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Above: A student washing hands at the high school before schools were closed (photo by Gary Caldwell)
Michigan State University physician-epidemiologist and public health specialist Nigel Paneth tells ELi people here need to see COVID-19 as a more serious threat than many people are seeing it. He characterized responses to the pandemic as an “under-reaction,” calling it an “urgent” situation.
The good news? Actions taken at the local level can save people in local communities.
If the East Lansing community works together, we stand a chance of avoiding the worst-case scenario where hospitals become overwhelmed and people die as a result – not just of coronavirus but also of car accidents, heart attacks, and other “normal” life-threatening problems that could be survivable but will not be able to be treated if there are no more ICU beds and not enough doctors and nurses.
Are current responses to the COVID-19 pandemic hysteria and overreaction? Why or why not?
Dr. Paneth emphatically responded that the risk of COVID-19 cannot be overblown, stating that he had never seen such a public health threat in his life. He is no rookie in the medical field, having earned his M.D. from Harvard in 1972.
Paneth cautions that the U.S. may face an Italy-like situation in a couple of weeks. Italy currently has 24,700 cases and 1,809 deaths. So far, infection rates of COVID-19 in the U.S. have mimicked Italy, and our health care system may not be equipped to take on thousands of sick people in need.
For those who think that Italy’s case is due to an inherently weaker medical system, Paneth says, “think again.” While Italy may have fewer hospital beds in absolute numbers, Italian hospitals actually have 20% more beds per capita than the U.S. ones. Northern Italy, the epicenter of the European pandemic also has some of the best intensive care units and doctors in the world.
Above: Nigel Paneth (photo courtesy of MSU)
What can we do in East Lansing?
We can mitigate the worst-case scenario by severely limiting personal contacts, going further than the measures we have in place now. Paneth advocates for an immediate closure of all restaurants, bars, places of worship, and any other place where large crowds may gather. Only the necessities, such as pharmacies and grocery stores, should remain open. (Note: Today, the governor announced the closure of all in-dining service in Michigan. Paneth told ELi yesterday that take-out and delivery can generally be considered safe.)
The community also needs to consider the outcomes of decisions it makes. Paneth called MSU “wise” for suspending in-person classes, but pointed to what followed as a point of concern. With no immediate academic concerns, MSU students crowded into bars and frat houses. Many subsequently left East Lansing, it is possible that they carry the virus with them and can pass it along to others who are more susceptible to COVID-19.
Why does “flattening the curve” matter?
Flattening the curve means delaying and shrinking the peak caseload of COVID-19 cases. Instead of having the number of cases peak rapidly, a flattened curve results when the population more gradually contracts the virus.
Social distancing is crucial in achieving this goal. But we need to do much more in terms of social distancing.
Paneth called for people to stay home and cancel dinners and parties with friends. At a personal level, Paneth’s daughter has kept his grandchild from seeing him. Children seem to carry the virus while appearing asymptomatic or experiencing a mild case. They can then act as vectors, passing the virus on to others who are more vulnerable to its affects.
Keeping people away from other people limits transmission of the virus. If the virus cannot find new hosts, it will eventually die off, stopping the spread of the pandemic.
We know many people are likely to get this virus. So what are we trying to avoid?
According to Paneth, flattening the curve will help prevent our health care system from being overrun. If too many people succumb at once, hospitals will not have enough beds, ventilators, or other supplies to treat patients. That means that not only will some people die needlessly of coronavirus, some who might have otherwise been saved will die from car accidents, drug overdoses, the flu, and random heart attacks.
Flattening the curve also buys time for medical researchers to develop therapeutic options. A vaccine still may some ways away, but Paneth mentioned that convalescent serum might be a useful tool in the meantime. The use of convalescent serum involves taking the antibodies of those who have recovered from the virus – by taking their blood – and giving the antibodies to someone else to help their weaker immune system fight the virus.
What would crisis look like?
Paneth foresees two possible major crises in the pandemic. The first would affect health care workers who frequently come into contact with the sick. These workers could be hospitalized themselves or sent home to stop the spread of the disease if they become ill. This might mean we have far fewer health care workers just when we need many more.
The other crisis would affect the elderly. In China, 95% of deaths occurred in those over age 50. In Italy, that number is about 98%. People under 40 seem to have very high survival rates.
While convalescent serum could help the elderly, Paneth believes an absolute lockdown of nursing homes is also important in protecting the elderly. Staff working in these locations should also self-isolate outside of work hours. He pointed to King County, Washington, where nearly 20 people died in nursing homes from COVID-19. This, he says, could happen anywhere.
In short, flattening the curve through social distancing is essential in making sure that those who provide medical care are able to do so. It also protects those most vulnerable to the disease.
Above: Social-distancing is maximally effective only if you stay at least 6 feet away from others at all times.
Should we all just try to get infected now and get it over with? Should we try to make some herd immunity that way?
Countries across the globe have taken various approaches to combatting COVID-19. Britain has done very little so far to stem the tide of cases, and some in government there have cited the idea of “herd immunity.” That’s the theory that, if enough people suffer from the disease, the society will become resistant to it, preventing the eruption of subsequent waves of the pandemic.
Paneth explained that 70% of a population needs to be infected and develop the antibodies against a virus for the herd – that would be us – to become immune. In the United States, this would mean 200 million people contracting the virus.
The outcome would be catastrophic. The death rate of COVID-19 is somewhere between 1% and 3%. This means somewhere between 2 million and 6 million people dying in the attempt to achieve herd immunity.
Paneth said in this scenario we would all know at least someone who died. This method provides no protection for the elderly, many of whom would die. Young people would also die in this scenario.
Herd immunity is only really achievable with a vaccine Paneth said, and we don’t have one now. So, we return to flattening the curve. It is unlikely that the U.S. will adopt China’s effective yet authoritarian approach to stopping the spread of the virus.
The bottom line?
Paneth was blunt: We need to wake up. We need more social distancing, particularly for the elderly. As children stay home from school, it should not be grandparents watching them.
The good news? We don’t need government orders to social distance or isolate. We can undertake and model that behavior ourselves. Communities that take this advice seriously now may wind up being the pockets of the country that avoid the worst outcomes of this pandemic.
REMINDER: The City of East Lansing is under a State of Emergency and you are encouraged to practice social distancing. Read more about what the state of emergency means. ELi has a special section dedicated to our reporting on COVID-19 for East Lansing. See it here and sign up for ELi's mailer to stay informed.
Note: The original version of this article indicated "Italian hospitals actually have 50% more beds per capita than the U.S. ones." That has been corrected to 20% after a follow-up from Dr. Paneth.
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