To the editor:
One of the courses I took in medical school included epidemiology in the use of statistical analysis of past events to determine cause and effect. I do not remember ever having a concept of the epidemiologist attempting to treat a population of people during an event in which the statistical analysis was not available. I believe at this time we are looking at an experiment in epidemiology in which we are attempting to determine the outcome of an experiment prior to the experiment being analyzed appropriately.
The consequence of this experiment is frightening to say the least. We are shutting down all of the usual activities in this country at great expense to the taxpayer and to the small business entrepreneur who has lost control of his productivity, income and ability to pay employees. The danger at this time is a large number of small businesses going into bankruptcy with the loss of the general productivity of the United States of America since small businesses provide most of the jobs in this country.
As we look at the overall analysis of this pandemic it appears to be a rather mild pandemic to say the least. As we review the data available it appears that of the individuals who are at risk with a positive test, at least 91 percent of them self-heal without the benefit of medical care. Of the most vulnerable (80-year-olds) 79 percent of these individuals self-heal without the need for medical care. Of the remaining 21 percent of the most vulnerable are at a high death rate. Again, the statistical analysis is not available to tell us exactly what that number might be, but is suggested to be around the same rate as flu or maybe less.
I certainly believe that recognizing the generally accepted concepts of cleanliness, sterilization, hand-washing and self-isolation of the sick is appropriate. The problem has to do primarily with the concept that is unproven that all of these things we are doing that are destructive to our way of life have some benefit. The decisions to change our behaviors doesn’t seem to be favorable to the overall quality life of Americans and others. The consequences of changing behavior of the general population versus that of the consequences of this virus have not been carefully observed.
The entire country is in panic mode with fear and anxiety the modus of the day. We have unbelievable runs on the grocery stores in the hoarding of food products and paper goods as if something is occurring that will cause us to lose food sources. Money is being allocated by families that was not intended and, certainly in the lower economic population, is critical to economic well-being.
In our state we have one patient who has been identified with a positive test out of approximately 2.5 million people. The family of this virus has been known since 1955 when Dr. William Mogabgab identified this family of the common cold virus. This virus typically resolves with increased environmental temperature and increased relative humidity. Treatment modalities are the same today as they were in the 1800s: fresh air, sunlight, environmental protection, sterilization and hand-washing. The SARS and MER viruses each killed less than 1,000 people worldwide and died out in short order.
We are assuming that this virus is not going to go away in the heat of the summer and we are busy, going about attempting to protect ourselves using techniques that have absolutely no statistical validation. Of course, epidemiology is attempting to pinpoint cause and effect statistically, which is their job. I’m not adverse to collecting data in searching for correctable features of any epidemic, pandemic or individual illnesses. Once again, my concern has to do with the consequences of the virus versus the consequences of the data collection and disturbance in the way of life.
It may sound harsh, but every year in the wintertime there is the harvesting by Mother Nature of the most vulnerable in our populations. We recognize a recurrent history of the world in which kill-offs occur and that we have little to do to prevent them when they happen. Floods, volcanos, drug overdoses, influenza, pneumonia, starvation … and many other environmental difficulties occur periodically, creating harvesting of the most vulnerable. Tried-and-true methods of prevention include thorough hand-washing with soap and water, fresh air, sunlight, a stable environment and the protection of the individuals who are at risk.
Eighty to 90 percent of those who contract this virus, in any age group, will have a mild or moderate case or no symptoms at all, get well and will develop antibodies that contribute to the resistance among the general population, which is perhaps better than a vaccine. I do not see this as a governmental agency prerogative to essentially frighten the population into panic mode in an effort to have the government involve itself in the epidemiology of this particular virus. I believe the government efforts at this time are counterproductive and the consequence of the government’s behavior is going to contribute to long-term effects of this pandemic, which most likely will disappear in the warm days of the summer anyway.
The huge economic consequences will last far into the future and be responsible for far more dire consequences physically, mentally and socially throughout the general population than the actual pandemic. We have had several pandemics throughout world history and many in just the last 100 years. (Look up the history of pandemics online.) We have never responded to this degree before. Will this be the response every time we have a new epidemic or pandemic arise? We don’t do this yearly for influenza, which infects and kills far more people in this country. If we did, we would have no economic stability — ever!
Experts don’t even know if these extreme isolation measures will actually have the hoped for effect. We do know absolutely that we need a functioning society. We need our jobs, schools, large and small businesses, transportation, commerce and tourism. All the things we depend on for survival. To think the Government is capable of protecting everyone from the damaging effects of this whole situation is just not realistic. The economic and personal ramifications of that are far too serious and widespread.
All of this for an illness that is 80-90 percent mild to moderate in those who get it? This generalized shutdown needs to end very soon to get the economy functioning again. Only people most at risk due to their own situations should practice the rigid isolation measures being imposed on the general population right now. Those who are less vulnerable can do much to help those in their families and communities who need to avoid exposure to the virus. Thus, we can get through this without all the collateral damage that is occurring now.
Robert Holbert, M.D.
Fellow of the American College of Physicians
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