The Morning Jolt

Health Care

Last Night Was a Long Year

A man wearing a protective face mask walks through Waterloo station in London, Britain, March 10 2020. (Henry Nicholls/Reuters)

How are you doing this morning? Take a deep breath. We’ll get through this, step by step, one day at a time.

There was a stretch last night, in less than an hour or so, where President Trump announced we were barring travel to and from Europe starting Friday; Tom Hanks and Rita Wilson announced they were infected; Senator Maria Cantwell of Washington announced a staffer in her office was infected; right before the tip-off of a basketball game between the Utah Jazz and Oklahoma City Thunder, the players returned to the locker room with little explanation, and then the National Basketball Association announced that the season was being suspended until further notice.

Last night was a long year.

The Storm Arrives

Our leaders, at every level of government, have to make some difficult choices in the days ahead.

Yesterday on The Editors podcast, Michael Brendan Dougherty discussed his recommendation to the superintendent of his children’s schools in Westchester County that the school system close. (There are, as of yesterday afternoon, 121 cases in Westchester County.)

“Right now in New York, the guideline is, ‘close the school once a teacher or student is infected.’” MBD pointed out that because many people can be asymptomatic for days, closing a school once someone tests positive means it’s too late. There’s a good chance they’ve been walking around spreading it for several days.

It’s a good point. But if that’s too late, when’s the right time?

According to the CDC, as of yesterday, 38 states and the District of Columbia have cases of coronavirus. If there hasn’t been a case in a state, it probably doesn’t make that much sense to close schools there. There have been 33 cases in Texas, mostly in Dallas and Houston; it may not make much sense to close the schools in, say, Abilene if the closest cases are 180 miles away. In my neck of the woods, Fairfax County is currently preparing two courses of action — closing one particular school deemed at risk, and then closing schools county-wide.

Then again, we’re trying to account for a lot of unknowns in this decision. We have the number of officially reported cases and deaths but . . . how many people are walking around asymptomatically?

Dr. Scott Gottlieb, who was commissioner of the Food and Drug Administration from 2017 to 2019, wrote this morning that at this moment, “we follow a path similar to South Korea or one closer to Italy. We probably lost the chance to have an outcome like South Korea. We must do everything to avert the tragic suffering being borne by Italy. While testing capacity expands its not evenly distributed to places most needed, we’re far behind current caseloads. Too many people still can’t get screened. So we can’t identify clusters and isolate disease. In some respects, our fate rests on the entities that are capable of sharply ramping testing and distributing the services nationally. Academic labs can serve their institutions. Only big national clinical labs like LabCorp and Quest can fill the void. A lot rides on them now.”

With Saint Patrick’s Day parades canceled, the NBA season suspended, members of Congress closing their offices, the NCAA Tournament preparing for no fans to be in the stands, and a decision coming soon on Broadway . . . maybe the best option is to go for the most extensive quarantine possible for two weeks, take the economic hit (which will be bad) and then open up afterwards, hoping that slowed down the rate of growth enough for our hospitals to handle the load.

A critic at New York magazine made the argument that as extreme as it sounds, maybe the best way to ensure New York City doesn’t go the route of Italy is a really far-reaching shutdown of public spaces:

It’s time to close. Opera, theater, movies, clubs, bars—these places of leisure are vectors for accelerating the spread of a disease that takes advantage of the human instinct to get on with life no matter what. Going out for the evening often means jamming bodies together at rush-hour levels of intimacy. We jostle for a drink at the bar, wait on packed lines, dance in wriggling masses, navigate claustrophobic lobbies, and sit for hours with strangers breathing down our necks. (And don’t even think about the bathrooms.) A visiting Martian might conclude that the whole point of live entertainment was group physical contact…

. . . It’s difficult to imagine New York without its nightlife, even for a month or two, and especially at a time when the need for distraction is sharpest. That’s precisely why the decision to stifle it is so agonizing to contemplate. So far, decisions about social distancing have been left up to individuals. If you’re sick, stay home. If you’re feeling fine, knock yourself out. But each of us has a different attitude toward risk and civic responsibility, or what “sick” even means. I shouldn’t have to trust that my seatmate’s cough is the result of seasonal allergies. The frail music lover struggling toward her seat, pain be damned, shouldn’t have to wonder whether the performance will be worth exposure to a bug that could kill her in a couple of weeks.

It’s also not fair or sensible to leave decisions up to institutions and presenters whose business agendas run directly counter to sound public health. If they shut down preemptively, they have to take the hit. If they are forced to close by government edict, they can at least start haggling with their insurers.

The optimistic scenario is that cases such as Tom Hanks, Rita Wilson, Utah Jazz player Rudy Gobert, and the Cantwell staffer suggest that many of us have encountered the coronavirus through casual contact already. If we’ve got it, and haven’t shown any symptoms worse than a cold, we’re probably going to pull through okay. At some point, the virus stops encountering paths to new uninfected bodies.

The pessimistic scenario is that that we’re still in the early stages of how the virus spreads through a country, and that our reluctance to go into intense, economically destructive quarantines means that we won’t “flatten the curve” enough. The trillion-dollar question is whether we keep the number of serious cases in the United States below the 65,000 or so ICU beds we have. Doctors say we can double that in an emergency.

(One other note to add to the discussion of ICU beds: As of 2018, the U.S. military has 26 military treatment facilities with 300 to 400 ICU beds. As of 2004, the Department of Veterans Affairs has another 2,000 or so in VA hospitals.)

The President Addresses the Nation

Whatever you think of the president’s delivery or the policies announced in last night’s prime-time address to the nation, there’s the initial problem that spokesmen for government agencies and the private sector said shortly afterwards that the policy changes the president announced were not the policy changes they are enacting.

One: The president said, “To keep new cases from entering our shores, we will be suspending all travel from Europe to the United States for the next 30 days. The new rules will go into effect Friday at midnight.” He added, “there will be exemptions for Americans who have undergone appropriate screenings,” which doesn’t mesh with the preceding statement of suspending all travel.

According to the Department of Homeland Security, the order “suspends the entry of most foreign nationals who have been in certain European countries at any point during the 14 days prior to their scheduled arrival to the United States. These countries include Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden and Switzerland.” Returning U.S. passengers — U.S. citizens, their family members, legal permanent residents, and “certain other individuals” — who have traveled in parts of Europe must “travel through select airports where the U.S. Government has implemented enhanced screening procedures.” Those airports have not yet been announced. The policy goes into effect Friday.

Two: The president also said, “these prohibitions will not only apply to the tremendous amount of trade and cargo, but various other things as we get approval.” About an hour after the speech, the president turned to Twitter and declared, “trade will in no way be affected by the 30-day restriction on travel from Europe. The restriction stops people not goods.”

Three: Trump stated, “earlier this week, I met with the leaders of health-insurance industry who have agreed to waive all copayments for coronavirus treatments, extend insurance coverage to these treatments, and to prevent surprise medical billing.” A spokesperson for the industry group America’s Health Insurance Plans said the president was not correct. “For testing. Not for treatment.”

It is very bad if a president’s address to the nation does not accurately describe the policies being enacted. The president’s staff is failing him right now.

The president’s address can be seen here, with about 30 seconds lead-in. At 1:27 and 3:30, he pauses to catch his breath. Considering the presence of Representative Matt Gaetz on Air Force One after his exposure to a coronavirus patient at CPAC, I hope the president has been tested, out of an abundance of caution.

We have enough problems on our plate without the president getting sick. Perhaps it’s just the stress of the crisis, or allergies, or the sniffles. Let’s test him just to make sure.

ADDENDUM: I realize it’s easier, and maybe something of a psychological relief, to argue about whether it’s racist or xenophobic to call it the “Wuhan virus’ or “Chinese coronavirus’ or some variation of that label. I would note that we have much bigger problems right now about whether someone feels that those labels are offensive. You would think a global pandemic and the prospects of a serious threat to America’s elderly and immunocompromised would get people to put woke virtue-signaling on the back burner, but apparently this country is not capable of that . . .

. . . yet. Italians aren’t having these arguments right now.

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