The fact that the first death from COVID-19 of a U.S. citizen on U.S. soil has just been reported is highly significant, signaling an ominous new stage of this growing threat to the nation’s public health.
Although few details are known about the Coronavirus victim, we do know that he was a middle-aged gentleman in his early 50s with serious pre-existing medical conditions who was living in an advanced nursing facility in Washington state. While he had the symptoms of COVID-19 for some unknown amount of time, he only recently “qualified” to receive a specific test to confirm the diagnosis.
But in the meantime, he had extensive contacts with and exposure risk for potentially hundreds of staff, visitors, and all of their contacts. They will all need to be identified, interviewed, potentially tested, and perhaps quarantined, if not hospitalized. Is it possible that none of these people contracted the infection? Maybe. But that is statistically highly unlikely. What makes matters even more unsettling is that some experts believe that the incubation period may be significantly longer than the 14 days that is currently believed to be the outer limit.
If we needed further evidence that people can become infected from with Coronavirus without travel in an area experiencing a significant outbreak or contact with another infected person, this fatality in Washington state is more evidence of so-called “community transmission.”
So, let’s review what we know and don’t know, as of this writing, about the status of the global outbreak of the virus known as COVID-19.
Why the caveat that describes what we know about the crisis as of today? It’s because reliable information concerning the behavior of this virus is grossly incomplete and the trajectory of the outbreak is essentially unpredictable. And let me acknowledge that “persistent uncertainty” with respect to a new disease that can be (and has been) lethal is clearly uncomfortable for most of us, including health professionals. This unsettling uncertainty is exacerbated while we have no specific treatment or means of preventing infection in the first place.
Here are five points worth emphasizing:
First, this is a pandemic. Let me repeat, as that designation is generally and properly understood, we are dealing with a true pandemic, even if the World Health Organization is refusing to call it by its name. We have a new virus not previously known to affect humans that is capable of transmission from person to person, that can be fatal, and has clearly crossed international boundaries. Yes, happy talk and unwarranted reassurance from President Donald Trump notwithstanding, we need to call this outbreak what it is.
Does anyone actually believe that Trump is contradicting his own highly concerned and very competent public health experts because of anything other than his loose relationship with truth or science? Much more likely, he’s terrified that a declared pandemic on his watch, along with a serious economic downturn, will diminish his re-election prospects.
The president continues to indulge himself in crackpot, baseless claims that, for instance, come April, the threat will be gone—presumably because of the arrival of Spring. And it was just days ago that Trump said, "It's going to disappear. One day it's like a miracle, it will disappear."
Second, we should also be clear that not all pandemics are created equal. The so-called Spanish Flu pandemic of 1918 erupted during a time of very limited international travel and much more primitive medical care, and it killed between 50 million and 100 million people world-wide. This included nearly 700,000 Americans. On the other hand, the 2009 H1N1pdm09 “Swine Flu” pandemic that occurred in 2009 killed about 200,000 people world-wide and just over 12,000 in the U.S.
Third, contracting a COVID-19 infection is not a death sentence! So far we’re approaching 3,000 COVID-19 fatalities, which means, if we believe the global tally of about 85,000 cases, means that 97-98 percent of people who become infected will survive, with most having only mild to moderate illness with cold or flu symptoms.
Fourth, the U.S. is grossly unprepared for a rapidly evolving pandemic. While some states and localities are reasonably prepared, we need to see some real evidence that the country, as a whole, has sufficient plans for expanding hospital bed availability and securing adequate supply chains for everything from food, face masks for the public, and protective gear for health care workers to critical medications that so many Americans depend upon.
Should we be confident that all of this is or will be in place in the near future? Given the unconscionable delay in developing and widely distributing reliable Coronavirus test kits, the failure to imagine and plan for the worst case scenarios and a steady stream of bullshit coming from the White House, it’s hard to be confident that the administration really knows what it’s doing.
That said, we should also acknowledge that some states have bypassed federal assistance to be ready as possible for whatever comes. A number of states, including New York and California, have just been approved by the Federal Drug Administration to develop and deploy their own capacity to test for Covid-19. According to New York Health Commissioner Howard Zucker, “We’re ready to deal with this potentially unprecedented public health challenge.”
Finally, one of my greatest concerns is that we don’t truly understand, and haven’t planned for, the impact of this crisis on our social fabric, transportation, educational systems, commerce, and family lives if we don’t have sufficient capacity to prevent, control, or mitigate the great pandemic of 2020.
It’s pointless to bemoan the fact that we should have done more earlier and faster. China should have been far more transparent about what they were seeing as far back as early December. We could have pushed the development of effective anti-Coronavirus drugs more aggressively earlier, and we should have focused on the development of effective test kits weeks ago.
Right now what’s called for is a massive war-room mentality with federal and state officials, academic scientists, and private sector expertise across many disciplines sequestered and working together to figure how to fast-track mitigation efforts as if our lives depended on making this mission successful. They well might.