If there is a self evident truth in this pandemic, it is different people see this dual crises in very different ways. Individually, we have different perspectives driven by the totality of our experiences. This different in perspective results in the inevitable tension of dealing with two crises at once – the health complications of COVID-19 and rapidly rising unemployment and business failures.
Perspectives take on even more meaning when scientists and policymakers are working in an environment of more questions than answers. During this pandemic, scientists have worked with less than complete data. This has resulted in a great deal of learning from our mistakes.
Science is an ongoing discovery process. We are learning – filling in gaps of knowledge every day in this pandemic. With this added knowledge noted below, we can begin to replace anxiety with the confidence required to successfully reopen the economy and continue to flatten the curve. We can begin to replace fear with hope.
We have learned a lot about the incidence of this virus. A population study with large scale testing in Los Angeles and Santa Clara indicated the mortality rate of COVID-19 may be closer to the rate of 3 in 1000 than the 3 in 100 suggested in original models. Studies indicate a significant number of people infected with no symptoms.
We have learned a great deal about the treatment of cases of COVID-19. This past week, the results of a randomized placebo-controlled large international trial of the antiviral agent Remdesivir was announced. The trial of over 1000 patients with COVID-19 pneumonia showed the median time to recovery of a person taking the drug is far better than those not taking it. More people got well and got well faster with the drug. Dr. Anthony Fauci noted Remdesivir “will be the standard of care”.
During the pandemic, a lot of things have been hyped as game changers. Remdesivir is a real game changer – an effective treatment of the virus. New trials of other pharmaceuticals and plasma antibodies working in different ways against the virus will be completed soon and hopefully we will add more new effective treatments.
Much of the anxiety associated with COVID-19 is the aspect of a disease with no treatment. The concern of people – both well and sick – are heightened when they think they might transmit a disease with no treatment to another. Remdesivir will likely lessen some of the anxiety associated with reopening the economy.
Researchers combined and analyzed multiple small studies of hydroxychloroquine – a drug used for years in other medical conditions. The meta-analysis collected physician observation on the drug’s impact on patients with COVID-19. Over 90% of physicians reported improvement of patients after taking the drug. This drug has been used extensively by doctors across the country and world during this pandemic.
We have learned a great deal about the demographics of the disease. We have learned that the incidence of complications of COVID-19 virus are much greater in people who are older, male, and African American with underlying chronic illnesses. This leads to greater concentration of prevention efforts on this subgroup of people.
We learned there are definite patterns of COVID-19 hot spots within the community. This helps design solutions and apply resources that are not just a shotgun approach. Examples of more laser-like solutions is the Caddo Commission/LSUHSC mobile van for testing in high-incidence areas.
States who have concentrated intense effort on preventing the spread of the illness in nursing homes have a significant reduction of mortality in that population. The mortality rate in Florida is 1.2% and 10-18% in New Jersey/New York.
We have learned about the effectiveness of social distancing but the health systems remain prepared for worst case scenarios. The original COVID 19 surge in Northwest Louisiana did not overwhelm the health system. In preparation for any unexpected increase of patients, Ochsner/LSUHSC is building more ICU beds for surge capacity and Willis-Knighton Health System has a dedicated ICU ward for COVID-19 patients.
We have learned there are powerful negative outcomes associated with strict community lockdown strategies. On the positive side, the lockdown strengthened social distancing strategies and flattened the curve to prevent overwhelming the health system. On the negative side, we created unemployment figures and business failures not seen since the Great Depression. We can expect the same negative outcomes with continued strict limitations or re-instituting the lockdown in the future.
The negative health outcomes of unemployment and poverty are well established. Our economy reopening efforts that result in supporting business and reducing unemployment will also serve to protect our public health. Economic and public health go together.
The COVID-19 virus will be around for a while but what we are learning helps us engage it on our terms. As we move forward as a community, health systems and community leaders will begin to look at the virus differently. Our health system and community will move past the idea of COVID-19 as a total focus of all our thoughts. We will continue special COVID-19 nursing floors and ICUs. But at some point very soon, the health systems will turn their attention back to all the other acute and chronic problems we are called on to treat.
So what do we do now as we move forward? First, we accept the inevitable tension of different perspectives. We continue social distancing in our businesses. We concentrate on prevention efforts for the vulnerable population in the “hot spots” within our community, nursing homes, and large indoor gatherings where distancing will not be easily accomplished. We stay focused on doing what needs to be done to flatten the curve to protect our health systems.
We must reopen the economy with the sense of urgency brought on by Great Depression like unemployment numbers. It will be done in a graduated way as outlined by national guidelines. We will support our local businesses. People will return to work. Louisiana Senator John Kennedy said “we need to save both lives and livelihoods.” We must and will do both.
Adults will experience a new normal. Children will be back in school and playing on playgrounds. And we will build on the humanity that is shown every day in our community and nation around this pandemic.
What we are learning every day helps us engage the virus more on our terms. We are learning our emotions don’t just have to be anxiety and fear. We can replace these emotions with hope and confidence when we work together in social distancing efforts; apply ourselves to protecting the most vulnerable; and succeed in supporting the job creators and getting our community back to work.
Dr. Phillip Rozeman is a practicing cardiologist. He is past board chair of the Greater Shreveport Chamber of Commerce, Blueprint Louisiana, and Northwest Louisiana Medical Society. He currently serves on the statewide board of the Louisiana Committee of 100, CABL, PAR, and LABI.