As the local numbers quickly and significantly go up, things are changing rapidly.. I would like to address a few points .
One basic premise that I stated a few months ago is that coronavirus infections typically tend to decrease in the mid-spring and to return in the early fall. We cannot behave in the fall as we did in the summer if we expect to beat COVID without many casualties and deaths.
A second premise is that what I’m writing is not about the politics of personal choice vs. government mandates. My agenda is from a medical perspective. It is to minimize damage to ourselves and our families while maximizing life as much as possible. Our collective goal should be to be as safe as possible while keeping life as close to normal as possible: children in school, businesses and stores open, and religious life functioning. If we don’t do this on our own, it will be done through state government action and will be at times heavy handed and arbitrary. The state is not acting as a partner with local government. It has decided to be the overall supreme authority.
What are the common misconceptions that can really hurt people?
1) “I already had it. I can’t get it again.”
This is wrong. We don’t know that and there are suspected second cases. In addition, even IF you can’t get it again in the short term, and 3 months MAY be a reasonable window, it is not a lifetime pass. Furthermore, it’s quite possible that you can carry and spread the disease even if you can’t get sick.
2) “I have antibodies so I’m protected.”
This, too, is wrong. Antibodies are a nice epidemiologic tool to track the disease. Antibodies mean that you have been exposed to the virus. They do not guarantee immunity and don’t justify risk taking.
3) “It’s over.”
This is so wrong that hearing this said is incomprehensible to me. Look at all the numbers. They are rising. We are a hot spot. We don’t have herd immunity. It’s not over. It’s not even stable. It’s getting worse. The good projections show us going from what was a handful of daily deaths in the State in the summer to triple digits daily deaths by late fall.
4) “I’m only seeing family so I’m being careful. It’s only my siblings, my married children, etc.”
This, too, is wrong. If they don’t live in your house, they have a different world of risks and contacts. Common DNA is not a source of protection.
5) “I don’t need to mask.”
It doesn’t help. It isn’t worth the discomfort. It’s my personal choice. I’ve heard all the reasons. While a non N95 does not (fully) protect me from you, you and I wear masks to protect you from me. It is a communal obligation to be part of society and a collective obligation not to put anyone else at risk. This isn’t about me taking a chance on MY health or life. It’s about me taking a chane on YOUR life.
6) “If I’m in quarantine, I can take a test to see if I have COVID, and if I’m negative, I can end my quarantine.”
Wrong. It can take up to 14 days to turn positive. You cannot test yourself out of quarantine. A negative test early in the period does not rule out COVID.
7) “My grandchildren are coming in from out of state. They look healthy and I’m not quarantining them. There’s no need.”
Wrong. I don’t even understand this thought process. Do you think it’s okay to endanger your neighbors?
8) “I’m taking a vacation in a quarantined state, but I’m flying into Philadelphia, or I’m driving all the way, so I don’t need to quarantine.”
Who’s to know and I feel fine. Really? Does the 14-day incubation period needed to develop COVID not apply to you? I get calls from people every day asking me to do something about their neighbors. We all have to make this behavior socially unacceptable.
What do I really think is going to happen?
The data point to a “U” shape graph of infections and deaths. We were high in the spring, low in the summer, and are rising now. The question is how high the right side of the “U” will be. We do have some control over this.
1) The virus will be in our lives for a long time. It will change the way we live and interrelate, and we will adapt. We will have a “normal” life, but it will be a new normal.
2) A vaccine will be released and have some efficacy. It will either give some people transient immunity or weaken the disease in the immunized or do both. When? My guess is the spring.
3) Anti-vaxxers will oppose any vaccine, no matter how safe or effective, thereby decreasing the chances for herd immunity. Agendas always outweigh reality. (I’m not advocating for a risky or poorly protective vaccine. The risk:benefit ratio will have to be good.)
4) Some people will have side effects from the vaccine, but the overall risk will be lower than getting the disease.
5) Politicians will open and shut our lives based on their political agenda, not based on flattening the curve.
6) Some people will ignore common sense and put other people in jeopardy because they believe in the words of Louis XIV: L’etat c’est mois. It’s all about me.
7) Hospitalizations and deaths will increase through the fall, yet many people will say that it’s insignificant until it strikes their families.
What must we do?
Neither herd immunity nor a vaccine is imminent. So what should we do NOW to minimize illness and disability and death?
1) Wear masks.
2) Social distance.
3) Avoid crowds. This includes religious services, weddings, other celebratory parties, etc.
4) Stay home if you’re sick, even if you think it’s not COVID.
5) Stay home if you’ve been exposed. You can’t go out wearing a mask if you’re in quarantine.
6) Unless you have a real medical contraindication, get a flu shot. Remember that those over 65 need a stronger vaccine. These seem to be in short supply so now is the time to get it.
The right play is not about avoiding detection. It’s about doing the right thing.
Most of all, use common sense. If it looks risky, it probably is.
The goal is to come out the other side as good as we went. It is to maintain health until there is a vaccine or a treatment. It is to buy time until we are safe.
For most of us it is an obtainable goal with a little inconvenience.
Marc J. Sicklick, M.D.