April 25, 2020

My handy Corona Virus counter shows we’re closing in on three million cases world wide (doubtless a huge undercount for both political and logistical reasons), one million cases in the USA and just over six thousand cases here in Alabama. The greater Birmingham area remains relatively virus free due to the local population continuing to adhere to social distancing requirements. The state hotspots are Mobile (likely due to proximity to New Orleans) and the Georgia/Alabama border area around Auburn. I have no need to travel to either of those places. I haven’t been much of anywere other than work in the last six and a half weeks. I’m still working on the same tank of gas I put in the car in early March.

There is still a population out there who want to believe, mainly for idealogical reasons, that Covid 19 is no worse than the flu and isn’t worth all the fuss. As a point of comparison, we are currently at just over 51,000 death in the US from the disease (again, likely an undercount due to inconsistent reporting methodologies and spotty testing) and, at current trends, will hit 60,000 by the middle of next week. This means the disease will have killed more Americans in eight weeks than were killed in eight years of misadventure in the Vietnam War. Every one of those deaths was someone’s child, someone’s parent, someone’s colleague, someone’s friend. The ripple effects are going to be enormous and long lasting as we’re still in an upward trajectory.

Some are advocating opening up and herd immunity. Herd immunity happens when enough of a susceptible population is immune to a disease process so that a communicable disease cannot get established and transmitted. It’s what protects the small portion of the population that cannot be vaccinated for medical reasons from common infectious diseases. Enough people are vaccinated to keep it from ever reaching those vulnerable ones. Herd immunity has been studied and is one of the more basic concepts in epidemiology. It is easy to calculate, based on a simple formula which depends on the transmissability of the disease. In simplest form, if an infected person is capable of transmitting the disease to two people, 1/2 or 50% of the population must be immune to achieve herd immunity. If it’s three people, 2/3 or 67%, four people, 3/4 or 75%. The more transmissable, the higher the percentage must be. The transmissability of Covid 19 is hotly debated and is somewhere between 2.2 and 5.7 meaning between 55% and 82% of the population must be immune to achieve herd immunity. In the US, with a population of roughly 320 million, that’s between 172 million and 256 million infections that need to happen. How many excess deaths would that cause? It’s unclear as there seem to be significant numbers of subclinical cases – people who have the disease but never know it. The percentage of asymptomatic cases is unknown and spot studies have shown everything from 5 to 80% which is too wide a spread to be of much use. What is clearer is the mortality rate for symptomatic cases which seems to be about 3.5%. This leaves us with a low of 35 million to a high of 243 million clinical cases to achieve herd immunity and 1,170,000 to 8,270,000 deaths.

It may or may not be possible to save those individuals but the longer we can delay their becoming ill through social distancing and flattening the curve, the greater the chance of developing a vaccine or coming up with medications which, if not cure, can at least lessen the damage the disease causes. Then there are the issues of the health system. It cannot cope with tens of millions of cases at once but it can begin to cope with lower numbers over a longer period of time. We’ve been relatively blessed in Alabama with not a lot of our health care workers becoming ill and stocks of PPE lasting. That’s not true for the country as a whole. I saw somewhere that it’s estimated that 10,000 US health care workers have caught the disease on the job to date. By contrast, in forty years of HIV care, fewer than fifty US health care workers have contracted that disease on the job.

Reopen Rally – Madison Wisconsin – April 24, 2020

I see the crowds rallying at statehouses, riled up by politicans and economic forces that do not have their best interests at heart and I don’t understand. We all want it to be like it was. I miss getting together with friends, having rehearsal, going out to dinner but I know that as a responsible citizen and member of society, not to mention a health professional caring for a very vulnerable population, that that has to be put on hold for a while. Even if lock down orders are lifted, it’s not going to go back to 2019 behavior patterns the next day. People have learned a lot these last few weeks and are going to be much more cautious in their choices. They’re going to have the freedom to not do things as well as to do things and the economy is going to remain in trouble, driven as it is by consumer spending. There is no way to get through this process without economic disruption whether that’s by shutting things down or by doing nothing and letting a significant portion of the population suffer and die all at once bringing down the health system with it (and the health system is nearing 18% of GDP). And, quite frankly, if those are the choices, I’m happy to take the former.

If no vaccine is found, ultimately we’re all going to be tested by fire and get Covid just as our ancestors all got small pox. The majority of us will survive, life, society and civilization will go on, just different. How different? I don’t know. There are tantalizing clues in studing the pandemics of the past and their effect on society (The plague of Justinian effectively ending the Roman Empire in the west and leading to the development of Byzantine society, the black death of Medieval Europe allowing for the Renaissance, Reformation and modern world, even the Spanish Flu effectively helping end World War I). Unfortunately, I left my crystal ball in an old handbag at the left luggage counter of Victoria Station some years ago so my prognostication abilities for the current pandemic are, shall we say, limited.

Be safe, be well, wash your hands.

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