Yes, you. You’re reading this, so I’m talking to you. And you appear to be missing some crucial information essential to interpreting the present situation.
There exist quite a few out there who are conversant with such terms as “flattening the curve”; I’m fairly sure you can explain why we’d want to do such a thing, how we might go about it, and what will happen if we don’t. So far so good. (If you aren’t among that number, click here for a decent article on the basics.)
But what you seem to be missing is what comes next.
Our approach — presently called “social distancing” — is hardly a new one; it’s what many cities employed during the 1918 Spanish Flu, and they learned about it from doctors, who had studied it in school. (Editor: Yes, I know it didn’t originate in Spain. Different topic. Stay focused.) It’s a ‘soft’ quarantine, one designed to keep society functioning at a minimal level while reducing contagion. It was never intended to eliminate sickness; for that a quarantine has to stay absolute. Instead, it’s a way to buy time at the expense of convenience, industry, and economics.
What this means is that the illness is going to be with us for a while. It will end when one of three things happens:
- We develop a cheap and effective vaccine or inoculation and spread it around the world.
- We develop a cheap and painless treatment which will neutralize the deadly aspects of this in even the most immuno-compromised.
- Enough of us catch this and recover to create herd immunity — between 60-65% of the population.
Our medical researchers are working feverishly on 1. and 2.
In earlier days, a weak vaccine might have been available in a matter of months for health care providers; we’re hearing about engineered treatments and clinical trials right now, and that may well be what they deliver. A strong vaccine is unlikely for eighteen months or so for the simple reason that it’s likely to have side effects; we’d be ill-advised to field a cure that’s worse than the disease. As a result, we shouldn’t count on the vaccine to defeat this.
Treatments exist, and we’re trying them in our hospitals. You may have heard about the chloroquinine regimen and Remdesivir; it’s not that they don’t work but that they don’t generally work. There’s also tilt tables and other more primitive (yet proven) options. We know of a thousand methods to address the deadlier symptoms, but because this is still new — and because each method requires dedicated nursing — we haven’t yet developed protocols. We don’t know when to do what, how much, and for how long. It would be optimistic in the extreme to rely on someone inventing a treatment in the form of a simple pill at this point.
As a result, right now we’re looking at Option 3.
This means 220 million people in the United States need to catch this and recover — at a rate our hospitals can handle. That’s is about a million per week at the moment presuming the present rate, 10% of cases resulting in symptoms severe enough to require hospitalization. In case the scale is unclear, it will take about four years for that to happen. Temporary hospitals and alternate facilities were mobilized and abandoned during the first spike; during the second, we can expect our capacity to quickly triple at the least. Combined with expected advances in treatment protocols, we should be ready for this by midsummer.
I can picture you asking: “Since there’s no common test that tells us who has recovered, how can we possibly know when we reach the 220 million?” The answer is simple: There’s a 3% death rate in Hubei Province in China. Once six million Americans have died of this, we’re there.
Actually, it’s not that bad; with adequate hospitalization and moderate treatments, that number is closer to three million — if we don’t overload the hospitals. Projecting a mild curve of protocol advance, and extrapolating for our somewhat less vulnerable population, that number could be as low as one million by autumn.
I don’t want to dwell on the horrible, but it needs to be mentioned: Half a million people will die suddenly of COVID-19 instead of their terminal cancer, heart disease, and so on. They will die away from their families and with less access to nursing than we’re accustomed to provide. There’s little dignity to be had in death; there’ll be even less for the next six months or more. This is awful — and it’s not likely we’ll be able to avoid it. If you’re on this list, say your farewells now; don’t wait, and don’t trust to hope alone.
(Editor: Journalistic standards be damned. I can’t just say this and leave it cold like this. I’m sorry as hell to have to say what I just said; I hate the whole situation, and I feel your pain and fear. In order to stay honest, I have to tell it straight and plain, and that doesn’t leave any room to soften the blow. I’m very sorry to cause you pain — and I know I have.)
What “flattening the curve” means for us is that, if we do this right, a million Americans are about to die — and I consider that a reasonably optimistic assessment. Dr. Fauci is being optimistic about the numbers because that’s his job; if pressed, he’d probably tell you what I just did. Bear in mind that four million Americans normally die every year; from a societal standpoint this won’t be catastrophic — but on an individual level that’s a half million more tragedies than normal.
The next step, once the diagnosis curve starts to plateau, will be to gradually remove quarantine on small segments of the population. Those who can certify their recovery will go first; small parts of the work force — manufacturing, perhaps, and a very few dedicated restaurants and service businesses — will go next. This will be followed by another spike in contagion (mild, we hope), and as time goes by and that declines, large rural areas will be completely released. City dwellers will be the last to have restrictions lifted.
People will be tempted to blame a million deaths on our politicians, or on China for failing to contain this at the outset. This is palpably absurd. At most we can target the “wet meat” market in Wuhan for being the origin, but let’s face it: After the 2009 swine flu we didn’t stop eating bacon.
We have some flaws in our culture worthy of blame; we should change them going forward. We’re far too complacent about travel; our airlines and hotels are intransigent about changed plans due to illness, the which we also treat with insufficient respect. Everyone, particularly food service personnel and basic supply industries, needs a healthier sick leave system. And our entire healthcare system desperately needs to be converted from a for-profit model.
That we have done none of these things is a national shame. If we fail to do so now that we know better, it’ll be criminal.
(Editor: By curious coincidence, there’s an election coming up. And neither Trump nor Biden plans to make this change.)
One other thing we might consider is creating a world in which I don’t need to ask for donations to keep The Not Fake News going. Until we live in such a world, however, your money is most welcome — the more so because, like an honest politician, it’s so rarely seen.