Let me begin by wishing everyone who has been infected during the super-spreader events last week a safe and healthy recovery from their infections. This is a serious disease with long arcs of symptoms and recoveries.
Hubris will never defeat reality, and this virus will infect people who let their guards down.
Occam’s razor: The simplest explanation is usually the best.
I have posited in the past that the underlying strategy of the current administration is that the same number of people will die from COVID-19 whether we observe social distancing, masks and isolation or whether we allow the virus to spread quickly. The only difference, according to this strategy, as expressed clearly by Dr. Atlas and Dr. Rand Paul is whether those deaths occur in a short period of time or are spread out over a couple of years.
This strategy incorporates the deficits of economic harm and potential additional deaths due to depression and isolation into its equation and concludes that the overall effects of stretching the disease out is worse than allowing it to run its course as quickly as possible.
This is the strategy: “infect as many people as possible, as quickly as possible; absorb the deaths that will occur and the short term harm to the economy; do this because the country will achieve herd immunity quickly and be past the disease and move back to normal in a matter of months.”
Now, if you weigh all political decisions and statements against this strategy, you will see that the simplest explanation for those decisions is that they ARE weighed against this strategy:
- Open states up as quickly as possible without abiding by CDC recommendations
- Twist the arms of all of the health care experts to modify those recommendations so that any strong recommendations are recast as equivocated suggestions.
- Open restaurants and bars whether any of the CDC-stated goals for the community have been reached or not, and then move through the phases of reopening at a pace faster than could be possible if you were measuring infection rates
- Force communities to open schools
- Create doubt about the effectiveness of masks and make it a matter of personal freedom
- Distribute videos of people assembling in large amounts without masks and no social distancing to seed the impressions that this is acceptable
- File lawsuits or encourage your supporters to file lawsuits to remove any restrictions that might prevent viral spread
- Encourage those Governors who support your strategy to move beyond not issuing mask mandates, to prohibiting communities within their states from issuing their own mask mandates.
- Create doubt about whether YOU will be able to become infected or if you are, that YOUR disease will only be “the sniffles”.
THE MISCALCULATION
There are both scientific, medical and political miscalculations resultant from implementing this strategy.
Scientifically: Ignoring scientific recommendations that are based on research and data will always result in mistakes. We know how viruses spread based on prior research; we know how this virus spreads based on laboratory studies. Overlooking that work and “wishing” that the disease will miraculously go away simply fuels the pandemic. Scientists continually modify their positions based on data. Early concerns about hard surface transfer has been replaced by concerns about aerosolization; initial concerns about citizens hoarding limited supplies of masks and thereby reducing availability of those PPE items to healthcare professionals has been supplanted by clear recommendations that the best way to prevent spread is to wear a mask. It is the moral and responsible action to protect others from you.
Medically: Medical recommendations are based on the facts that the longer you have to look at empirical data, the better you can treat patients. And the more you actually KNOW about the workings of the healthcare system, the better you can predict how many patients you can treat, how you can get the needed therapeutics and what protocols can be used.
A basic fault in the outlined strategic logic is that the same number of people will die whether you stretch out the infection period or not. This ignores the limited hospital assets that can be provided for patients at any point in time. It also ignores the fact that therapeutics, vaccines and protocols evolve over time.
The fact that Mr. Trump has been infected in the past few days rather than 4 months ago means that we now know that hydroxychloroquine does not work and may be dangerous to a man his age in his condition; we now know that Remdesivir can be ameliorative; we now know that dexamethasone can be used to counteract the inflammatory immune response in the lungs; we now know that oxygen therapy is important ASAP when decreased pulse-ox levels are seen; we have begun to develop directed monoclonal antibody therapies that may have some value.
All of these advances have increased the ability to treat patients, reduce hospitalizations and reduce lethality.
Politically: Finally, political hubris surrounding this strategy is particularly troubling. The basic assumption of the strategy is that WE, the ruling elite can encourage a wide-spread contagion with a quick period of infection followed by a quick period of deaths and then a recovery for YOU, but WE will be protected because WE can do a lot of testing, restrictions of people near US and be We will be safe.
This political strategy has a fatal flaw. You can be tested for virus today and be found to be negative. You MAY be negative, but you also MAY be infected, but in the incubation period before you have begun to shed virus. So, you really are not negative, it is only that your current test was negative. This appears to be the case with the current outbreak within the White House. We can expect to see more and more people that were involved in the SCOTUS announcement become ill over the next week. We can expect to see many of the donors who were at the fund raiser in Bedminster last week to become positive this coming week. And we can expect to see aides and other workers in the White House and congress to test positive also.
A final note: I have begun to consider the phrase “asymptomatic” as inappropriate and would prefer to use the term “undeterminable”.
Here is why. Although the term asymptomatic translates as “showing no symptoms”, it has been popularly read as “free from any effect from the virus”. And this is not true.
A patient who is infected with COVID-19 may show a wide spectrum of symptoms. Sometimes those symptoms are debilitating and result in that patient presenting at a hospital.
Among the remaining patients who may be positive to the virus, there is a fraction that has mild symptoms or decide to “tough it out” at home. They may survive, or they many die, but because they did not present to their physician, they are categorized as asymptomatic.
Among those patients will also be a group who show no OUTWARD signs of disease. They would generally be categorized as asymptomatic since they are not showing symptoms (!). However, it has become increasingly clear that this virus can cause decreased oxygen in the blood to critical levels, and yet those patients don’t “feel” anything different. There may be damage to the lungs, the kidneys, the liver, the brain or the heart without acute symptoms. The damage may not be felt or seen initially, but it may result in significant health deficits that appear over the coming months or years.
Personally, I am of the opinion that there is only a very small percentage of individuals who, when tested positive for virus have no actual clinical repercussions. I believe that the vast majority of people who have tested positive have, in fact had a disease and even if they did not report outward symptoms, they have paid an internal toll on their health.