I have had some excellent questions come to me as a result of my recent blog articles and am happy to respond with my opinions which are, I hope, knowledgable but I will reiterate that I don’t claim to be a world expert. I am giving you my opinions as a local family doctor and neighbour.
One question that I thought was a very good one went something like this. “If the number of cases under the curve on the graph are the same, the blue ones the same as the red ones, why don’t we just let this virus run it’s course and get it over with quickly since the curve shows that the illness will deplete faster with the red curve. Get it over with.”
If we quickly look at the graph, that seems like a very logical question and the idea that eventually at least half of us are going to get this virus, one way or another, would suggest that we might as well just bear it now and get on with it. More people will have immunity and the virus will run out of steam.
The problem with this view is that we are not looking at that dotted line that indicates what our Healthcare System capacity is. If we go for the red curve you can see that very quickly we will overwhelm what resources we have to manage it. Conceivably the number of people infected if it is totally out of control might not be 50% but 70%. As a consequence, many more people will die because they will not have access to life-saving ventilation or hospital care.
A younger demographic may argue that the severe illness and death rates are in the elderly and those with chronic illnesses mainly. That fact is true, but others do succumb from this virus. And if the hospitals and medical staff are depleted of resources and spaces, where will your kid go when they are hit by a car and have a head injury, or you have a heart attack and need bypass surgery, or your sister needs cancer surgery or your wife has a postpartum bleed? The argument is not entirely about suppressing the total number of cases, but about making the inevitable manageable so we can continue to provide adequate health care to all.
I think many senior folks (I don’t like being called elderly) will agree with me that we might have a bit of a fatalistic attitude to the prospect of death from this virus. We realize that we will all die sooner or later. For those of us over 70, there is a bit more sooner and a bit less later in that equation and we know it. Sure, we think about our increased risk, but I suspect most of us worry more about our families and friends than ourselves.
To put this in perspective, let’s say in the greater Kingston area we have about 200,000 people. If half of those gets COVID-19 in the next few weeks that means 100,000 infections. Of those, 80,000 will take acetaminophen, stay home from work, feel lousy but get better. That will mean 80,000 people off work for at least two weeks, by the way. Another 10,000 will need some sort of medical care and a further 10,000 would benefit from hospitalization. Do we have 10,000 hospital beds to offer them? Even more drastic is that 5,000 will need ventilation. We have 35 ICU beds currently at Kingston General Hospital and they are usually full with people who need immediate intensive care with things other than COVID-19. So where will these 5000 people get their needed intensive care? Maybe we could handle it if they came in slowly but in a glut, the system would be overwhelmed and unmanageable. Bear in mind that with a high peak that means more health care workers would also be ill and out of commission to serve as well.
The proposal is that if we follow the advice we are receiving for Social Distancing (in addition to all the handwashing, sleeve-sneezing advice) we can spread these infections out over time. Flatten the curve. Perhaps, if we can slow the spread over the next few weeks or months, science will come up with an anti-viral medication that can blunt the curve even more. Eventually there will be immunization available. People will develop natural immunity. With time the infection rate will slow down. China has put very stringent social interaction controls in place. In the last 24 hours, China has reported 24 new cases. Canada has had 89.
I present this to you to emphasize that we need to be doing everything we can NOW to minimize the shape of this curve and keep the inevitable crisis to within manageable bounds. I saw a headline somewhere that said “This is not a snow day.” We will all be required to sacrifice in some way in order to keep our community as safe as possible from a situation that could overwhelm our Healthcare System and be detrimental to us all, not just our vulnerable elderly neighbours and relatives. We can not just think about “me” but rather aim to help “us”.
John A Geddes MSc MD CCFP
Kingston, Canada
March 15, 2020.
