5 Thoughts on Coronavirus (COVID-19)

Joshua Merris, MD, MOH

It’s early for me on a Saturday morning (the day I usually look forward to all week to finally sleep in) and I am wide awake with no prospect of returning to rest.  The reason – my observations of how many are treating the coronavirus crisis, and the incessant danger of so many popular points as well as their counterpoints to our society as a whole.  So without further ado, and with the disclaimer that if you feel a little uncomfortable reading I likely accomplished my mission, here are my current thoughts on coronavirus:

1.  Politicization of coronavirus is wrong and nonproductive.
Let’s talk about the Elephants …  and Donkeys that are in the room.  I’m bound to upset a lot of people with this idea as I think there are marked problems with arguments being made on BOTH sides of the aisle.  I’m pretty sure the Trump Administration doesn’t want this virus to spread or impact Americans anymore than his most vicious critics do.  Overall, I feel their approach and strategies to be harmonious with this aim.  Limitations and mistakes have and will inevitably occur as this process unfolds, as they have historically in comparable situations, and as they do now in every other country affected.  Hindsight is always 20/20.  President Donald Trump and Vice President Mike Pence will evolve in their understanding and approach to this issue, just like any American, as our understanding of what is happening grows.  Our leaders need our support, and we would all be more united and benefit by asking not what our country can do for us, but what we can do for our country.
With that said, I am perhaps more deeply concerned by a growing trend to marginalize or diminish the gravity of this issue in the name of political defense.  I am noticing a growing trend of conservative commentators and individuals who seek to demean the severity of this situation because they think this is somehow a ploy by Democrats to make Donald Trump look bad, or even worse, some devious conspiracy.  This is reckless and wrong.  Many are going about in cavalier ways with a general disregard of advised precautions because they feel this crisis is somehow imagined more than real, or insignificant compared to a host of other problems.  Rush Limbaugh has declared that the coronavirus is “the common cold” and is “being weaponized” against Donald Trump.  This is dangerous rhetoric – first, because it contributes to a cavalier and careless approach that will foster spread of the disease, and second, because Rush Limbaugh, a 69 year old man undergoing treatment for cancer, is ironically a person who is empirically at increased risk of becoming severely affected by it. 

This virus is no respecter of persons and does not discriminate on the basis of Republican, Democrat, or Independent affiliation.  We would all be best advised, and most united, in keeping politics out of it altogether. 

2.  Not all “medical professionals” are created equal.
First, I want to readily and transparently recognize my own credentials and limitations as I make this point.  I am an occupational medicine physician and participate in the treatment of individual injured or ill workers, as well as advising the health, safety, and surveillance of worker populations.  I have a bachelor's degree in public health, an MD, and a master’s degree in occupational health which is in the context of my medical specialty, a more focused equivalent of an MPH degree (most occupational medicine residencies still pursue the traditional MPH).  What that means is that I work in a preventive medicine specialty with training in public health, with significant emphasis upon epidemiology, epidemiological research, and biostatistics.   It also means I am not an expert in infectious disease or on the front lines of epidemiological efforts specifically devoted to the spread of infectious disease.  But what it perhaps most importantly means, is that I am very keenly aware of how little formal training a typical physician receives during traditional medical education regarding epidemiology and biostatistics.  There are many physicians and other healthcare professionals making claims and assertions in the news, and on social media, regarding coronavirus that likely have little more expertise on the topic than the average American.  For example, I initially found solace in, and almost even shared, a video where Dr. Drew Pinksy becomes infuriated as he provides his expert medical opinion that the media is way out of line in sensationalizing the threat of the coronavirus.  The problem is, Dr. Drew works in addiction medicine (which he is by all means very good at), and I know of no compelling reason his training, expertise, or experience is relatable to the issue at hand.  You wouldn’t go to a dermatologist to have your knee replaced, or an orthopedic surgeon to have a suspicious mole evaluated.  Be careful and cautious in the stock you place in the opinions and commentary of medical professionals.  I’ve seen some very influential statements and articles come from physicians and healthcare professionals that upon further review, are likely out of their element.  I personally have sought to limit my statements to be reflective only of empirical data  and potential projections I have reviewed, as well as opinions of medical professionals with demonstrable, relevant expertise.

3.  Don’t be lulled into a false sense of security by comparing coronavirus to the flu.  Coronavirus will be impactful not because it is highly virulent, but because it is not. 

The common refrain has become to dismiss the seriousness of coronavirus by comparing it to the impact of the flu.  This is problematic for a multitude of reasons.  First, the flu is vaccine preventable and has more concrete, established post-exposure treatment.  Second, highlighting the proclivity of coronavirus to only significantly affect elderly or immunocompromised individuals, as some kind of indication to dismiss concern is itself, deeply concerning.  Almost one out of seven individuals in the United States are elderly.  And consider for a moment how many people you know and care about who are diabetic, have cardiovascular disease, hypertensive, or are being treated for cancer – all of which are empirical risk factors for increased mortality based upon our data from China.  Those of us who are less likely to be impacted should be more, not less cautious, in an effort to not become careless vessels in spreading the disease to those we care about and those others care about too.  The blasé notion that we just ought not to be bothered by all of this is a disservice to so many.  Some reputable epidemiologists predict 40-80% of Americans becoming infected by the novel coronavirus within the next year, and anywhere from 0.1 to 3% mortality, with this risk significantly increasing in elderly or immunocompromised individuals.  Do the math with even the most conservative estimates, and the potential impact of the novel coronavirus becomes inevitably serious.  Third, maybe all of these comparisons and considerations ought to be reason not to take coronavirus less seriously, but to take the influenza virus MORE seriously.  There were over 34,000 deaths from influenza last flu season (2018-2019) in the United States.  A healthy 17 year old kid just died after presenting to an urgent care I recently took my son to.  We’re still only vaccinating about half of the population, and the never ending nonsensical anti-vaxxer movement shows no signs of slowing. 

4.  Be wary of conjecture – there is simply a lot we don’t know right now.

There is currently a lack of information and an abundance of misinformation circulating on this topic at an alarming rate.  The reality, and I believe most honest answer – we don’t really have a clear picture of what is going on.  Mortality rate estimates range from .1 to over 3%.  The percentage of Americans likely to become infected ranges wildly as well.  The general conjecture, which is reassuring, is that as more subclinical cases become uncovered, the fatality rate will go down.  The problem is, to date, we have not generally had the capacity or means to test beyond those who are severely ill or those who have serious symptoms.  Cruise ship data might be reassuring, but also might not be representative of the population at large.  This is an evolving picture that becomes clearer by the day.  For now, I would recommend being guarded and cautious of the data.  There is simply a lot we don’t know right now.  I will say, that when the forecast calls for 10 inches of snow the following day, I’m not terribly surprised to find 5 or 15 inches on the ground the next morning but generally don't expect no snow to fall or to experience a blizzard.  Hopefully, this all turns into a dusting, but no one would reasonably argue that there is little harm and better security in preparing for the off chance of a blizzard than for no snow at all.

5.   Stigma and hysteria can be more impactful than the virus itself.
I’m really bothered by this.  I have already heard reports of Asian Americans being harassed or stereotyped based upon some uneducated and misinformed notion that they are more likely to carry or somehow responsible for the disease which has spread from distant China.  How despicable and shameful.  There is simply no room for such idiocy and shameful racism and ethnocentrism in America.  Furthermore, the hysteria associated with this crisis has already highlighted some of the worst traits of humanity, with hysteria itself posing a threat to our health and welfare in multiple, meaningful ways.  I hope we can rise above it.  The scars of stigma in more remote crises, such as the HIV/AIDs epidemic, are still tender to the touch.  Let’s not add to them.  Let’s unite in both caution and concern for one another, and the ultimate resolution that as in all else, united we stand and divided we fall.