COVID-19 Craze Continues

I wrote last week about the novel coronavirus strain that has the world paralyzed. Of particular note is the experience in Italy with their ICU beds filled to capacity. The state of that nation has driven increasingly drastic isolation responses in the US. As I’ve tried to get some perspective on Italy’s situation, I would point to a few tempering facts. 1) The rate of infection, the surge, or the “curve,” of cases is admittedly of concern for sudden capacity stress within the US hospital system. I just listened to a JAMA podcast (Journal of the American Medical Association) with a physician director of critical care in the hard hit Lombardy region of Italy. Around minute 9:00 he reports that their area has roughly 8 ICU beds per 100,000 population. In comparison, I found that the US may have 20-30+ ICU beds per 100,000. US capacity for care appears much better, by multiples. 2) Italy has an older population, with elderly and those with co-morbid states (cardiopulmonary disease and diabetes, for example) being primarily those who die from COVID. Per wikipedia search, Italy’s elderly are about 20% of their population, compared with 15% in the US. Of note, also, per prior wikipedia search, their smoking rate is 20% – higher than the US, although a smoking link with COVID mortality is assumed by me but not proven. So, there are some definite population differences. 3) To compare illness numbers, Italy in recent years has had influenza deaths averaging 17,000 per flu season. COVID deaths are numbered at 3,400. In addition, the World Health Organization COVID dashboard shows Italy’s new cases to be leveling off.

As China and South Korea seem to be mostly through their epidemic, deaths to date from COVID are 3,250 and 94, respectively (see WHO.int dashboard for those countries). In a bad year, influenza deaths worldwide can range between 250,000 and 650,000 (noted in previous blog). Again, admittedly, the surge of COVID may vastly outpace the rate of rise of influenza cases, as well as have a higher mortality rate. But as the data is collected the numbers do not look catastrophic. As testing of the population becomes more common, the mortality numbers are declining. Of course, much is still unknown, data is still being gathered, broader testing of the public is just being rolled out significantly this past week in the United States. However, we do have some data from the aforementioned and other countries, as well as cruise ship isolations/quarantines, that COVID is not the Spanish Flu of 1918 or the Bubonic Plague. From the public health, media and government responses, one might think it was and that disability and death were knocking on our doors.

Regardless of tempering data, this week has seen some (in my opinion) extremely authoritarian government mandates. US state governments have varied in their responses, but multiple states are in a condition of self-quarantine or in-home isolation for all citizens, work stoppage, forced closure of businesses. In my state of current residence, the Pennsylvania governor mandated closure of all non-life sustaining businesses. Some states have forbidden the gathering of more than 50 or 25 or even 10 persons… with calls to the public to report violators to the government. Restaurants that attempt to seat and serve diners have been shut down by law enforcement, with arrests made. Aside from any gross violations of Constitutional Law or the Bill of Rights which would guarantee citizens’ rights of speech, association, labor and movement, there has not been any appreciable civil libertarian resistance.

Again, while COVID may carry higher infectious and mortality rates than influenza, examining numbers adds perspective. In the US, the current flu season has seen 36M confirmed cases, 370K hospitalizations and 22,000 deaths. In comparison, COVID here has caused about 15,000 confirmed cases and 200 deaths to date. This is no guarantee that the health care system could not become overwhelmed, but again, we’re seeing disease patterns and numbers here and elsewhere that permit insights and reasons for optimism, rather than panic and complete lock down.

Hospitals are preparing for potential surges of COVID related pneumonia cases. In order to make rooms and ICU beds available, as well as to minimize potential infectious spread, surgical cases are being minimized. My affiliate hospital in Pennsylvania stopped performing elective surgical and procedural cases (from OR to GI lab to interventional radiology). As an anesthesiologist who covers these sites and cases, I’ve observed our case load decrease by up to 75%. Another factor constraining our service is the national shortage of Personal Protective Equipment (PPE, like gloves, masks, goggles and disposable suits). Health care workers are uncertain of our exposure risk, especially from asymptomatic patients who may shed virus for up to 14 days. Universal precautions with typical surgical masks may not be enough as viral particles are aerosolized. A tighter fitting and more filtering mask, the N95 (used to protect against TB exposure), is in high demand and short supply, although companies are ramping up production.

Meanwhile, economic, social and governmental controls and fallout are increasing daily. I’ll post in the comment section some articles of interest as we proceed. While I do hope to persuade any readers to take a more tempered and thoughtful approach to this situation than what is being pushed by media and government, equally I write in order to create a log of an event that afterwards will likely quickly fade from memory, having been a precipitant to societal change which will certainly just be an accepted norm at some point in the near future, with historical perspective and roots retained by few.