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As states in the deep South and elsewhere are starting to open up from shelter-in-place orders I think we need to get some things straight.

Things that the virus is not:

  1. A deep state conspiracy. It was not created in a lab in Wuhan. It almost certainly is a naturally occuring coronavirus that moved from a bat to humans via an intermediate mammal.
  2. Going to magically go away. Very few people have immunity right now. Summer does not make this virus go away. We are stuck with it until 60% to 80% of Americans get it (culminating in about 1,500,000 dead Americans), we get a vaccine (unlikely in the next year) or we take stopping the spread of the virus seriously as other countries have done.
  3. That thing you had in January. It is almost certain that only 1% to 5% of the population in any place in America except New York City has been exposed to the virus based in antibody testing
  4. Just a bad “flu.” In a really bad flu year in the United States we have 61,000 deaths over the entire season. We have had at least 75,000 deaths from this virus in 2 months.
  5. Not going to hurt me. Randomly people die in car accidents. Randomly people die of this virus. Less randomly older and chronically ill people die of this virus when exposed.
  6. A plot by big pharma to harvest your healthcare dollars. This is a virus that is killing people. It is not activated by masks. It is spread through coughing droplets on others.

What the virus is…The virus is real.  It  came over from China (west coast) and Europe (east coast). It has almost certainly killed almost 100,000 people in this country so far although the death toll will be artificially low due to the way we categorize deaths (I know, I fill out death certificates all the time). It is almost certain that a medication will not help with mortality. If you get the virus, your risk of death depends on your age (very few under 65 die as compared to a lot over 80), your underlying health (those with chronic illness and/or obesity fair much worse than those who are basically healthy), and your exposure history (if you do not come in contact with droplets of spit contaminated with Covid-19, you will not catch it).

The way it came into the United States is a follows. Initially people got off an airplane from either China or Europe with the virus growing in their upper respiratory tract. They may have had a fever, cough and body aches. They may have developed a fever and body aches once off the plane. They may never have done so and cleared the virus. The travelers then went to an activity where there were a lot of other people. A scientific meeting in Boston, A jet setter party in Connecticut. Mardi Gras in New Orleans. They coughed on people at these places and a lot of them got infected. Problem was we were not testing those folks who were coming from infected areas. No tests.

First 100 deaths in the US didn’t happen until the last half of March. How did it happen? The people at  Mardi Gras, at meetings, in New York, the ones who were young and healthy then went and infected a couple of other people and mostly, the virus stopped there. Sometimes, before these people got sick (or even after), they went and did another group activity. They went to a community sing along. They went to a funeral and cried on their sister’s shoulder. They went to church and coughed on someone. At these events, though, there were older and sicker folks. When these folks got sick, they got really sick. Sometimes they went to the hospital, who couldn’t test them. When they got to the hospital there may have been lack of concern because it wasn’t in the community (again, no tests), and/or a lack of protective clothing. Health care workers would get exposed. They would get sick but, because they are troopers, would continue to work through the “flu.” If their job happened to be in a nursing home, many older people who were at risk would get exposed and some would die (either in the nursing home or in the hospital), many other health care workers would get exposed, and then many more people died. The workers in the nursing homes then go back to THEIR families and the cycle continues. Although, as the saying goes, we all have to die sometime, it doesn’t have to all be in the next month. Even now, we do not have enough tests, the ability to administer tests, or protective gear for folks caring for nursing home patients. About 1.5 million people live in nursing homes in this country. That will be a lot of deaths that don’t have to happen

So, the country is opening up and, in the words of the President, “some people will be affected badly.” Assuming you do not want to be the proximate cause (or the 2 degrees of separation cause) of someone’s Papa’s death, there are some things you can do:

  1. Wear a mask. If we get infected we may not know it for 3 or more days. A mask keeps us from infecting someone else who may have an underlying condition or just be older and more susceptible.
  2. Wash your hands or use hand sanitizer. This will keep you and others from getting it.
  3. Stay physically active. Outside is usually safe with social distancing.
  4. Stay away from and don’t hold gatherings of more than 10 people now and 50 people until there is a vaccine. There is clear evidence that social distancing works and when it goes away people die. Stay 6 feet away from folks you are not quarantining with.
  5. Stay home when possible. Remember, you don’t know if you will become sick 2 days from now
  6. Most importantly, stay home if you are sick. If you have a new loss of smell, cough, fever, shills, shaking chills, or shortness of breath but are otherwise healthy, don’t go out for 14 days.

Unlike many countries, we missed the opportunity to control this virus before is became endemic. If we follow the above measures, become much better at testing and protection of healthcare workers and first responders, and learn how to give up some freedom so that those infected can be isolated, then we can get control of our lives back with minimal loss of Meemees and Papas. The alternative is to lose 2,000,000 folks. Guess we each have some choices to make.


154919_600Me, interviewing applicant for medical school: So, have you been following the Ebola outbreak? What do you think?

Student, very sincerely: I have been and I guess I would go. Isn’t taking care of the sick what we sign up for when we get into medical school? I do spend a lot of my time trying to talk sense into my friends who are caught up in the hysteria so maybe that should count for something.

Fear has often been used by people in power to exert control. Fear of disease is powerful, especially when that disease has elements of the unknown. The latest Ebola hysteria seems by many to be whipped up, in part, to “demonstrate” the powerlessness of people, the monolithic failure of government, and the need for us all to purchase guns, vote for individual responsibility (mostly Republican, it seems), and build individual border fences around our homes to keep out the eye bleeding zombies.

The counter-argument is not being made very well. Partly is is because we have “A PERSON WITH EBOLA” in this country and everyone is yelling about it, drowning out civil discourse. Partly it is because America seems to go on despite the presence of Ebola, much to the chagrin of the yelling class. Why is that?

1) The food supply in this country is safe – Much has been written and said about the number and amount of calories available and the subsidization (through what used to be called food stamps before that term was demonized). Many west Africans live on a subsistence diet. This diet relies on “bush meat” as a protein source. Bats, monkeys and other primates, pangolins, and other assorted animals found in the wild constitute bush meat. How does this spread Ebola? These animals are a natural reservoir. They bite, kick, and scratch while being captured and killed. Unscrupulous hunters are likely to bring in an animal found dead to market (less biting) and the consumer is none the wiser. So, every day you wake up without Ebola (or dysentery,  ptomaine, botulism, etc) thank the feds.

2) We have safe water and sanitary sewers – although the direct link is difficult to prove, it is very likely that poor sanitation has contributed to the spread of the disease. Though many people think of Ebola as the “bloody eyed ISIS monsters coming from Mexico” disease, it is actually more akin to cholera. The death is not caused by zombification but actually by profound diarrhea (as much as 5 and 1/2 liters per day). It is spread through contact with body fluids and if there is that much vomiting and diarrhea, chances of exposure are high. Most west Africans in villages have no sanitary water. In Liberia, only 17% of the population has access to toilets. If there is NO TOILET and 5 and 1/2 liters of diarrhea, the chances of exposure are very high. The Environmental Protection Agency plays a large role in making communities comply with laws regarding clean drinking water and those  requiring sewage treatment prior to emptying the raw sewage into the nearest body of water. Next time you don’t wake up with cholera, typhoid, polio, or Ebola, thank the feds.

3) We have access to medical care – Although not perfect, the experience with Ebola in this country shows that western medicine does help. With cholera, there is not much vomiting so oral rehydration is sufficient. With Ebola, the patient vomits it back up so early and massive amounts of IV fluids are proving essential. If Thomas Eric Duncan had been admitted at the earliest sign of the disease, we now think he would be alive. IV fluids are not available in many areas of western Africa. Early access to care is now guaranteed to most Americans through the Affordable Care Act. Next time you have a fever, vomiting, and contact with a friend with Ebola and want to seek care, thank the feds.

A lot of work is left. This disease has been around a while. If this were a disease of the west, it is likely there would already be a vaccine developed. Let us hope that happens next. If it does, the development likely will be funded through the National Institutes of Health. And if it is, you can thank the feds…

Josh Freeman points out that my last post was not only a comparison of  health planning to community planning but it was an especially apt comparison because healthy communities are needed to facilitate human health. This is something we have known for a while. Suburban living left unchecked contributes to obesity, respiratory problems, mood and affect disorders, and limited access to health resources to those who need it most.

The CDC has put together a web site to help guide us to making healthy choices and to help developers create a healthier living environment. In their words:

Healthy community design can improve people’s health by:

I encourage you to take a look.