I say the best case scenario because we are so close to what would have seemed impossible before a pandemic: to create, test, authorize, manufacture and distribute not only one, but several vaccines in a wonderfully compressed timeline – certainly one of our greatest medical achievements in recent times. . We’ve also learned so much about the virus in real time, and we have new – and some old – drugs to treat it.
The worst case scenario has to do with how the patient himself is doing. Increasingly fragile, vulnerable and critically ill. At the beginning, the disease was localized, easier to manage with a good prognosis. Over time, however, my patient did not always follow the recommendations, and the disease spread to all countries in the country.
By comparison, in the week of 18 May, the country recorded an average of around 23,000 new cases per day; by the week of July 4, that number had jumped to about 48,000.
Last week was so bad that, according to a calculation from the Institute for Metrics and Health Assessment at the University of Washington, Covid-19 was the leading cause of death in the United States, beating coronary heart disease.
Despite the best advice and care, the patient’s condition continued to deteriorate. And instead of locating itself to several hotspots that required aggressive treatment, as was the case in July, the infection now swallowed almost the entire patient.
The reason that is so dangerous is that there was a lot of built-in reserves and redundancies in the previous pandemic, even in July. If one part of the body is in crisis, other parts of the body can take over and do the work to keep the patient relatively stable. For example, we saw doctors and nurses rush to help in the spring and summer, when a place – such as New York or Houston – was flooded. Alternatively, patients could be transported from a stunned hospital to a less stressful facility in a nearby region.
Discharges, escape holes, reserves – call them what you will, but they no longer exist for the patient, the ground. Now the state behind the state reports that hospital systems have reached their breaking points. It’s not just that there are fewer hospital beds available, but leading healthcare professionals and support staff – from doctors and nurses to nurses to hospital cleanups – are getting more and more tired, worn out and sick in numbers. And no one has to replace them.
How long can a patient last?
Usually, when the human body is confronted with a crisis situation – whether it is an uncontrollable infection, extensive bleeding or something just as catastrophic – there are all these biological defense mechanisms that give speed, tricks that the body attracts to compensate for unbalanced systems. These instincts of self-preservation are part of the reflexive nature of our biology.
But this patient, our country, instead of compensating and trying to keep his balance at all costs, decompensates and shows little willingness to do what he can to keep him from getting worse.
The IHME predicted that states would respond as soon as we reached the 8 per million dying threshold, and that the country’s defense mechanisms would be put in place, leading to the resumption of measures such as residence orders.
Eight people per million die produce about 2,800 deaths a day – and we’re done. But the country’s defense mechanisms have not been restored on the necessary large-scale basis. While many people in this country wear masks and follow instructions to move away from individuals, too many do not yet.
Wearing a mask remains a political statement and is not mandatory in 15 states. Only seven states have any kind of residence orders, advice or curfews that have been the subject of many battles.
The outgoing Trump White House began this week’s holiday season, with more than a dozen group rallies scheduled, spreading US Centers for Disease Control and Prevention guidelines for size restrictions, as well as Washington, DC, internal rally restrictions. Most of us missed spending time with our families during this holiday season, and I’m constantly on TV, reminding people of the danger that it will be possible. However, the administration itself has already been the epicenter of at least three Covid-19 outbreaks between staff and allies, and a number of events, such as festive gatherings, are likely to endanger several hundred other guests, workers and staff.
It’s even like American Surgical General Dr. Jerome Adams released Fox News on Friday, a plea. “We have to lead by example to all the leaders out there over the next few weeks and really help people get across the finish line because it’s in sight again,” he said.
And the end is really in sight. Help in the form of one or more vaccines is on the horizon. This patient, our country, will, of course, survive. Any immediate vaccine, even if it is nothing more than a scientific and logistical miracle, will not be an immediate fix. Distribution to communities everywhere will take several months to half a year.
The question we must ask ourselves is: How many Americans will we let die in the meantime?
Newly elected President Joe Biden told CNN’s Jake Tapper on Thursday that as one of his first presidential acts, he will ask Americans to wear masks for 100 days. On Friday, the US Centers for Disease Control and Prevention strengthened its recommendations regarding the use of masks and called it “critical” for controlling the spread of coronavirus.
According to the latest IHME model, the number of predicted Covid-19 deaths could be reduced by 66,000 by April 1 if 95% of people wore masks. Think about it. One of those lives saved could be the lives of your own mother, your neighbor, your favorite musician, or another great scientist. It can even be your life or mine.
In addition to wearing masks, we need to limit our activities and reduce the capacity of certain types of businesses. A model study conducted by researchers at Stanford and Northwestern Universities shows that a small minority of places people visit represent the vast majority of coronavirus infections in large cities. And it suggests that reducing maximum occupancy in such places – including restaurants, gyms, cafes, hotels and religious facilities – can significantly slow the spread of the disease.
This type of movement will cause or, of course, cause some pain to the patient – so leaders should be prepared to offer pain medication. In this metaphor, morphine comes in the form of money for the suffering, as an economic stimulus.
Our human spirit has made us innovative, creative, inventive and tenacious enough to see this dream of vaccination bear fruit. But it is our human behavior and biological reflexes that dictate how deep our wound goes in the end. No amount of science can save us from ourselves.
I can only hope that the instinct of self-preservation in this country will start soon and long enough to get us across the finish line as much as possible.
Andrea Kane of CNN Health contributed to this report.