “Glenn TV” on March 24, 2020 from The Blaze. Entitled “Coronavirus disinformation DEBUNKED: Here’s what they’re not telling you,” he laments the current state of the popular media: “The Trump administration is constantly, constantly getting criticized for not unleashing the American public.  Really?  You’re only feeling that way or your friends are feeling that way because they don’t believe the press anymore.  The media refuses to report on what is actually true, they don’t care: they just want you pissed off, scared, and they want Trump to lose.  That’s it.”  (Glenn Beck, The Blaze).
Video Image Screenshot

Another Telling Example

How many questions did reporters ask about why President Trump insisted on calling the virus the “Wuhan Virus” or the “Chinese Virus”?   He repeatedly explained that he was doing so for logical reasons—i.e., that the outbreak initially began in Wuhan, China and that he was extremely concerned about the Chinese Communist Party’s disinformation campaign, which allowed the virus to spread unchecked across the globe.  By repeatedly pushing this narrative, insisting that his use of the name “Wuhan virus” or “Chinese virus” was pure and simple racism and xenophobia, these “journalists” once again happily threw away their opportunity—and their responsibility—to elicit crucial medical and safety information for the American people.  Instead, they’re breathlessly quoting “public health experts” that due to President Trump’s “long record” of negativity regarding illegal immigration, his referring to the “Wuhan virus” is proof positive that he is racist and xenophobic.  Hmm, does this mean that those who named “Lyme disease,” “West Nile Virus,” and the “Ebola Virus” after the locations where these diseases were first identified are all also racist and xenophobic?  (For the record, I was living in Clinton, CT when Lyme disease was named.   The disease was named in the late 1970s after a small shoreline town in Old Lyme, CT, where the first documented cases were identified.  Old Lyme is just a few towns away from Clinton.  I can tell you that no one in our area took any offense when the disease was named.)

Advice from the Nation’s Foremost Infectious Disease Experts

While more and more in the popular media are ceasing to air the daily press briefings, the President continues to stand on the podium every day, where behind him are the nation’s foremost infectious disease experts, including Dr. Anthony S. Fauci, and Dr. Deborah L. Birx, who is coordinating the nation’s efforts to fight the coronavirus.  President Trump is essentially walking a tightrope, leaning on the evidence that continues to develop and balancing serious concerns about the plunging economy with necessary measures to best help to protect all our American citizens. 

Video Image Screenshot of Daily Press Briefing

In attempting to strike the appropriate balance—weighing cautious optimism against worst-case scenarios—he had said over the last few weeks that he would like to reverse the drastic measures associated with social distancing, potentially by Easter, this April 12th–perhaps rolling out easing of restrictions based on the evidence indicating those at least risk, while continuing restrictions for those at highest risk.  This was met by a firestorm of outrage in the popular media, as shown by the following headlines:

  • “In Weighing Safety Against the Economy, Trump Offers a False Choice, Experts say,”  The Boston Globe, By Laura Krantz and Victoria McGrane, Globe Staff, Updated March 24, 2020, 7:56 pm.
  • “President Trump is Already Considering Defying Health Experts to Boost the Economy,” Time, by Brian Bennett and Tessa Berenson, March 23, 2020.
  • “’My Mother is Not Expendable,’  As Trump itches to get U.S. back to work, experts warn of deaths, economic calamity,” NBC News, by Allan Smith and Shannon Pettypiece, March 24, 2020, 3:27 PM EDT; updated March 24, 2020, 5:47 PM EDT.

Yet last night (Sunday, March 29th, 2020), based on recommendations by Dr. Anthony Fauci, Dr. Deborah Birx, and other advisors, President Trump agreed that the guidelines should not be relaxed too soon.  Earlier yesterday, Dr. Fauci had estimated that based on current data, there could be up to 200,000 fatalities due to the Covid-19 virus in the United States.  Dr. Fauci said, “The idea that we may have these many cases played a role in our decision in trying to make sure that we don’t do something prematurely and pull back when we should be pushing.”  He stressed that extending the guidelines until the end of April was a “wise and prudent decision” that President Trump had reached after several days of discussions with Drs. Fauci and Birx.

Different Standards?

While many in the popular media continue to parrot that “Trump’s lies continue to endanger the public,” in contrast, many have no qualms about reporting on “truths” as presented by current and former Democratic officials.  For example, Joe Biden stated that the Trump Administration cut the Centers for Disease Control (CDC)’s budget (which Mike Bloomberg also repeated in a campaign ad) that was then picked up by other popular media outlets and repeated over and over again.  Per The Hill, AP fact-checkers said former Vice President Joe Biden and former New York Mayor Mike Bloomberg painted a “distorted picture of federal infectious-disease bureaucracy as rudderless and ill-prepared for a coronavirus threat,” saying that the two presidential candidates were “both wrong” to say President Trump cut funding to the CDC.  Though Trump’s 2021 budget proposal does propose a budget cut to the CDC, the budget has not been enacted and was overruled by Congress—which actually increased the CDC’s budget.  Further, the proposed cuts by the Trump Administration would trim funding from the CDC’s chronic disease activities, where Health and Human Services (HHS)’s officials prefer the CDC to focus more closely on its primary missions to prevent and control infectious disease spread and other crucial, emerging public health concerns, including opioid abuse.

Video Image Screenshot

Further, in the midst of this global pandemic, Red State published an article about the “paper of record,” The New York Times, entitled The New York Times Tries to Spread Panic About Ventilators, Gets Epically Fact-Checked.”  Posted at 10:00 pm on March 26, 2020 by Bonchie , the article notes “Today, the paper of record went back to the old steadfast during this crisis, which is to try to create panic in order to score political points … [The story] willfully lies to readers about the timeline in which those ventilators will be needed.”  The story was tweeted by Trip Gabriel, who describes himself as “Codeword level access: Covering 2020 for The New York Times.  Ex-National correspondent, 2012 and 2016 campaign beats, former Styles editor.”  Per the Red State article,  “Luckily, a former Times writer chimed in and absolutely eviscerated Gabriel with a fact-check.” 

Coming Together?

Nearly all of us remember exactly where we were and what we were doing on 9/11/2001 when we saw or heard about the first and then the second plane hitting the Twin Towers in New York City.  And how did we react as Americans?   We came together and put our differences aside, intuitively understanding what is truly important in life.  Unfortunately, over the last several years, I’m sure that many of you would agree that our nation has become so divided that an increasing number of people have lost sight of what makes our lives matter.  Yet with our world changing so rapidly during the last several weeks, many of us are again being reminded of the gifts that truly matter most: our loved ones, health, and safety; our beloved pets; our livelihoods and lifestyles; and our faiths, in God, our neighbors and communities, all those who are working at personal risk to help keep us healthy and safe, or all of the above.

My hope is that their message will be taken seriously by all, enabling us to unite around the facts of our current situation and to stop seeing everything—including the most important considerations in life—through the lens of political ideology and agendas.

Writing in an opinion / commentary piece in The Wall Street Journal, Drs. Eran Bendavid and Jay Ghattacharya posed a crucial question, “Is the Coronavirus as Deadly as They Say?  Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude.”   Their piece further emphasizes just how critical it is for our officials and the popular media to base decisions, communication, and reporting on the facts and evidence to obtain credibility with and accountability for the public.  My hope is that their message will be taken seriously by all, enabling us to unite around the facts of our current situation and to stop seeing everything—including the most important considerations in life—through the lens of political ideology and agendas. 

The authors begin by stating that the very premise that has caused so much fear and misinformation is inaccurate.  They note that that premise is based on its high estimated case fatality rate—“2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization (WHO) and others.  So if 100 million Americans ultimately get the disease, two million to four million could die.  We believe that estimate is deeply flawed.  The true fatality is the portion of those infected who die, not the deaths from identified positive cases.”

They explain that use of  identified positive cases is extremely misleading due to selection bias concerning those who are tested (since in the US, currently, those whom are most likely to be tested are symptomatic).  They note that “The degree of bias is uncertain because available data are limited.  But it could make the difference between an epidemic that kills 20,000 and one that kills two million.  If the number of actual infections is much larger than the number of [identified] cases—orders of magnitude larger—then the true fatality rate is much lower as well.  That’s not only plausible but likely, based on what we know so far.”

They emphasize several factors that are crucial to consider: the fact that the testing used to identify cases does not currently identify those who were infected previously and have now recovered.  Further, testing rates were initially very low and typically conducted for symptomatic cases with severe illness. They stress that “…given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions is now critical.  We don’t know the true infection rate in the US.  Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial.  Nearly every day, a new lab gets approval for antibody testing, so population testing using this technology is now feasible.”  They conclude that based on the current evidence, “A univeral quarantine may not be worth the costs it imposes on the economy, community, and individual mental and physical health.  We should undertake immediate steps to evaluate the empirical basis of the current lockdowns.”

Are Our Current Efforts Worse than the Virus?

So how do we take all necessary steps to get through this pandemic, while preventing panic and protecting and effectively treating as many people as possible and turning our economy around?  Another  important evidence-based perspective has been provided by Dr. David L. Katz, president of the True Health Initiative and the founding director of the Yale-Griffin Prevention Research Center.  Writing an opinion piece in The New York Times, entitled “Is Our Fight Against Coronavirus Worse Than the Disease?  There may be more targeted ways to beat the pandemic,” he notes that “We routinely differentiate between two kinds of military action: the inevitable carnage and collateral damage of diffuse hostilities, and the precision of a ‘surgical strike,’ methodically targeted to the sources of our particular peril.  The latter, when executed well, minimizes resources and unintended consequences alike.”  He stressed that with today’s coronavirus pandemic, “the same dichotomy applies. This can be open war, with all the fallout that portends, or it could be something more surgical.  The United States and much of the world so far have gone in for the former.  I write now with a sense of urgency to make sure we consider the surgical approach, while there is still time.”

Dr. Katz explains that a pandemic occurs when an entire population is not immune to a specific infectious pathogen.  People develop immunity when they develop antibodies to target the pathogen, whether naturally or due to receiving a vaccine.   If exposed to the pathogen again, their immune system eradicates the pathogen before infectious, symptomatic disease develops.  He then explains “that robust immune response also prevents transmission.”   If the pathogen isn’t able to affect you, you are not able to transmit the pathogen to another person even if he or she is not yet immune to that pathogen.  Therefore, he writes, “When enough of us represent such ‘dead ends’ for viral transmission, spread through the population is blunted, and eventually terminated.  This is called herd immunity.”

From the data that is currently available from the United States and other countries, Dr. Katz notes that deaths from Covid-19 have primarily clustered among “the elderly, those with significant chronic illnesses such as diabetes and heart disease, and those in both groups.”  Unlike with influenza, “The clustering of complications and death from Covid-19 among the elderly and chronically ill, but not children … suggests that we could achieve the crucial goals of social distancing—saving lives and not overwhelming our medical system—by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.”

Why Does This Matter?

Dr. Katz then poses a crucial question:  “Why does this matter?  I am deeply concerned that the social, economic, and public health consequences of this near total meltdown of normal life—schools and businesses closed, gatherings banned—will be long lasting and calamitous, possibly graver than the direct toll of the virus itself.  The stock market will bounce back in time, but many businesses never will.  The unemployment, impoverishment, and despair likely to result will be public health scourges of the first order.  Worse, I fear our efforts will do little to contain the virus, because we have a resource-constrained, fragmented, perennially underfunded public health system.  Distributing such limited resources so widely, so shallowly, and so haphazardly is a formula for failure. How certain are you of the best ways to protect your most vulnerable loved ones? How readily can you get tested?”

He noted that in more places across the country, gatherings are being limited to smaller numbers.  (During a recent daily press conference, President Trump encouraged that gatherings should be limited to no more than 10 people.)  Dr, Katz describes such policies as “horizontal interdiction,” where policies are directed at the entire population without assessment of their specific risk for severe infection.  Yet he is extremely concerned that as schools and colleges are closing, and as more and more employees are being laid off, young people of unknown infectious status (who may well be infected but asymptomatic) are now being forced to self-quarantine at home (i.e., what he has termed “vertical interdiction”) with parents and other relatives in their 50s and 60s and grandparents in their 70s, 80s, or even 90s who are at highest risk for severe infection.  This “horizontal and vertical interdiction” is causing enormous strain on our medical system including by those who are considered low risk, severely limiting the system’s ability to direct such resources to those who truly need them.  Our healthcare providers, who are also at increased risk for being infected with the virus, are overwhelmed and worried about lack of respirators, ventilators, hospital beds, masks, and other crucial personal protective equipment (PPE), while simultaneously worrying about fulfilling family demands.  And again, due to the closure of schools, colleges, and many businesses, multiple generations are often sheltering in place together, leading to potentially increased exposure to infection among those at highest risk for severe infection.

So because we do not yet have widespread testing, rather than using a strategic, “surgical strike” approach that specifically focuses on protecting those populations who are known to be at the highest risk, he fears that using such a diffuse approach may well be ineffectively fighting—or even potentially spreading—disease, with the collateral damage of unintended consequences, including minimizing the resources we have, causing our economy to collapse all around us and, ultimately, full societal disruption.

Dr. Katz poses another crucial question: “What is the alternative?”  His response: “… We could focus our resources on testing and protecting, in every way possible, all those people the data indicate are especially vulnerable to severe infection: the elderly, people with chronic diseases, and the immunologically compromised. Those [who] test positive could be the first to receive the first approved antivirals.  The majority, testing negative, could benefit from every resource we have to shield them from exposure …”

He continued, saying that “If we were to focus on the especially vulnerable, there would be resources to keep them at home, provide them with needed services and coronavirus testing, and direct our medical system to their early care.  I would favor proactive rather than reactive testing in this group and early use of the most promising anti-viral drugs.  This cannot be done under current policies, as we spread our relatively few test kits across the expanse of a whole population, made all the more anxious because society has shut down.”

Dr. Katz argues that by strategically focusing on a much smaller segment of the population based on evidence of whom is at most risk, this “would allow most of society to return to life as usual and perhaps prevent vast segments of the economy from collapsing.   Healthy children could return to school and healthy adults go back to their jobs.  Theaters and restaurants could reopen, though we might be wise to avoid very large social gatherings like stadium sporting events and concerts.   So long as we were protecting the truly vulnerable, a sense of calm could be restored to society.  Just as important, society as a whole could develop natural herd immunity to the virus.  The vast majority of people would develop mild coronavirus infections, while medical resources could focus on those who fell critically ill.  Once the wider population had been exposed and, if infected, had recovered and gained natural immunity, the risk to the most vulnerable would fall dramatically.”

He concludes that “a pivot right now from trying to protect all people to focusing on the most vulnerable remains entirely plausible.  With each passing day, however, it becomes more difficult.  The path we are on may well lead to uncontained viral contagion and monumental collateral damage to our society and economy.  A more surgical approach is what we need.”

All of this leads to these final questions:  What is our country going to look like after the pandemic ends?  Will we as a society learn the crucial lessons this time?  Will we finally become proactive rather than reactive?  Will our public officials continue to use a diffuse approach, or will they use a methodical surgical strike at the source of the next pandemic?  What will our economy look like?  How many people will remain unemployed, and how many small businesses may never return?  Will our popular media stop moving in lock-step and begin to report objective truths and evidence?  Will we finally be ready to together look through the lens of reality versus personal opinion and bias?   I pray that in the words of William Shakespeare,  “All’s Well that Ends Well.”  But we shall see.