Many patients tell me “I just want this thing to be over with.” They “can’t stand this any longer.”
The virus is not listening.
COVID has upended much of modern life, but it already possesses a “long tail.” This “devil’s prong” will continue over decades, first through statistics of death, destruction and disability, but later in matters of sensibility. Will we continue to actively ignore its violence, or will we learn from it? First a few facts:
The Matter of Death
Statistics can be manipulated, but death is hard to fake. Many politicians, starting with the president, have manipulated COVID numbers, but the matter of “excess deaths” is hard to deny. Now the CDC has estimated about 300,000 more Americans have already died this year than was expected, with a scary 26.5% increase in those aged 25-44. Covid does not just kill economies and old people, it also sweeps up the young, even when they survive:
The Disability of “Long COVID”
Many physicians like myself have been baffled and horrified by a disease with more than a thousand faces. Your immunity gets shot, you get bacterial pneumonia, you pull through. Then two months later you get autoimmune pneumonia. What illness does that?
You get through an upper respiratory infection “no problem, piece of cake.” But weeks later you wake up some days so fatigued you can’t get out of bed. You’re fine one day, the next morning you can’t remember what you did the day before.
You were a dedicated, agile runner. You get hospitalized with COVID, out in a few days. Now your breath is short and labored. You can’t run. You can walk, but not all that far. Your youth feels gone.
Your doctor also mentions you now have chronic kidney disease. And there’s this funky spot on your lungs. We’ll just have to watch.
How many people will have “long COVID?” Will it be one in ten, one in twenty? It’s early. We do know in-hospital studies that over 80% of people had neurological symptoms. Months later a German group of asymptomatic folk shows a similar proportion of MRI heart inflammation.
The facts are that in America, we’ve already had over a million COVID casualties. In winter that number will climb.
Ignorance is Strength
George Orwell knew the powers, perils and pleasures of propaganda. Stalin and Hitler taught that people can and will believe anything, no matter how self-destructive. Civilizations shattered. Tens and tens of millions died.
Orwell would probably recognize Florida Governor Ron DeSantis as an effective “1984” type. Told to lockdown in the spring, the governor hesitated; one team of epidemiologists figured 80% would not have died if the move had occurred two weeks earlier. When the death count reached 4,000 the governor crowed about how Florida had done so much better than harried northeastern states like NY; time to open up.
Florida did. Bars, restaurants, fully open for business. The death count quadrupled. Then in late September, he suggested a student “Bill of Rights” against universities. Included would be a “right to party:” after all, why come to university at all if you couldn’t get shitfaced? Things were going so well there was little point in daily updates to COVID statistics. Time to end them.
Now we’re told stadiums should be open and fully packed, so we can repeat the disaster of Lombardy where soccer matches led to massive superspreading.
Has someone explained to Governor DeSantis that COVID is an infectious disease that spreads exponentially? That a large viral reservoir sets you up for explosive growth in the winter when people come to play in sunny lands?
Sure they have. He knows. That’s why Florida’s statistics on percentages “positive cases” is always listed as half or less than what other groups, like Johns Hopkins, report. Change the numbers, change the situation. What’s bad is now good.
The University of Washington Institute of Health Metrics and Evaluation figured that Florida would double its death numbers between October 1st and the end of the year. We will get close to previously derided numbers of NY. That estimate was made before full opening up.
In the end, the excess death numbers will tell the tale. Given the governor’s interest in numbers, we won’t get those statistics until long after.
To fully open up in America, you need effective trace and track. Effective quarantine. Isolation support. Effective, standardized data collection.
Florida has none of these. Regardless of the weather, this winter will be harsh.
Each country deals differently with the COVID crisis, as does each community and individual. Perhaps one of the longest “tails” of COVID will be the loss of safety, of comfort and confidence in daily life.
Today, visiting Walmart is not a quick, fast dash for groceries, but an obstacle course. Invisible enemies along the way can kill you. The vacation across the seas can’t be made. Americans are pariahs. Countries won’t let you in. No one knows the true risk of death or disability flying from Miami to London.
Yet no crisis should go to waste. COVID teaches Americans that we are fragile, that our way of life is unsustainable.
It’s not just invisible enemies. The climate we grew up with is gone. The hurricanes will be faster, the storms stormier, the floods more encompassing.
Yet saving the public health can also help save the public commons. A similar mindset and policies can create a new public health and environmental framework while growing the economy. Not incidentally, your long term survival depends on it.
The president said, “science doesn’t know.” Science does, and so do we. Will we act on it?
COVID has made people think about the gift of living each day. Now it’s time to think about the next.