Arkansas isn’t expected to see the spread of COVID-19 peak for another 6-8 weeks. It is going to push our medical system to the brink. But we still have a choice to minimize the damage, as state Representative Denise Garner outlined in an opinion letter in the Arkansas Democrat-Gazette. We must take decisive public health prevention and suppression action now to curb the spread of the disease.
I’ve been called passionate, over-reactive, and worse, but I am sounding the alarm.
I’ve been cautioned to avoid stirring up panic, but frankly, those who are paying attention are already panicked, and those who are going about their business as usual–for the sake of the rest of humanity–need to be alarmed. But I don’t want just panic, I want action.
I am a state legislator, but I am writing these views from my personal experiences in public health. I have served as a nurse practitioner. I am married to a 66-year-old cancer survivor, who is an MD/JD on the front lines of this crisis here in Fayetteville. I am the mom of one MD, MPH, MSHE son who’s at the epicenter in Tennessee, trying to lessen the curve just across the Mississippi River. I am the mom of one son who is at the moment out of a job because of the shutdowns. I am also the owner of a restaurant which has had to close until things are safer.
I confess to being obsessed with pandemic research and admit to comparing lessons learned from the Spanish flu pandemic to data coming out today.
A research team at Imperial College in the United Kingdom plugged infection and death rates from China, Korea, and Italy into epidemic modeling software and ran a simulation. It compared what would happen based on: (1) keeping business as usual, treating it like the flu; (2) mitigation, which is what we are doing now; (3) and instituting a suppression strategy.
• Under business as usual, 80 percent of Americans are predicted to get infected. A staggering 2.2 million people, or about 0.9 percent of the population, would die.
This model projects 4 to 8 percent of all Americans over 70 years old will die of covid-19. In this unmitigated epidemic simulation, the U.S. would need 30 times the number of available ventilators. Because of their scarcity, nearly 100 percent of those with a “severe” response to the disease will die, instead of the 50 percent who might survive if ventilation is available.
This prediction does not count those who could not be treated for other diseases due to lack of hospital beds or a decrease in health-care workers.
• The next simulation utilized “mitigation” defined here as (1) symptomatic patients are placed in isolation, (2) families are quarantined, and (3) Americans over 70 utilize social distancing.
This helps, but not nearly enough. In this mitigation simulation, there are still 1.1 million deaths, assuming adequate medical capacity. The peak need for ventilators would drop two-thirds, but would still exceed the number of ventilators available by 8 times.
• This study concludes our only viable strategy at this point is “epidemic suppression”: isolating symptomatic cases and quarantining family members until free of the virus shed, social distancing for the entire population, closing down all social gatherings, most workplaces, schools and universities.
Social distancing does not mean isolation. Restaurants could continue with takeout, drive-through, providing food for children out of school, families out of work, or senior meals on wheels. Libraries could still maintain book checkouts or computer access if the “6-foot rule” was utilized. Communities need to be innovative in determining new ways to engage while the pandemic continues.
Our first priority must be to minimize the loss of life with immediate and decisive measures, and then make policy decisions to deal with the very real economic pain facing families and businesses. Aggressive action needs to be taken now. That includes a vigorous public information campaign.
Since the federal government has been slow to employ necessary strategies, governors must step up.
Because it takes 1-2 weeks before any progress from interventions is seen, we cannot wait. We know the cases from this virus have been doubling about every three days. The number of cases in the U.S. grew from 89 on March 1 to 8,760 by Wednesday.
We need to (1) ensure our work force has protective equipment, (2) drastically improve testing, and (3) increase hospital capacity. Suppression also gives more time to develop treatments and vaccines.
Unfortunately, we are having to develop plans in the middle of the crisis. We will eventually get to the suppression phase regardless of what we do now. The question is how many lives will be lost each day we wait.
There is no need for panic; there is a need for action. We can and will get through this. We’ll be stronger for it. But our leaders must sound the alarm, and we must take action now.
