The Coronavirus Winter
The New Atlantis has a good, short interview with Dr. Michael Osterholm, one of the world’s top infectious disease specialists. Excerpts:
The New Atlantis: How serious is this situation? Are we locking things down too early or too late?
Michael Osterholm: This is a very serious situation. We will overwhelm the American health care system. It won’t be equally distributed around the country — some places will get hit much harder than others. We will run out of critical personal protective equipment for health care workers, which will ultimately result in infections that they will acquire on the job.
We will continue to see, I’m afraid, certain political responses which will lead people to challenge public health recommendations on ideological as opposed to scientific grounds.
And we don’t have a sense of how this is going to play out relative to time. I tell people we’re responding to this just like we’re responding to a Minneapolis blizzard, where we’re going to lock down for a couple of days and everything will go back to normal — as opposed to the fact that this is going to be a coronavirus winter and we’re just in the first week or two of a long season. This could last for months.
Osterholm says we shouldn’t take comfort from the relatively low number of cases now. Those data are fairly useless because they reflect only what we are able to test for — and we’re not testing many (here in Baton Rouge, our drive-thru testing facility ran out of tests today within the first hour). He goes on:
TNA: So given that the testing in the United States is still so inadequate, what do we actually look at then, what are the indicators of the progress of the disease?
MO: I think that we will begin to catch up with hospitalizations and intensive care. I think that is really the tip of the iceberg that is exposing what is underneath it. So as goes intensive care bed needs, so goes the epidemic in that area. And deaths also, but deaths are more difficult because it’s almost three weeks of illness before the average patient dies. So you’re going to expect to see the number of fatal cases delayed relative to the actual number of new cases by onset.
Osterholm tells TNA that he’s worried about “mitigation fatigue” — that people are going to get tired of the stringent things they’re having to do to flatten the curve, and give up.
It is necessary now to close schools and businesses, and tell people to drastically reduce social contacts in a way that is economically devastating to many businesses and workers. But there is a trade-off: The better we get at interventions to identify and isolate specific people with the virus, the less we should need to rely on interventions that isolate the entire population. That’s a reason the ramp-up of widely available testing remains such an important goal for the U.S.: More testing should, in time, allow for more normal living.
We are seeing this already in other countries: South Korea and Singapore been successfully addressing their coronavirus epidemics with less extensive social-distancing measures than are currently seen in Italy, France, and parts of the U.S., in part because of their effective testing and surveillance regimes. The Financial Times reports today on the town of Vò, Italy, which successfully stopped its local outbreak though a strategy that involved widespread testing of the population and isolation of those who tested positive, even as the rest of Northern Italy did not fare so well.
We have to hope and pray for that. Meanwhile, take social isolation seriously. Here’s a thread from David Lats, who is a youngish, healthy man suffering from COVID-19. Excerpt:
Me, I’m not leaving the house for anything. Today I ended up in bed almost all day long. I’m pretty sure my latent Epstein-Barr Virus has flared up again. I feel like a dishrag, and sleep deep and long during the day. It’s stress-related; probably hasn’t been such a great idea to be so immersed in thinking and writing about the plague, though to be honest, I’m a lot less troubled now that more people, including the US Government, are taking it with sufficient seriousness. Still, I have to finish rewrites on my forthcoming book in the next two weeks, and maintaining focus through the EBV brain fog is not easy.
By the way, young readers, don’t for one second think you are immune. From a Dutch newspaper (Google translated):
The idea that only vulnerable seniors are at risk from the coronavirus is incorrect. Of the 96 corona patients who are in intensive care in the Netherlands on Monday evening, about half are younger than 50, says Diederik Gommers, chairman of the Dutch Association for Intensive Care.
How are the people who end up in intensive care? Gommers: “Those people come to the ER with respiratory problems. Often they can breathe themselves the first day, then they deteriorate hard. They have to work very hard to get air in them. They exhaust themselves, as it were, and at that point we are going to intubate. We insert a tube and take up breathing with a device. It is called ‘mechanical ventilation’. “
Without that device they have no chance. “They are exhausted, cannot breathe themselves anymore.” A patient does not notice the ventilation: it is put to sleep, just like during an operation.
They end up on the ventilator for up to a month. This is happening to young people too. Take this seriously!
Collins also spoke about civic responsibility and the importance of selflessness in the midst of a pandemic. “I think we as a nation have to get into a place of not just thinking about ourselves, but thinking about everybody else around us, and particularly the most vulnerable people—those who are older and those people with chronic diseases. Young people may have a relatively low risk of serious illness, kids seem to have a very low risk, but if you want to avoid what could be the deaths of hundreds of thousands of people, then it is incumbent on all of us to severely limit our social interactions. We need to ask the question about every interaction we have, and whether it is necessary or not. I’m going to speak very strongly about that. Obviously, people do have to get food in the house and do other absolutely essential things, but beyond that, we should be volunteering to engage in the most stringent kind of isolation.”
He added, “that means we all need to take responsibility even if we are thinking of ourselves as relatively impervious to this illness. It would be easy for a young person to look at the data and go, ‘Well, you know, what if I get it? I’m probably going to be fine.’ But you have to think of yourself also as a vessel for other vulnerable people. Even if you don’t think you need to do this kind of isolation for your own good, you’re doing it for the rest of the country—and particularly for your grandparents and other people who are in a vulnerable state.”
And Collins also offered a big picture-perspective for Americans. “I think people need to be prepared that we are going to be in this space for more time than they will like,” he said. “In many ways, the best sign that we’re making progress will be that the duration of the epidemic goes on a little longer. That’s what flattening the curve means. It means that the most serious cases do get stretched out over time and don’t all happen right at the beginning. So anybody’s who’s imagining that this will all be over and done within a month, needs to get their mind around the fact that we’re in this, I think, for quite a long stretch of time. I can’t imagine that schools that have decided to give students off two weeks will be back in session then, and probably not for this whole academic year. I think we’re facing the fact that at least until June, we all need to be in the space of taking this with the greatest seriousness—and that means every American taking responsibility about this and not coming up with reasons why it’s not necessary.”