October 21, 2020

A View from My Porch: Keep Calm and Carry On

Original 1939 UK poster. From Wikimedia Commons, the free media repository.

The title of this essay is derived from a poster designed by the British government in the late 1930s to maintain morale when war against Germany became imminent. This essay roughly considers “a day in the life” of Southeastern Connecticut residents as the COVID-19 pandemic impacts each of us and our collective ability to “carry on” our lives as usual. I will present the key elements of this crisis, drawing from the wealth of real data that have become available, and define some of the terms used by our public health professionals so that you can better understand the basis for the required actions.

The Statistics: 

The Connecticut Department of Public Health (DPH) reported on March 23 that there were 618 confirmed cases of COVID-19 in the state; with multiple cases in each of Connecticut’s eight counties. Fifty-four patients were hospitalized, and 12 residents have died. Over 60 percent of Connecticut cases are in Fairfield County.

The Centers for Disease Control and Prevention (CDC) reported over 50,000 cases and nearly 700 deaths across the United States. The World Health Organization (WHO) reports over 415,000 cases and nearly 19,000 deaths worldwide. Note that these numbers change, and probably increase, daily. 

Excuse me in advance, but this isn’t our first rodeo; and we’ve successfully dealt with pandemics in the past. These include the HIV/AIDS crisis that began in the mid to late 1970s, and the 2009 H1N1 pandemic. 

Unfortunately, our response to COVID-19 was late and disorganized with mixed and confusing messages coming from the highest levels of the federal government. As a result, testing for the disease started late, supplies of critical personal protective equipment (PPE) like masks and gloves for health care personnel became scarce, and were not replenished in a timely manner.  The same was true of essential hospital equipment like ventilators, which are the “breathing machines” used for treating patients in severe respiratory distress. 

And so, on March 10th, Connecticut Governor Lamont joined several governors in nearby states and declared both a public health emergency and a civil preparedness emergency. A public health emergency gives the state authority over quarantine, while a civil preparedness emergency grants the governor broad powers over state institutions, allowing him to restrict travel, close public schools, some businesses, and public buildings.

As a result, only “essential businesses”, which include: grocery stores, pharmacies, medical offices, hospitals, childcare, auto repair, banks, and emergency services remain open. Restaurants may remain open, but for takeout and delivery only. Schools were closed on March 31, and there is some thought that they may remain closed through the end of the semester. Hospitals have changed visitation rules.

I will not list the “non-essential” businesses. Tele-commuting is encouraged when at all possible. These restrictions and closures have resulted in significant displacement of workers and unemployment has grown.  

Important Terminology: 

COVID-19 is a disease triggered by a coronavirus, which is a relatively common virus that can cause both upper and lower respiratory tract infections. 

In the past, most coronaviruses weren’t dangerous and caused only mild respiratory problems. However, in early 2020, following a late 2019 outbreak in China, the World Health Organization identified a new type of coronavirus. Officials named this new virus “severe acute respiratory syndrome coronavirus2 “(SARS-CoV-2)”. This highly contagious and virulent microorganism is the agent that causes COVID-19; which can lead to pneumonia, respiratory failure, septic shock, and death.

Older adults and any individual with a serious underlying medical condition are at higher risk for COVID-19’s more serious complications. The CDC notes that people may be most contagious when they are at their sickest. However, note that many cases are still mild to moderate and not life-threatening. These can be treated at home.

You may have also heard this virus referred to as “novel”, which, very simply, refers to a virus that has not been seen before, or has never infected humans before. As such, it’s unlikely that anyone will have immunity, or antibodies that protect them against the novel virus. 

Public health professionals stress the need to “flatten the curve” as a means of controlling this disease. The curve refers to the rate of growth of new cases displayed graphically (i.e., the projected number of new cases over a specific period of time). A “flattened” curve staggers the number of these new cases over a longer period, so that people have better access to care, and do not overburden the healthcare system. 

Transmission:

The virus is spread primarily from person-to-person, commonly through respiratory droplets produced when an infected person coughs or sneezes, saliva, or from some hard surfaces on which the virus may live for four or five days and remain infectious for even longer.

Prevention:

The best way to prevent this disease is to avoid being exposed to the virus. The CDC still recommends social distancing to reduce the probability of contact between individuals carrying the infection with others who are not infected. 

The goal is to minimize disease transmission, and its resultant morbidity, and ultimately, mortality. The minimum recommended measures include:

  • Allow six feet of interpersonal space, which means avoid crowded social activities, like going to pubs, bars, and restaurants, sporting events, theaters and cinemas.
  • Wash your hands thoroughly and frequently; use hand sanitizers.
  • Stay home when you are sick. 
  • Use the “usual” coughing and sneezing protocols.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. 

Testing is a good thing:

It is correct that testing does increase the number of individuals identified with the disease, but it also provides the data required to target resources and plan for future needs. Testing is now widely available. All acute care hospitals have the ability to test, although for those that utilize the DPH lab in Rocky Hill, testing is reserved for patients that have been admitted to the hospital.

There are also a number of outpatient testing sites that use private labs, and do not need to comply with the admission restriction. All sites require a physician’s order, who, at present, must make an appointment for the patient.

Critical and Immediate Issues:

This crisis will not end soon. Only one source predicts an end by April 12, which is Easter Sunday in the United States. Most experts agree that an end date is difficult to predict, but 60 days is feasible.

There is currently no vaccine or “miracle” drug specifically targeting COVID-19 — no antiviral drugs are licensed by the U.S. Food and Drug Administration (FDA) to treat patients with COVID-19. The National Institutes of Health (NIH) and collaborators are working on development of candidate drugs for rapid testing and evaluating re-use of drugs approved for other diseases. Current treatments often focus on protecting against opportunistic infections and alleviating symptoms while the disease “runs its course.”

We do not yet know what the recurrence rate is for patients, who have recovered from COVID-19. 

Americans have never really faced the rationing of healthcare services. It is clear, however, that we must plan for a possible surge of critically ill patients and identify additional space in which to provide care. Unfortunately, it may be possible that our medical professionals will need to make decisions regarding assignment of scarce resources like ventilators. 

I am confident that the United States will allocate resources to support our citizens and small businesses that face economic hardships as we move through this crisis. 

Make certain that you know the source of the information about this disease. The most reliable data comes from Connecticut DPH, Ledge Light Health District, and the CDC. 

Finally, God save the United States if we ever reach the point when we have to value a life lost in this pandemic less than a life lost in an economic downturn (whatever that is.)

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