I worked for 18 years on the front line as an on-call staff clinical neurophysiologist in high-risk surgeries. I care deeply about those of us who are getting sick and dying from COVID-19. I am horrified by the incessant march of death by illness, war, murder, suicide, auto accidents and other causes and by our inability/unwillingness to both uphold high-quality life more effectively and to provide support for each other when stricken.
I also am frightened by the silent and passive acceptance by almost everyone of the unprecedented overnight loss of freedom worldwide. I write in hopes that my knowledge may help others understand what the numbers mean so we can face what we must, learn from it and find the will and resources for real solutions. My ideas are not about elections or beliefs; they are about facts, what they mean, and what good may come out of this unprecedented worldwide disaster.
On March 23, 2020, Pennsylvania Gov. Tom Wolf issued a stay-at-home order for Allegheny County and six others. While there is no question that the COVID-19 outbreak poses a significant threat to public health and the order likely conforms with Pennsylvania law(s), the order violates the constitutionally guaranteed right of peaceful assembly. I have filed a complaint asking the Pennsylvania ACLU a) to provide an opinion regarding the governor’s encroachment on the First Amendment right to peaceful assembly, b) to ask the proper court to set the order aside and c) to identify and take legal action to overturn the state emergency law(s) that empowered the governor’s order.
Most of us are willing to take recommended safety measures including staying at home when we are sick or at risk. That said, surely there are those who inadvertently or even willfully expose themselves and others to infection, e.g., the Solid Rock Congregation of Lebanon, Ohio, or the innumerable minyanim that continue daily worldwide. However well-justified, well-meant and potentially tragic these incremental flaws in quarantine may be, that is a price of the freedoms guaranteed by the U.S. Constitution.
I am concerned that the governor’s constitutional overreach may be repeated with our next seasonal flu outbreak. The CDC’s current weekly situation report shows 38 million flu cases nationwide and 23,000 deaths. By comparison WHO’s daily COVID-19 situation report #66 (March 26) shows 63,570 U.S. cases and 884 deaths, a tiny fraction of the flu numbers. One of the good things that may come out of our reaction to the COVID-19 outbreak is a more forceful response to each year’s seasonal flu.
Many people are alarmed, as am I, by reports that the proportion of those infected who get sick or die is high. But death rates reported to date may reliably be understood as upper bounds for the following reason. COVID-19 tests are preferentially administered to those at highest risk for infection, i.e., those who have been exposed and those who are symptomatic and/or hospitalized. That reasonable but biased sampling strategy misses the vast majority of cases that are not symptomatic or otherwise not tested. Since the proportion is the number of deaths divided by the number of confirmed cases and the cases are artifactually undercounted, the proportion is correspondingly inflated.
Others are panicked by reports that the number of cases is doubling every few days. But since large-scale testing began only recently due to testing supply shortages, the alarming rapidity with which the case counts are rising is artifactually amplified by daily increases in testing rather than increases in the number of new infections.
The problem that U.S. hospitals may be, or already are, unable to care for the flood of sick patients is longstanding. Hospitals are built, stocked and staffed to handle a steady case load. That business model optimizes their finances — no business can efficiently staff and stock itself to handle peak loads. That is why hospitals are often overloaded by large accidents and mass killings. A national insurance system, even a single-payer one like Medicare for All, still has financial efficiency as its primary priority and therefore will not result in a system competent to handle peak loading.
When it’s all over, as we all hope it soon will be, we will still face the extraordinary problems which limited our responses and cost so much life and freedom. I look to what good might come out of it and what we can solve for next time, for there surely will be a next time.
The justified concern of health officials and the public with inadequate hospital resources provides a powerful impetus for a publicly funded national health care system and a national vaccine development initiative. That impetus, the compelling importance of serving the health needs of the population, and the out-of-control financial picture we see with for-profit health care, all pull in the same direction. Hopefully they will generate the political will we need to abandon our barbaric “you’re on your own” system and join much of the rest of the world with a national health care system worthy of our wealth and power. Hopefully too, the success of the current global mobilization to curb this deadly outbreak may galvanize the full force of America’s wealth and power to solve the global warming crisis. PJC
Don Krieger is a research scientist and clinical neurophysiologist living in Squirrel Hill.