Nobody asked me…

The internet has started labeling people like me as panicked alarmists. When I say people like me, I mean professionals or citizens who feel that these restrictive and protective public health measures are necessary. There are some people who are understandably panicking and a lot of people reasonably alarmed. I assure you, I am not panicked, but I am concerned. I am also attending three hours of Zoom meetings every week to discuss our plans to safely take care of you. I am also reading dozens and dozens of emails a day, full of bad news, ever changing protocols, and additional paperwork. I am also still going to work, answering all four of my pagers, washing my hands, and wearing a mask all day.

It would be wonderful if there was a better way to fight the COVID-19 pandemic than social distancing, cancelled gatherings, and closed businesses. But I’m not sure there is. A vaccine is far away and unfortunately Doc Brown and his DeLorean are not available to go back in time and not cut the CDC budget or accept tests from the World Health Organization.

One well intentioned idea that has gained steam is what Dr. David Katz called the “surgical approach” in his New York Times piece a few weeks ago. The idea is that by now, after two weeks of shelter in place orders, we can lift restrictions and only isolate the vulnerable and the sick. The “surgical” part of this idea refers to the precision of this approach, as opposed to the broad public health measures that have been put in place. It’s gaining momentum in other opinion pieces, in Facebook comments, and in video chat arguments. But it’s also facing a lot of understandable criticism. A surgical approach to this problem is not as simple as it seems. 

There are not enough tests

The crux of the proposed surgical approach involves lots and lots of testing. In order to properly quarantine infected people, we need to know they’re infected. Right now, we barely have enough tests for hospital patients. In some places, it takes days to receive results. We aren’t testing asymptomatic people right now due to the testing shortage, even though we know that asymptomatic or presymptomatic people are spreading disease. Until there are enough tests with a quick enough turnaround, the “surgical approach” is not a viable option.

There are a ton of people at risk in the US

I know everyone pictures an 80-year-old nursing home resident as the epitome of vulnerability, but the reality is there are a lot of people at risk for severe COVID-19 complications. Who is vulnerable enough to be protected with isolation and work at home accommodations? Thirty-five million Americans have chronic lung disease and 34 million people have diabetes, two of the biggest cited risk factors. In 2020, over 50 million Americans are over the age of 60. And there are countless more undergoing cancer treatment or experiencing other acute illnesses that make them vulnerable. Obviously some of these people overlap, but the point is still clear; even if we isolate only the most vulnerable, this is likely 25% or more of the US population. 

And what about the slightly less vulnerable? Hypertension? Mild heart disease? Your 55-year-old mother who is pretty healthy but hasn’t seen a doctor in a while? What about the healthy 37-year-old resident physician in Michigan who died? The Washington Post found nearly 200 cases of COVID-19 deaths for people in their thirties. These may seem like crazy flukes, but remember the more people exposed, the more “totally unlikely” deaths we will see. No one is invincible. 

We will still have to isolate healthy folks

Think about the nexus of one vulnerable person. They probably don’t live alone. Maybe they live with family, who now shouldn’t go to work or school. Maybe they live in a nursing home, staffed by people who live with other people who shouldn’t go to work or school. Healthcare workers shouldn’t live at home if their families are working, or else risk connecting their husband’s boss to their cancer patient. If you think hard enough about what it means to truly isolate the vulnerable, you realize how difficult that will be. 

We do not have good data on anything

A lot of the articles in favor of this “surgical approach” quote an Italian report from March 17, which demonstrated that over 99% of people who died from COVID-19 had other illnesses and only 5 people in their thirties had died. But this is not a validated research study. This is a hasty report from the first weeks of their surge. The report is not useless, but it is by no means conclusive. There are a lot of case reports about patients, especially young ones, dying weeks after diagnosis from heart problems. We haven’t recorded those deaths yet because they are just beginning to happen. Further anecdotal evidence suggests that the way we have been recording COVID deaths is underestimating the toll. My friends are telling me from the front line that young healthy people like them are dying in ICUs. I believe them. How can we make good decisions about who is vulnerable and who is not when we have so little information?

We’re still working to collect data in a more standardized way and fully understand how the disease manifests, how it spreads, and why some people do so poorly when they contract it. The reality is that we have very little modern information about global pandemics. There is no such thing as a “normal” pandemic and virtually no one has lived through let alone managed a global pandemic response before. Until we have enough information to properly and safely mount a precise response, we have to rely on broad social distancing. And to the best of our knowledge, this does work.

We will still overwhelm the health system

The risk of lifting protective measures is not just about who will or will not die if infected with COVID-19. Emergency Departments and hospitals flooded with COVID patients, whether they’ll recover or not, will crowd out other folks with problems that have nothing to do with COVID. There will not be enough space, resources, or staff to properly take care of your tragic car accident, first heart attack, or meningitis. The purpose of these stringent and protective public health measures is partially just to give us more time. We need more time to plan, expand, produce, and arrange so that we’re ready for the onslaught. We are not prepared yet to handle the increased case numbers that will come from lifting restrictions and pivoting to a precise approach. 

We will still have an obligation to protect each other

Even if we managed to make more tests overnight, fully isolate the vulnerable, and begin properly collecting data tomorrow, we will still have an obligation to one another. We will need relief for folks who still need to work from home. Businesses will still have trouble with so many people in isolation. People will still be scared and at risk for mental health crises and domestic violence. These are very real, urgent problems that need to be solved. But lifting public health protections or moving too quickly to a “surgical approach” doesn’t actually solve them. Small businesses will still need loans, vulnerable folks and their networks will still need accommodations and assistance, and healthcare workers will still need funding, support, and supplies to do their jobs.

Ultimately, this is a value judgement. My economics degree does not make me better equipped to decide who and what is important to us as a community. Nor does my medical degree. Nor does my public health degree. We have to make these decisions for ourselves, together, generously. No one wants any of this to be happening. No one wants to stay inside all the time. No one wants to be separated from loved ones. No one wants to have their businesses shut down and lifelong dreams crushed. No one likes to have the things that give them meaning banned by bureaucrats. And no one likes to ask for help, especially from the government. But we don’t always get what we want. A lot of my friends and family who were laid off from their jobs or own their own businesses are scared and frustrated and a little annoyed, but they are also embracing their new roles in the community, grateful that there is assistance from their national community, and relieved that they don’t have to choose between their job and their family or community’s safety. 

Just because a precise approach isn’t appropriate now, doesn’t mean it will never be. Once we have enough tests, improved healthcare capacity, and a plan to support each other through this crisis, we can think about slowly and thoughtfully lifting restrictions. Rushing to undo everything devalues the sacrifices we have all already made for each other.