I believe that medicine’s potential is much more than the version we see in the world today. A doctor should be an educator with the goal of bringing patients to a place of deeper understanding of who they are in the world. To me, medicine is ultimately about self-empowerment through self-knowledge and growth.
You’re the next contestant on the Pandemic Game Show!
“You’re the next contestant on the Pandemic Game Show!”
I can’t tell you how many famous philosophers and sages over the epochs have compared pandemics to television Game Shows.
Actually, I can tell you. None.
But that’s beside the point because you have two curtains in front of you at this moment.
And this game is different because you don’t have to choose one or the other. You get both, but you have to understand them. There is Good that needs to be mined from everywhere.
Curtain Number ONE
Behind curtain number one is “Stop the Spread.”
It’s a logical approach. There’s a new damaging disease here. Let’s limit the direct damage. In fact, let’s try to have no one get it and wait for a vaccine, so goes this approach.
These signs are everywhere: in stores, on buses, in offices.
In this approach, mounting case reports can feel scary and like a failure or at least something to try to avoid.
When ‘Stop the Spread’ is the strategy, there are several ideas we are accepting.
Mitigating the Direct Damage from the virus is the main focus. This is done with testing, contact tracing, quarantine, distancing, hand hygiene, masks, respiratory etiquette, ventilation, avoiding crowds and some degree of lockdown, whether it be restriction, bans or closures. People deemed vulnerable to the virus are best protectedwith this strategy.
The exposure is in the Indirect Damage that comes out of the policies of the Stop the Spread: mainly economic, but also the medical, social, and cultural impact on everyone. A separate category of people are more vulnerable to the indirect damage caused these policies and they suffer greater, depending on the restrictiveness of the policies. (To be clear, all medical, social and cultural impacts cannot be blamed on the policies. In the Pandemic these are high in any approach.)
Indirect Damage increases the more cautious the approach to the Direct Damage is.
This approach makes the assumption that an effective vaccine can be created. More on this below.
With “Stop the Spread” we have specific challenges and opportunities:
Scientists say a vaccine is not a guarantee. Johnson and Johnson had to pause their phase three trial because of an adverse event this week, details not offered. There are examples where vaccine attempts are not successful. Vaccines have limitations.
It’s confusing to live with the idea that positive case reports are somehow reflective of us losing the battle.
As we get better therapeutics and a better understanding of how it spreads the direct damage falls. Case fatality rates are better today than the waves in late winter and early spring. There are many factors there. But if the Direct Damage is less impactful the less we have to rely on every aspect of the ‘Stop the Spread’ approach.
Curtain Number TWO
Last week we talked about AIER’s “Focused Protection” approach in the Great Barrington Declaration. It’s an inverse approach the “Stop the Spread.” It emphasis is different. It could be considered part of an approach I would call “Flatten the Curve.” The general gist is to take on the Direct Damage of the virus, which thereby serves to spare the population from the indirect damage of restrictive policies.
Some points on this strategy:
The same approach of ‘testing, contact tracing, quarantine, distancing, hand hygiene, masks, respiratory etiquette, ventilation, avoiding crowds and more’ is used in a good “flatten the curve” policy, but with the intention to limit cases enough to allow the important benefits of an open and functioning society, not to stop the spread. The restrictions are reduced as much as possible. Direct damage needs to be maintained in a manageable range. Hospitals need to be able to have room for the sick, for example.
It’s not vaccine-centered. In the case of vaccine failure or delay, it seem to me that ‘Flatten the curve’ is the only option.
There was a point early on when the struggle to contain the novel virus was lost. It was a sad and scary moment when the pandemic became an inevitability. Mitigation became the approach and “flatten the curve” was the motto. This strategy acknowledges that containment is long gone. Cases will happen and the pandemic will pass with or without a vaccine.
Recoveries from mild or asymptomatic cases are an outcome that moves us along towards our common goal, passage. Mounting cases, especially with improving fatality rates means we are moving through.
It’s not one or the other. Take the best of both.
There are unknowns at every turn.
No solution is without unprecedented challenge and suffering in a global pandemic.
Mitigating the impact of suffering, illness and death which can come directly or indirectly, finding the right balance are the keys.
Many, many people SHOULD live entirely in the ‘Stop the Spread’ paradigm for their personal approach. Society as a whole will need to incorporate some “flatten the curve” strategy to help navigate what will almost certainly be a less than perfect vaccine scenario. Coronaviruses have been studied for decades and don’t offer an easy target for the vaccine home-run.
I postulate that we already are living somewhere in the middle between these two inverted policies. We just seem to be angrier at each other about it all and more confused than we need to be.
The hybrid approach should use testing, contact tracing, quarantine, distancing, hand hygiene, masks, respiratory etiquette, ventilation, and avoiding crowds, but at the same time use restrictions very cautiously and only only when the hospitals are overwhelmed.
Even though WHO is very vaccine centered, WHO envoy Dr. David Nabarro told the Spectator magazine last week: ‘We really do appeal to all world leaders: stop using lockdown as primary control method’.
I think we aren’t as divided as we feel we are.
As we enter the second half of October and face all the political and infectious disease challenges it’s important to nourish ourselves.
Did you know we have two nutrient streams? Two ways we nourish our bodies? We are nourished through our digestive tract as well as through our senses. Taking in sights, smells and sounds is actually nourishment. Light is nourishment, whether we get it from plants that have synthesized it, or whether we get it directly. We get way too much dead light: electric light. If you care about your food quality, start to care about your light quality. The Sun provides worlds more goodness than we can measure.
Your prescription is to get 1 hour of outdoor time every day, (not necessarily direct sunlight) preferably at the same time so you can experience how the light changes over the course of the year. Set your routine. Furthermore, I heard this rule recently (20-20-20 rule). When you are on a screen, place yourself near a window and every 20 minutes, take a 20 second break by looking out the window at something 20 feet away or more. It’s a nice counter balance to the dead light from the screen.
Let me end with some good news:
The Berkshires continue to have low case incidence. Only nine new cases total over that the last week.
The daily death rate in America since July to the present remains at half of what it was in April, despite the new case counts since July being twice what they were in April. The trend of more cases and less death continues. People aren’t getting as sick on the whole. (COVID still has great lethal potential, don’t get me wrong!)
It took 90 days to reach 100,000 deaths. 120 days to reach 200,000 deaths. and the month since we passed 200,000 deaths we only have 15,000 deaths, on pace to take a 200 days to reach 300,000. The curve sounds flat.
The reported 8 million positive tests in America grossly underestimates the total case counts. In March and April we basically weren’t testing people. There were literally millions of uncounted positive cases back then. Plus the asymptomatic cases were and are mounting everyday, but many aren’t testing. I would say 30-40 million cases is a conservative number. That’s 30-40 million at least partially resistant people. When the virus meets resistance the pandemic winds down, which it will do, as sure as the sun will rise tomorrow morning.