I say the very best-case scenario because we are so close to doing what, pre-pandemic, would have seemed impossible: creating, testing, authorizing, manufacturing and distributing not just one but several vaccines in an amazingly compressed timeline — certainly one of our greatest recent medical achievements. Also, we have learned so much about the virus, in real-time, and have new — and some old — medicines to treat it.
The worst-case scenario has to do with how the patient itself is doing. Increasingly frail, vulnerable and critically ill. In the beginning, the disease was localized, easier to manage with a good prognosis. As time went on, though, my patient didn’t always listen to the recommendations, and the disease spread to every state in the country.
For comparison’s sake, the week of May 18, the country was seeing an average of approximately 23,000 new cases a day; by the week of July 4, that number had jumped to around 48,000.
This past week has been so bad that, according to one calculation from the Institute for Health Metrics and Evaluation at the University of Washington, Covid-19 was the leading cause of death in the United States, beating out coronary heart disease.
So despite the best advice, the best care, the patient’s condition has continued to deteriorate. And instead of being localized to a few hotspots that required aggressive treatment, as was the case in July, the infection has now engulfed almost the entire patient.
The reason that’s so dangerous is that earlier in the pandemic, and even in July, there were a lot of built-in reserves and redundancies. If one part of the body is in crisis, other parts of the body can take over and do the work to keep the patient relatively stable. For example, we saw how back in the spring and summer, when one location — such as New York City or Houston — was overwhelmed, doctors and nurses came rushing in to help. Alternatively, patients could be transported out of an overwhelmed hospital to a less-strained facility in a nearby region.
Redundancies, escape hatches, reserves — call them what you will, but they no longer exist for the patient, the country. Now, state after state reports hospital systems reaching their breaking points. It’s not just that there are fewer hospital beds available, but front line health care workers and support staff — from doctors and nurses to orderlies to the hospital cleaning crews — are getting fatigued, worn out and sick themselves in ever-growing numbers. And there is no one to replace them.
For how long can the patient hang on?
Usually, when the human body is faced with a crisis situation — be it an out-of-control infection, widespread bleeding or something equally catastrophic — there are all these biological defensive mechanisms that kick into gear, tricks that the body pulls to compensate for the systems that are out of balance. These self-preservation instincts are part of the reflexive nature of our biology.
But this patient, our country, instead of compensating and trying to maintain balance at all cost, is decompensating and has shown little inclination to do what it can to keep itself from getting worse.
The IHME predicted that states would respond once we hit the threshold of 8 people per million dying, and that the country’s defense mechanisms would be triggered, leading to measures such as stay-at-home orders being reinstated.
Eight people per million dying works out to about 2,800 deaths per day — and we’re already past that. But the country’s defense mechanisms haven’t revved up on the large-scale basis needed. While many people in this country wear masks and follow physical distancing guidelines, too many still do not.
Mask wearing continues to be a political statement and is not mandatory in 15 states. Only seven states have any kind of stay-at-home orders, advisories or curfew, over which many a battle has been waged.
The outgoing Trump White House kicked off its holiday party season this week, with more than a dozen group gatherings planned, flouting US Centers for Disease Control and Prevention guidelines for size restrictions, as well as Washington, DC, restrictions for indoor gatherings. Most of us missed spending time with our families over this holiday season, and I am constantly on television reminding people of the dangers of doing so. Yet the administration itself has already been the epicenter of at least three Covid-19 outbreaks among staff and allies, and a series of events such as holiday gatherings will likely put several hundred…