Until this week, I felt that I could continue to do whatever I could get away with as long as I didn’t get infected or infect those I love. I could go to the gym and work out if I kept my distance and washed my hands and my weights. I could meet two friends at a restaurant for lunch if I just wiped down the table and didn’t eat with strangers. It was like the story of two men on a camping trip who see a bear coming right at them. One says I’m getting out of here. And the other asks him “do you really think you can outrun that bear?” “I don’t have to,” the first man replies. “I just have to outrun you!” I thought I just had to outrun the 30 percent of people who were going to become infected. I was wrong. I made a mistake. We are all tied together.
If we don’t slow the spread of infection, we are headed towards an absolute disaster where all of our hospitals will be filled beyond capacity and a great many people will die. We are 11 days behind what is happening in Italy, where on Sunday almost 400 people died from COVID-19, and health facilities are turning very sick people away. It is no longer acceptable to do whatever we can safely get away with. We must do everything we possibly can to break the chain of transmission and flatten the epidemic curve so that overwhelming numbers of people don’t get sick at the same time. Everybody must do everything possible if we don’t want to be forced to adopt what was recently suggested by the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care: “It may become necessary to establish an age limit for access to intensive care.”
This pandemic is new and there is much we don’t know about it. We don’t know if we ourselves will become sick, and if we do, whether we will survive. We don’t know if those we love will become sick or die. We don’t know how many people in our community are already infected. Without widespread access to testing for the public, our public health officials are, to some extent, flying blind. We don’t know how long this pandemic will last, how many will die. We don’t know how long it will be before our lives return to normal. There is no vaccine or proven effective anti-viral drug and we don’t know when they will be available. We don’t know if we can trust what our government is telling us because we are hearing contradictory things from the country’s top scientists and the administration’s top officials.
We’ve always turned to CDC right here in Atlanta for science-based health information, but now we wonder whether they are free to give us the facts and tell us the truth. Some of us have had our faith in CDC shaken because we hear that CDC is responsible for our not having adequate numbers of tests for the coronavirus. Mistakes were reportedly made by CDC when they decided not to adopt the World Health Organization test, but to develop their own.
But CDC does not deserve all the blame. The best available analysis I could find, by Olga Khazan, writing in The Atlantic March 13th, suggested four reasons for the trouble with testing: red tape limited the FDA’s emergency authorization of tests developed by many labs across the country; virus samples were initially hard to get; few places other than academic research institutions had the equipment needed to perform the original CDC tests; and there were problems with leadership and coordination at many levels. When science becomes politicized, it hampers our ability to fight those problems that threaten our health and well-being, whether they be tobacco, climate change, or gun violence. When science becomes politicized in the midst of a crisis, critical messages get corrupted and our very lives, livelihoods, and financial futures are all put at great risk.
Not knowing the answers to so many questions makes us all very anxious. Hearing 24/7 about an impending COVID-19 disaster makes us even more anxious. And this is occurring at the same time that our usual means of dealing with stress and our daily routines have been pulled out from under us. We can’t go to work, go to the gym, go shopping, meet with friends, go out to eat, go to religious services, or even see our children or grandchildren at a time when we are worried about their health. We are all uncertain, anxious and stressed, a combination that can lead to higher levels of depression, anger and violence of many sorts. Depression and social anxiety are associated with increases in intimate partner violence, child neglect and abuse, suicide, and substance abuse. Thinking that we are helpless and passive victims in the face of an advancing enemy that we can’t see or stop makes it all so much worse. Fatalism can be as serious a threat as the virus itself, but it is something from which we can protect ourselves.
First, we can protect ourselves by knowing the truth. CDC has always been a trusted source of information and we need CDC to play that role again. CDC can collect and let us know on a daily basis how many people have become infected, how many have become ill and whether their illness is mild, moderate, or severe; how many have been hospitalized, recovered, and died. What is the capacity of our hospitals and where we should go to seek help? CDC is an extraordinary resource and we need it to play this role for the duration of this outbreak and well beyond.
Second, handwashing and social distancing are things we can actively do to protect ourselves and to break the chain of transmission.
And third, we can change gears and go into full virus battle mode. I am not thinking of myself as passively withdrawing into my shell, but as part of a widespread mobilization for protection. I am actively doing everything I can to break the chain of transmission, everything I possibly can to socially isolate myself to protect myself, my loved ones, my community, and my country.
And what I do, if I do it right, will protect even those I don’t know and will never meet. It will increase the chance that intensive care beds will be there for those who need them, even if they are older than 60. I feel better now taking these active steps and doing everything I possibly can. I think we all will.
Mark L. Rosenberg, M.D., is an epidemiologist, infectious disease physician, and psychiatrist. He is president emeritus of The Task Force for Global Health and a former assistant surgeon general.