Musings on the Wuhan virus

We have had pandemics before, but not when so interconnected with the internet, social media, and Google and never in an age where there was such vitriolic divisiveness in the culture or toxic partisanship in politics. Everything is now subject to scrutiny. Everything, even a virus, is politicized and, with more information at our fingertips than ever, you don’t know who or what to trust.

First, the virus. As with nearly all viruses, we have no cure and don’t expect to have one anytime soon. A vaccine is promised but when, and if, it may arrive is pure speculation with few expecting one in less than a year. Even if we develop a vaccine, we have no clue how effective it will be. Our only precedent is the flu vaccine and its effectiveness varies widely from year to year, from as low as 40% to has high as 80%. Given these accepted facts, our only hope is either full containment or enough exposure for the population to develop sufficient immunity, “herd immunity”, to stop the spread.

Let’s look at containment. How has that worked out? Social distancing, mask wear, sheltering-in-place, and locking down the economy have unquestionably worked to slow the spread and prevent hospitals from being overwhelmed in the early stages of the pandemic. The cost has been huge, not only in dollars, but in lives as well. Economic experts who do such calculations have estimated that the cost in years of life due to these measures has been more than double the loss of lives due to the virus and longer they go one, the greater the disparity. Everyone agrees that we cannot continue indefinitely with these measures. The economy cannot sustain it and people are already beginning to push back against the social isolation and loss of income, jobs, careers, and businesses built over a lifetime.

No one, and I mean no one, has said that the above measures will stop the virus; the goal was to give us breathing space until our medical resources could catch up. That has been accomplished and, for that, we should all be grateful. Now, however, the narrative has changed. The question is: when do we open up society and the economy and how fast do we do this? That question has become so politicized that the answer depends more on what political camp you are in than on evidence-based medical decision making. We know that, as we open society and the economy, the numbers of those infected with the virus will rise, and it has, yet the media and the “experts” act as though this is a huge surprise and once again have begun trumpeting the clarion call to isolate, socially distance, shelter-in-place, and shut down.

As a physician, I see the rise in cases as a good thing. A case mind you, is simply someone who has tested positive for the virus. Totally asymptomatic or on a ventilator in a hospital ICU bed, all are “cases”. Absent an effective treatment or vaccine, and knowing that we cannot stay locked down indefinitely, our only hope for dealing with this virus is to turn to the most effective anti-virus agent known to man: a healthy immune system. That will only happen when a sufficient number of people are exposed. Yes, some will die and that is tragic, but to think we can avoid this is to live in a world of illusion, not reality.

I believe the U.S. populace has become inured to its vulnerability to something such as the Wuhan virus. Modern medicine has allowed us to live without discipline or constraints with the knowledge that, if we get sick, medicine or surgery will somehow fix it. Technology has made us the most sedentary people in history and our success in providing unlimited food conveniently has fueled an epidemic of obesity, diabetes, hypertension, heart disease, metabolic syndrome, and more, all of which compromise our immune systems and make us more susceptible to something like the Wuhan virus. We have succeeded in extending our life expectancy to the point where those over 65 now make up 16% of the population, and most of those are not particularly healthy, with a rate of obesity of over 40%.

We are engaged in the largest social/economic experiment in history. Never has a pandemic been managed in this fashion, by shutting down an entire economy and quarantining an entire population, including those that we now know are at little risk from the virus- children and healthy adults. The media takes exceptional cases, which exist for every illness, and magnify them to enhance the narrative of how dangerous this virus is. This has fueled an irrational fear so that many people, including children and young adults, walk around wearing masks outdoors, where there is almost no risk of infection. Others have delayed necessary “elective” medical care for fear of the virus.

As a physician, I have been dismayed at how poorly the numbers have been presented. We are told the numbers of cases are rising, but with no context. How many are asymptomatic? How many are mildly ill? We are given numbers of those hospitalized with the virus but not told how many of those are asymptomatic individuals from nursing homes and are hospitalized because there is nowhere else to put them and they cannot stay where they are. The numbers I have seen locally suggest that close to 50% of admissions may be for such reasons. We witnessed the debacle of that particular policy in the 5000 nursing home deaths attributed to New York Governor Andrew Cuomo’s ill-conceived policy of returning residents who tested positive for the virus to their nursing homes. Deaths are also reported using non-standardized criteria such that we have no real idea if we are under- or over-attributing deaths to the virus.

We repeatedly hear the mantra that this virus must be contained “at all cost.” Really? Have we really calculated the cost of our measures to this point? Except as indicated above, by a few academics, it does not seem to me that those who are pushing extraordinary measures have really considered the real costs of such an approach. As I have said, this virus will not be stopped or even fully contained until it has run its course, whatever that may be.

I would be remiss if I did not mention a spiritual side to this pandemic. There is an irrational fear of death among many people such that they will accept any measure, no matter how extreme, if it will possibly extend their life for a few more weeks, months, or years. Those who hold not hope for a future beyond their current existence often value duration of life over any meaningful quality. I see this as a physician with patients who hang onto life beyond anything reasonable for fear of what comes after. Those who have a hope for a future after death have no such fear. I have personally met many of the truly elderly, who have lived long lives, have no fear of death, and view this virus with equanimity.

I may be simplistic in my thinking, but in the absence of an effective treatment or vaccine and with an economy that must reopen fully or collapse, perhaps irrevocably, the only logical course is to focus our protective measures on the most vulnerable, the very elderly and sick, which we know how to do, and let the rest of the country resume work, social engagements, large gatherings, etc. immediately, knowing that we will see a rise in cases and trusting to our innate resiliency and immune competence, coupled with our medical providers’ knowledge and experience to protect us. Those younger adults who are deemed to be at risk from obesity, diabetes, illnesses or treatments that compromise the immune system, should take whatever measures necessary to protect themselves. The rest of us need to get back to work and life.

Richard T. Bosshardt, MD, FACS

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