Viral Times, Times of Uncertainty

As a physician in the biologic sciences, a lot of my training has involved living with uncertainty, being forced to make decisions affecting patient lives with insufficient information. Yet, faced with our current coronavirus situation, I am as anxious, uncertain, and confused as the next person, perhaps even more so. That is because I am familiar enough with testing procedures to know that not all tests are created equal, and all lack precision to a greater or lesser degree. This is especially true when tests are being developed by multiple private firms at breakneck speeds, all vying with each other to be first to market, pressured by governments and public demand to release a product without the usual checks and safeguards in place. A similar arms race is taking place in the arena of potential treatments.

Our current policies of social and business lockdown are based on mathematical models, which under the best of circumstances may contain significant errors of untrue assumptions.  When the model deals with a new virus of which very little is known, relatively small misjudgments can produce large erroneous outcomes when projected into the future. That is the reason why we need a lot more data based on reliable testing.

A recent study by Dr. John Ioannidis at Stanford examined some of our earlier data on the mortality rate among those infected, correlated it with a recent series of 3,300 volunteers from the San Jose area, and found that during the first week of April, between 2.5 and 4% of the local population had been infected with Covid-19. That’s 50-85 times the number of confirmed cases, implying a much lower mortality for the virus, between 0.12 and 0.2%. This is in line with the mortality from the Diamond Princess, the infected cruise ship that was quarantined off the coast of Japan. It is also similar to the mortality rate of other viral influenzas. So, did we make a grave error in subjecting ourselves to our current Draconian policies?

For those who have been listening to Dr. Fauci’s statements, the answer is no. His points were: we are seeing massive numbers of cases in some areas that are overwhelming the capacity of our health system, and we need to slow the spread of the virus in order to build capacity – beds, respirators, protective equipment, testing – in order to deal with demand. Hence, the need to flatten the curve. Thankfully, we seem to be achieving that goal. Why are we being faced with this crisis?  The answer is twofold. One, being a new virus with a high infection rate (every person with the virus seems to infect three more people), it spreads rapidly in the population where no one has any natural antibodies to it. The second answer is our lack of preparedness. Besides Bill Gates’ prophetic warning in a TED talk in 2015, the government has received over 20 separate studies from the CDC, from WHO, from the infectious disease community, all stating that such a pandemic was not only possible, but likely to happen in the near future. Unfortunately, these warnings fell on bureaucratic deaf ears, as funding for public health (less than 3% of our current health budget) is not a popular agenda item for politicians except during crises like these, when fingers get pointed in all directions except at those truly responsible.

Part of the problem is that the scientific questions the pandemic raises have complicated answers and do not lend themselves to sound bites and simple solutions, the type of solutions favored by pundits and politicians. It also means that there is disagreement amongst scientists themselves regarding the best course moving forward.

While we know that people over 65 have a mortality rate for the virus over 20 times greater than those under 55, the exact mortality is still being determined. We still don’t have a clear understanding of why New York State represents a third of all cases in the US to date, or why African Americans are affected in disproportionate numbers.  Even saying that lockdowns have worked to prevent the spread of virus is a premature statement in the absence of comparator of another place where lockdown didn’t occur.

There has clearly not been a central voice of authority and leadership to which people could listen and through which they could be educated. Part of that comes from our own ignorance of needed information, and a large part from politicians’ premature efforts to reassure everyone that everything is under control, and your government has answers to all the problems facing us. Also, if there is anyone to blame for this crisis, it is not them.

The scenario painted in most news releases is that “soon” we will have all the necessary testing, we can start going back to work, resuming our usual lives, and we should have an effective vaccine available within 18 months or less. The critical flaws in these assumptions lie in the fact that we may not have enough valid testing in place soon, that we may not have an effective vaccine in 18 months (it took five years to develop the Ebola vaccine, and we still don’t have one against Hepatitis C or HIV) and even if a vaccine is developed, it may work only in a small percentage of people.

How will we proceed? Will we have a series of on and off stay at home orders? Can we send our kids back to school? (Given the extremely low rate of serious illness among children, the answer is likely yes; but what about their teachers?) How long will the jobless rate stay above 20%? Clearly, no one has all the answers. While it’s important to maintain a positive outlook, hoping for the best scenario, we must prepare for a world where Covid-19 is not completely controlled for long periods of time, as well as for the possibility of another similar pandemic, about which we have already received warnings.

Writer Damian Barr recently wrote on his Twitter feed, “We are not all in the same boat. We are all in the same storm.” His statement succinctly summarizes our current situation. Some of us are in relatively luxurious vessels, can continue to work from home, still have professions and jobs that pay our bills, while others are awash in canoes, or hanging on for dear life to floating flotsam, desperately needing someone to throw them a lifeline. We need to come together as a country and as people, recognizing that in our plurality there is the potential for both wisdom and strength. Like with all crises, this one will eventually end, then be replaced by yet another. We can use the energy needed to surmount our current obstacles to build our own strengths. We can use this opportunity to reach out to our neighbor and offer a helping hand, realizing that sooner or later, we are likely to require someone to help us. As the saying goes, we are all but angels with one wing. We can only fly by putting our arms around each other.

Be well, stay safe.

This entry was posted in Covid-19, Family, Health and wellness, News and politics, Organizations, Thoughts & Musings, Uncategorized and tagged , , , , , . Bookmark the permalink.

2 Responses to Viral Times, Times of Uncertainty

  1. timfergudon says:

    Great summary! I have heard Dr. John Ioannidis talk on this subject. He is apolitical and has an incredible background in virology and epidemiology! I like that he has little faith in untested models.

  2. Thank you for this carefully and thoughtful response. The truth is, politicians run on 2-4 year dog-whistle policy ideas. Allocating money to infrastructure (public health should be part of that) is an ongoing area of expense. It does not play into campaigns effectively due to complexity and a need for these policies to be based on longer-term objectives.

    I hope that the current situation provides impetus for a less partisan long view but, sadly, I’m not holding my breath…. unless I’m in public. 😉

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