More About.... Addressing Coronavirus
[March 26, 2020: A personal statement from the P-POD Conference founder.]
I was reminded this morning that I did field work during credentialing as a Registered Dietitian, at Elmhurst Hospital in Queens NY. On March 6, 20 days ago, the United States death toll from COVID-19 reached 13, and a week later we published our coronavirus crisis page. Now, 13 further days later, I learn that 13 patients at Elmhurst Hospital have in ONE DAY died due to COVID-19 infection. For every one of us, there is some personal connection or insight regarding this pandemic that is stunning and emotionally riveting or devastating. I felt called to write about this today.
Almost everyone reading this is involved in some way with the work of the public health sector in the United States, and some are on the front lines of acute care providing at this catastrophic occasion. We all are profoundly moved by the heroism and sacrifice of care practitioners striving to treat burgeoning numbers of infected patients, while they struggle to make their facilities less conducive to virus transmission. And, at the same time we are deeply disturbed by the obstacles that countless practitioners face while trying to cope with all of this:
• Throughout the country, there have been multiple examples of disinvestment at the public and private levels, so that medical resources available for proper response and capacity-building for a crisis were inadequate, and the lessons well documented by epidemiological and medical authorities from past pandemics were not reflected in preparedness planning.
• Moreover, Personal Protective Equipment (PPE) necessary for the safety and functionality of practitioners themselves, had prior to this pandemic not been inventoried and distributed on a scale appropriate to the potential demands of a wide-ranging future crisis. Now, 9 weeks after documented arrival of the virus in the U.S., health care providers and their patients alike still face unanticipated risks due to finding widespread outages or rationed supplies of protective gear.
• After confirmed arrival of COVID-19 in the U.S. by Jan. 21, the absence of any substantive federal-level action other than banning travel from one country 10 days later, allowed unrestrained virus transmission for weeks, setting the stage for eventual crisis-level spread in 50 states. The Centers for Disease Control (CDC) directive discouraging gatherings of 50 or more occurred only 54 days after first virus detection. U.S. refusal to use World Health Organization COVID-19 testing protocols, failure in initial domestic federal-level attempts at accurate test development, and cumulative failure to mobilize national-scale crisis-proportioned testing capacity, all resulted in testing (the very heart of public health control measures) being rationed, right up to the present. Generally, only a subset of persons with the most overt symptoms has been able to obtain testing throughout the U.S., thus opportunities to identify and isolate carriers have been missed on a large scale.
• Wise public directives about social distancing, isolation/quarantine of the afflicted/exposed, and personal/institutional hygiene, eventually emerged from spokespeople for the National Institute of Allergy and Infectious Diseases, the CDC and various state governments, in efforts to slow the increases in COVID-19 cases throughout the U.S. However, statements from the highest levels of the federal government (just as is the case in a few other countries like Brazil) have often tended to disregard or minimize the threats of this health crisis, and presently are suggesting that it would be desirable and quite possible that guidelines urging no large gatherings would be removed by April 12. All this has tragically undermined the general public's understanding that any unusual protective measures need to be taken. The absence of consistently accurate or science-based or precaution-focused leadership from centralized government since January 21 has facilitated routine community virus spread among unsuspecting persons.
The above impediments to optimum public health systems' response, have had truly disastrous impact due to a fairly unique combination of qualities for 2020's coronavirus strain: unusually high contagious nature is matched to apparent unusually high transmissibility by persons who are asymptomatic or minimally symptomatic.
It seems crucial that our voices as health fields professionals (as well as allied educators, policy-makers, students and community activists) be united in demanding clear and unwavering societal commitments to the public health measures desperately needed now, though their implementation has in some areas been belated: uncompromisingly consistent support at all governmental levels for uniform public health messaging and mandates, such as about social distancing, quarantines and isolations, as dictated by science-based health policy authorities; emphasis within messaging that persons not showing overt disease symptoms seem to be doing the most spreading of infection; urgent massive investment in building capacity for intensive care of respiratory illness patients; urgent massive investment in production/distribution of Personal Protective Equipment on a scale appropriate for worst-case scenarios of pandemic expansion; urgent massive investment in validated virus testing resources and procedures, such that no testing request ever need be refused due to capacity limits.
Though our despair and depression may seem inevitable for the near term, there may be signs of hope about what could be accomplished over the course of several months. Countries that have conscientiously and widely sustained testing-and-contact-tracing and quarantine measures during the recent outbreak have achieved dramatically slower spreads of infection. Some remarkable statistical analysis has enabled us to make revealing worldwide comparisons at a glance. Some will be shared below.
The Financial Times (https://www.ft.com/coronavirusfree and #FTfreetoread) has kindly made key coronavirus coverage free of reader fees, and an extraordinary array of data is portrayed. At the end of this post you will find 2 charts showing the country-by-country trajectories (rates of change) in cumulative coronavirus cases or deaths. Documentation: "FT graphic: John Burn-Murdoch / @jburnmurdoch Source: FT analysis of Johns Hopkins University, CSSE; Worldometers; FT research. Data updated March 26, 2020." You will see reference lines for cases doubling every day, or cases doubling every week, or various rates between. It is especially instructive to study the trajectories of various East Asian nations, in contexts of their particular public health related efforts and timing. We thank Dr. Koushik Reddy for calling our attention to this precious data resource.
As society somehow gets toward the far end of this pandemic crisis, we who have embraced the missions of chronic disease prevention/reversal will have plenty of work to do! The major preventable chronic diseases which, combined, killed over 1,700,000 people in the U.S. in one recent year, are unfortunately not taking a vacation during any periods of social distancing, workplace shutdown, transportation curtailments or other preoccupation. Our work against cardiovascular disease, cancer, diabetes and other chronic conditions will soon have fresh and difficult challenges and questions to address:
• Whatever radar screen the country has for health matters has become totally filled by acute focus on infectious disease control, and "healthful lifestyle choices" now would be imagined merely as social distancing and handwashing. How can we bring the thoroughly forgotten chronic disease prevention/reversal possibilities and nutrition closer to constructive attention by institutions and by people in the street?
• We in the public health sector are advocating for massive emergency investment in actions and infrastructure for overcoming today's pandemic, but will this trigger in response some disinvestment (public and private) in resources and facilities suitable for addressing the chronic diseases that remain the nation's greatest killers?
• Disparities in access to health care (or to affordable or comprehensive versions of health care) are very real in our society, just like disparities in income or wealth or access to diverse nutritious foods. The most vulnerable in society tend to suffer the most from the conditions that underlie a medical crisis, as well as from the crisis itself. Can we now recognize how the most vulnerable will likely have a more difficult time than before with chronic disease risk and suffering, and can we brainstorm how health care institutions and practitioners might serve them better?
The United States will not be "open for business" on Easter Sunday, April 12, 17 days from now. There are no guarantees, but.... If the appropriate now-clearly-indicated multi-faceted anti-pandemic public health measures are implemented exhaustively and widely in the U.S., and sustained for as long as objective scientific guidance dictates.... then the United States could likely be reasonably open for business before the rescheduled P-POD Conference, beginning July 24, 120 days from now. A conference is a small thing, and could be postponed again. But, necessary public health interventions in a crisis of worldwide span and historically enormous scale, cannot be postponed. The number of lives now at stake is unthinkably large.
Thank you for taking the time to read this, and all caring wishes to you and yours,
Bob LeRoy, MS EdM RDN.