Updated 4/30/2020
By Martin Dubravec, MD
The U.S. is experiencing a new coronavirus outbreak, known as COVID-19, caused by SARS-CoV-2. The global death toll has reached 200,000 and continues to rise.
The media reporting and governmental response to the viral outbreak have been unprecedented. Our collective response has been tragic, and more concerning than even the virus itself. If despotic government overreach is not turned back, the result could be a new, enduring totalitarianism.
Let us consider the three pillars of a stable society and how each of these pillars (medical, legal/civil, religious) has responded to the virus.
Medical Considerations
Coronaviruses have been known in the U.S. since their discovery more than 50 years ago. Certain strains of these viruses infect humans, while some tend to infect animals. It has been shown that these viruses may have the ability to jump from animals to humans and vice versa. Previously, these viruses rarely caused death in humans; they are often cited as a cause of common colds. COVID-19 in most cases acts in the same way, but it can be deadly, especially in the elderly and the immunocompromised. It hits these populations fast and hard. Nonetheless, even in Italy, where the virus has killed thousands, nearly 75 percent of patients over age 90 recovered.[1] [1]
COVID-19 differs from the influenza epidemics in 1918 or 2010; those epidemics involved all ages. Most young people are spared serious illness from COVID-19.
In the absence of a vaccine or effective treatment, we have only a public health approach—non-pharmaceutical intervention or NPI. This involves shielding those at high risk until the virus has run its course through the country and population (“herd”) immunity has developed. Persons with cancer, lung disease, immune deficiency disorders, or advanced age should isolate themselves to the best of their ability.
The media constantly highlights statistics on the number of exposures, serious illnesses, and deaths. Scary projections from flawed models incite panic and despair. One model by Neil Ferguson of the Imperial College London predicted as many as 2.2 million U.S. deaths.[2] [2] Estimates by the Institute for Health Metrics and Evaluation (IHME), the main consulting organization that has been advising the U.S. Coronavirus Task Force on the predicted course of the epidemic, were much lower and ever-changing. In early April, the model projected nearly 94,000 deaths by late summer. A week later it put the toll by August at 60,400—a decline of 36 percent from the model’s previous estimate.[3] [3]
For comparison, here are approximate annual U.S. deaths from other leading causes:[4] [4]
- Heart disease: 650,000
- Cancer: 600,000
- Accidents: 170,000
- Chronic lower respiratory disease: 160,000
- Stroke: 146,000
- Influenza and pneumonia: 56,000
- Suicide: 47,000
Accurate figures for COVID-19 deaths are not available. Task force member Dr. Deborah Birx stated on Apr 7, 2020, that patients who died of other causes might still be counted as dying of COVID-19 if they had a positive test at the time of their death.[5] [5] Because of delays in data reporting, it will be months before we know whether all-cause mortality for the year is unusual.
Information on the sensitivity and specificity of tests for SARS-CoV-2 has been incomplete or conflicting. Some doctors have simply decided to treat suspected patients with azithromycin and hydroxycholoroquine, as testing was not available or perceived as inaccurate.
Because of the lack of testing kits, the total number of those who have contracted COVID-19 is much higher than reported, as most COVID-19 infections are mild or not even felt by patients.
Predictive modeling is meaningless if based on unreliable data. The Chinese communist government has lied about the epidemic from the beginning. Numbers from Italy may be more reliable, but can we assume the U.S. will go the way of Italy? Italy has the most elderly population in Europe, a high rate of smoking, and in northern Italy the highest concentration of Chinese workers, who frequently travel back and forth to home.[6] [6]
Despite these observations, the medical community has seemingly panicked to the same extent as the general population. Helpful and necessary therapies and evaluations have been denied to millions, citing concerns about spreading the virus. Many clinics have been closed out of a misplaced fear that they would spread the virus if they stayed open. Other clinics that desired to stay open had to close because they could not obtain stocks of necessary supplies, owing to hoarding and panic. How many strokes, heart attacks, pneumonias, cancers, fractures, etc., will be missed or untreated because the medical community has been afraid to go to work? How many suicides and drug overdoses will result from our current policies?
Telemedicine is being used as a response by those health professionals fearful of getting ill or of infecting others, but there is no substitute for face-to-face interactions with patients. A little common sense could go a long way: Patients with cough, fever, or bronchitis could be treated over the phone or in a protected setting. High-risk patients should be isolated if they are doing well, and their routine health appointments should be re-scheduled. Those who are otherwise healthy but need physical therapy, routine evaluations, follow-ups, orthopedic surgery, etc., should get them if possible. There is no need to stop seeing a 12-year-old for her acne if she has no other medical problems and the doctor is low-risk.
Most people do not get COVID-19, even if they are exposed to confirmed COVID-19 patients or travel to high-risk areas. The vast majority who are exposed are asymptomatic and may test negative. Why? Most likely, these patients have pre-existing immunity to the virus from previous exposure to COVID-19 or have cross-reactive immunity from being infected by related coronaviruses, which cause the common cold. Many people have stated that they suffered symptoms of coronavirus earlier this year, before awareness of this diagnosis. Without widespread antibody testing, we cannot know the extent of this immunity. A sufficient number of such persons (“herd immunity”) block the spread of the virus, and the epidemic dies down.
The Public Health Response
U.S. public health authorities have pushed for containment and mitigation. President Trump tried early to keep the virus outside the U.S. with a ban on travel from China. However, this did not prevent entry, for example, of a French businessman who visited China in January, returned to France, and then came to the U.S. from Europe. Containment did not work; the virus was documented on American soil by the end of January.
Mitigation is the concept that slowing the spread of the virus will blunt the surge of cases and prevent hospitals from being overwhelmed with seriously ill patients. Mitigation efforts have included ordering people to stay in their homes, closing “non-essential” businesses, and restricting where people can go. This may have had no impact on the virus, as these mitigation efforts are incomplete. For example, in Michigan, people were told to stay home except to go shopping, to go to essential work, and to exercise outdoors. Exemptions included Walmart, Home Depot, pharmacies, grocery stores, and liquor stores. The big-box stores were full of bored, scared, unemployed people. Viral spread is possibly very high in these stores. Also, fast-food restaurants have been busy with drive-through business. One asymptomatic window cashier could potentially spread the virus to dozens of carloads of people.
Not all states had massive lockdowns. As of Apr 5, these states (Arkansas, Iowa, Nebraska, North Dakota, South Dakota, and Utah) had no more COVID-19 deaths per million residents than neighboring states with lockdowns.[7] [7]
Efforts at containment and mitigation have failed. They cannot be complete. Our borders are thousands of miles long. Our population needs to eat and get medicines and other necessities. Even totalitarian China could not contain the virus in Wuhan. The mitigation efforts have, however, done untold damage. This includes delayed or denied medical care; job and business losses; increased suicide from prolonged sequestration; and damage to hospitals and medical practices from lost revenue. No country can adequately fight an enemy like an infectious disease without a working economy.
Epidemics end when the population develops immunity. This happens when healthy people get exposed to the disease and recover. With COVID-19, schoolchildren have virtually no risk of death, and healthy workers a very small risk. If they become immune they are a wall that stops the virus. If, however, they are locked down now, they remain susceptible and likely to infect vulnerable people later, when precautions are lessened.
Legal and Civil Liberties Considerations
Many are more concerned with what is happening to American society than with what the virus will do to us medically. Bad government policies imposed on us have led to economic destruction on a scale unprecedented in most of our lifetimes. State governors have been in a race to see who can cause the most dramatic removal of basic constitutional liberties.
Some states have police officers pulling people over to quiz them about where they are going. Some businesses have printed papers that their employees carry to show they are going to work in an essential business. All of this is reminiscent of Nazi and communist state control of people. It seems to be working; with their willing accomplices in media, Americans seem eager to exchange their freedom for what they believe to be security and safety. What they do not realize is if this is allowed to continue, they will lose their security, their safety, and their freedom.
On Apr 7, Dr. Deborah Birx stated: “And now we see, across the globe, people mitigating against this virus, realizing that their own behaviors can change the course and future of this virus in their communities, which is really astounding: the power that gives us to actually understand that we can compete against this virus and do well [emphasis added].”[8] [8]
Officials do not ask the question: What type of precedent will this set? What will happen with the next epidemic? Will we lock down the economy for the next outbreak of influenza?
What we are seeing is what works to corral people into almost total submission; it is taking about a month.
Religious Considerations
Because of panic about the virus, most churches have closed, instead of being increasingly active in this time of trial. President Trump announced a National Day of Prayer for this virus, but where were our church leaders? Where is the call for prayer, repentance, and mercy?
Hostility toward religion is on display by numerous governors and local officials, who even threatened worshippers attending outdoor services in which people sat in their cars with closed windows. Asking people to stay home if sick, enforcing social distancing, and other common-sense measures might suffice for liquor stores or big-box retail outlets, but apparently not for churches. Our liberty to worship, or to assemble for other purposes, is under assault, with little pushback so far.
Conclusions
Unprecedented restrictions on human movement and activity were placed because of a novel, highly transmissible disease with very severe consequences in some patients. Even as initial models predicting millions of casualties proved flawed, panic continued. Despite devastating economic consequences, most Americans have so far accepted extreme government intrusions into daily life, without even demanding evidence of effectiveness. Are we in a post-Christian, post-science society, manifested by unquestioning submission to political authorities, even by religious leaders, physicians, and scientists? Will love of liberty reassert itself with demands to respect our rights and restrain arbitrary, capricious, destructive acts by government?
Martin Dubravec, M.D., is an allergist and clinical immunologist with Allergy and Asthma Specialists of Cadillac, Cadillac, Mich.
REFERENCES
[1] Statista. Coronavirus (COVID-19) death rate in Italy as of April 24, 2020, by age group. Available at: https://www.statista.com/statistics/1106372/coronavirus-death-rate-by-age-group-italy/. Accessed Apr 25, 2020.
[2] Adam D. Special report: the simulations driving the world’s response to COVID-19. How epidemiologists rushed to model the coronavirus pandemic. Nature 2020;580:316-318. Accessed Apr 25, 2020.
[3] Bump P, Wan W. A leading model now estimates tens of thousands fewer covid-19 deaths by summer. Wash Post, Apr 8, 2020. Available at: https://www.washingtonpost.com/politics/2020/04/08/leading-model-now-estimates-tens-thousands-fewer-covid-19-deaths-by-summer/. Accessed Apr 25, 2020.
[4] National Center for Health Statistics. Deaths and mortality; 2017. Available at: https://www.cdc.gov/nchs/fastats/deaths.htm. Accessed Apr 25, 2020.
[5] Horowitz D. Horowitz: Dr. Birx: ‘We’ve taken a very liberal approach to mortality.’ Conservative Rev, Apr 8, 2020. Available at: https://www.conservativereview.com/news/horowitz-dr-birx-admits-overcounting-covid-19-deaths-heart-attacks-mysteriously-plummet/. Accessed Apr 25, 2020.
[6] McCain RS. Coronavirus: The price of luxury: fashion’s ‘made in Italy’ tag is connected to a Chinese disease. Am Spectator, Mar 20, 2020. Available at: https://spectator.org/coronavirus-the-price-of-luxury/. Accessed Apr 25, 2020.
[7] Trabert D. COVID cases trending down, states without lockdowns do better. The Sentinel, Apr 14, 2020. Available at: https://sentinelksmo.org/covid-cases-trending-down-states-without-lockdowns-do-better/. Accessed Apr 28, 2020.
[8] Remarks by President Trump, Vice President Pence, and members of the Coronavirus Task Force. Press Briefing, Apr 7, 2020. Available at: https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-april-7-2020/. Accessed Apr 26, 2020.
