What shall we do about COVID-19?

By David Webb, MD

Lanesboro, MN

There are now two conflicting strategies for dealing with it.

One, advocated by the Centers for Disease Control, the World Health Organization, and virtually all public health professionals is containment and mitigation. In the context of infectious disease, containment means readily identifying and isolating infected persons, tracing and quarantining contacts, and adequately treating those infected. Because contagious persons may be asymptomatic, identification necessarily means rapid and reliable testing. Adequate treatment implies access to health care regardless of ability to pay and having sufficient reserves of hospital and ICU beds, staff, and equipment to care for all in need. Mitigation comprises all those measures proven to limit the spread of disease when containment has not or cannot be achieved – mask wearing, social distancing, avoidance of unnecessary group gatherings, and so forth – with which we’re all now quite familiar and with which many of us are growing weary. However, a few countries which instituted such measures in a comprehensive, timely, well-coordinated manner have been able to reduce incidence of the disease nearly to zero and have largely been to reopen their economies without recurrence of disastrous outbreaks. With appropriate leadership, public support, and a concerted effort, that could still be achieved here.

The other strategy to which the President and his sycophants subscribe is to let the disease run its course hoping to effect herd immunity, or as Mr. Trump calls it, “herd mentality.” There are several problems with this approach, the most egregious of which is the casual acceptance of “collateral damage.” No, COVID-19 is not as virulent as, for example, ebola. But an infectious disease, even if it is not extremely virulent, can still be very deadly if it is very contagious. Already, in just one year, COVID-19 has become the third leading cause of death in this country. If millions more Americans are allowed to be infected with this virus, hundreds of thousands more will die  – something callously dismissed by Mr. Trump as, “It is what it is.”

Another problem is the mistaken belief that infection will necessarily confer immunity. Already there are cases here and around the world of individuals having recovered and then having been reinfected, often with worse symptoms the second time around. (Think of another coronavirus disease with which you have more familiarity – the common cold. Did having a cold once as a child, confer lifelong immunity for you?)

And if you think COVID-19 is just a disease of the big cities and that you are safe here in rural America, consider our neighboring state of North Dakota. Were it a country, it would currently have the highest per capita infection rate of any country in the world. All its hospital and ICU beds are full. Perhaps it’s because it hits too close to home and I don’t subscribe to the Texas Lt. Governor’s idea that we elderly should willingly sacrifice ourselves for the sake of the GNP. Perhaps it’s because two of three children, both front line health care workers, and two of three grandchildren, all in Minnesota, have come down ill with this disease. (Thankfully all seem to be recovering, but their father/grandfather nonetheless worries about possible long term sequelae, about which we still know very little.)

I’d like to think that it’s principally because as a matter of personal ethics, I believe that saving lives is more important than making money. In any case, I would vote for strategic option one above.