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April 1 Update: Why acting fast is so vital

  • April 1, 2020

April 1, 2020
Hannover, Germany

Good morning,

It has been nice to get feedback from people about what I have written. Most of the comments are friendly — so far nobody has written, “Stop this, we’ve had enough of this stuff”. 

There are more questions about the disease, about the epidemic, and how to handle the situation now and in the future. Important questions include: Are we doing the right thing? Are we doing enough? Are we over-reacting? Here are a few of my thoughts.

We always start with what we know. This is a highly contagious disease with no or few symptoms in most people infected. It causes medical problems with cough, loss of taste, and breathing problems in about 20%, and may end fatally for between 1 – 5% of patients. This applies especially to elderly patients who are unable to cope with an acute illness. So why is it such a disaster?

When such a virus occurs, a fast response is needed, even when it occurs on a small scale. I mentioned norovirus in my blog yesterday. Norovirus is highly contagious, causes diarrhea and may be fatal, especially in the elderly, if too much fluid is lost. It does appear frequently in hospitals – but it can be mitigated at the first case or two if we react immediately. Patients are isolated with their own bathrooms; clinicians use protective gear; everybody is afraid and worried but doing what they should to curb the infection.  

Sometimes we are a day or two late in acting. Then, a whole ward is infected, bathrooms are occupied all the time, IV fluids are in use. But if everybody is wears protective gear, and hand washing and disinfection practices happen continuously – it still works. After a week the (small) epidemic is controlled and the virus disappears.

With awareness and speed, and if people know what to do and adhere to the rules – you can fight a contagious virus. It has worked in a few countries; such as Taiwan, Singapore, Hong Kong. They were alert and had not forgotten their experience with the SARS virus a couple of years ago. They acted fast. Once a case was identified they were moved to isolation, people they had been in contact with were isolated, and protective gear, mostly masks, were used. The result: low numbers of positive cases and few deaths.

But other countries have reacted much slower. First, there was no hands-on experience with or recent memory of a highly contagious virus. Our experience is limited to the “normal” flu. The flu is also dangerous, but not nearly as contagious. People get sick throughout cold and flu season and the disease is more spread out over time. So, this is how politicians calculated in the very early days of the disease. With a fatality rate of less than 5%, perhaps even lower than 1 %, if 1 million people are infected the result is 10, 000 patients dying. It sounds cruel but this is “acceptable”. If you compare how many people are dying each year from the flu or other diseases, COVID-19 is a smaller problem. Some politicians shrugged their shoulders, especially the “tough” ones, and said, “We can manage this”. Boris Johnson, and other people in authority said that since everybody will have immunity eventually, the fatalities are the price society pays.  

What they didn’t think about was how contagious the coronavirus is and how quickly it spreads. This epidemic would not be spread out over several months like flu, it happens much more rapidly. The numbers of people infected rise exponentially and hospitals would be flooded beyond capacity. Add to that all of the problems of an acute epidemic: Too many patients at the same time, hundreds of patients in the ER, not enough ventilators, triage overrun, diminished capacity of the healthcare workforce as they contract the virus. They did not think in advance of the nightmare aspect of an epidemic:  Decisions must be made of who will live and who will die, as we’ve seen in Italy. Their imagination was not vivid enough (despite the huge popularity of dystopian movies) and the practical knowledge about viral diseases was not there. It was only when the numbers of patients rose sharply, and everybody started to become terribly afraid that more stringent measures were taken. The picture is clear – protective measures were only increased when things got worse. It was on the television before politicians even reacted.

The current measures we are taking are necessary. Quarantine is good, closing schools and businesses for a while will help. However, if we had done it earlier it would have worked better. 

It’s a complicated answer to the question “is it overreaction?” Yes and no. Overreaction early on in this pandemic would have helped to contain the infection. Whether this would have been possible in larger cities, I do not know. However, I do know that Mardi Gras, the Carnival in Germany, soccer games well into March, and international meetings well into the epidemic were not necessary, or advisable. Now I believe we will have to live with the shutdown for a while.  

Will we learn from the epidemic? I hope so. In the future, we will remember this experience with COVID-19. If we have small outbreaks of COVID-19 in the future, we (hopefully) will react faster and contain the spread of the virus earlier. We have no choice but to live with the virus in the future, but we will do so with more awareness and caution. Hopefully, we will have a vaccine. My favorite question is “how many people will be vaccinated?”  

In normal times, I would not have had the time to write this letter, and you would not have the time to read it – so there is that. I’ll finish by reminding you that I’ll do my best to answer your remaining questions about COVID-19 – you can email me at president@mdibl.org.

Stay well.

Best,
HH


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