May 1, 2020

  It appears that the pandemic is slowing down in most areas of the country. This may be a fact of the changing temperatures, humidity, quarantine events or a combination of everything. The next few months will likely be a trickle of events as some areas open up social movement and economic activity. With the current infection fatality rate at somewhere between 0.2% and 0.5%, the number of cases should be manageable nationally with the caveat that the densely populated inner cities are still the wild card for a resurgence until herd immunity is realized. This fall and winter may be altogether different with a resurgence coinciding with influenza season.

There is a sobering article in CNN health noting what we all know to be true that until we hit herd immunity, this is not going away. How it plays out is anyone's guess.

The opening up period will shed some further light on the risks of not being in full lockdown as is occurring in Sweden where data is showing an increased death rate as compared to neighboring Norway and Finland. According to Johns Hopkins Surveillance site, Sweden has 21,000 confirmed cases and 2600 deaths. That is a 10X higher case fatality rate or CFR than Finland or Norway, but still a small number compared to a population of 10,000,000 depending on the true infection fatality rate. These lives all matter, however, they need to be weighed against the backdrop of economic destruction and health damage. The dance of relieving economic damage versus negative changes in COVID death is going to occur in different ways in different locales and we are going to learn from it regardless of the outcome because the outcome is going to happen one way or the other.

There is much vitriol in the popular media about the opening up process occurring too soon, too slowly, and everything in between. The bottom line is that no one has the correct answer because COVID19 is new and we have never had to do this. Thus it is a best guess scenario weighing and measuring economic destruction inducing severe poverty which drives health into the ground and increases all cause violence versus an uptick in death for an aging segment of the population that are vulnerable.

This is an immensely difficult decision to process. It is a lose lose and COVID19 is the only winner. We will get past this over the next 12 to 24 months. My gut instinct tells me that we are on the right path trying to get as many low risk people infected and immune while still keeping the high risk individuals quarantined. However, I am no more qualified than you to know the truth of this question and answer.

I will leave you with this final note. If anyone tells you that they know that what we are doing is wrong or right, tell them that they should hold their truths insanely loose right now as the sand continues to shift and solid ground is still far away. I pray that Drs. Fauci and Birx, both highly intelligent public servants, are blessed with good decision making.

Continue to follow the recommendations of previous emails on health promotion and disease prevention for a best case outcome scenario. See the next piece for more information.

Be at peace for 99+% of you will see the other side and be stronger for it,

Dr. M

 

CNN Health Article
Johns Hopkins Maps of COVID19