By guest columnist Sheila Page, DO, President, TXAAPS
The demand for increased testing for infection or antibodies has been loud, and many have insisted that this will be our key to freeing people from the lockdown. None of this data should be used to shape policy. It is an imperfect, snapshot view of health that has high potential for being used as a weapon for political oppression. It helps us understand the spread of the disease and its prevalence, and it gives some reassurance about personal infection status at the time of the test; however, it is dangerous in the hands of bureaucrats. Using it to decide who is free to pursue a livelihood and who is on house arrest moves us into the territory of widespread government abuse of power.
Reporting COVID 19 Deaths
The broad public application of quarantine has not been supported by any reliable data, is not evidence-based, and seriously lacks common sense. Requiring communities to remain in lockdown until even mildly symptomatic cases are at zero is nonsensical. Many of the counties in the US have few to no cases:
· 1,603 Counties (52%) in the US have ZERO deaths.
· 447 Counties have ONE death.
· 443 Counties have 2 to 5 deaths.
There are serious inconsistencies between our response to this pandemic and ongoing observable data.
Unfortunately, multiple factors have made calculation of the infection fatality rate of COVID 19 very difficult. Variations in population density, faulty test kits, skewed testing practices, and inaccurate reporting on death certificates by hospitals have produced a range of statistics between 6% and .04%, https://thehill.com/opinion/healthcare/496436-covid-19-fear-syndrome
The number of cases that are asymptomatic can only be guessed. According to the data we currently have, that number is high. For example, in a closed population in Bexar County Jail, about 75% of cases were asymptomatic.
The recovery rate is greater than 99% of cases. A much better approach to assessing the severity of COVID 19 in a community would be to focus on hospitalization rates, rather than viewing every case as deadly.
Restrictions severely limit access to rural hospitals
Small hospitals in rural counties have disaster plans (for example, if a bus wreck with casualties occurs in the vicinity, or a natural disaster creates high casualties). Part of that plan is to ship cases to urban hospitals when the rural ones cannot accommodate the level of care or number of patients. Those plans have been in place for years now. COVID 19 did not change that. However government orders nearly shut down many hospitals, and severely limited the number of cases admitted in most hospitals in the United States. Rural hospitals, which are already at a disadvantage due to lower numbers of patients, have been threatened with bankruptcy. There are 1.4 million health care jobs that have been lost during a HEALTH CRISIS. https://www.bls.gov/news.release/archives/empsit_05082020.pdf
“But, the urban hospitals will be overwhelmed and can’t accept transfers…….”
The Pittsburgh, Alleghany County reports revealed that only 2% (about 110 of 5500) of the hospital beds were occupied by COVID 19 patients at the peak of the epidemic there. At the time of the report, 1300 persons in a county of 1,220,056, about 1:1000 people, had tested positive. The hospitalization rate is very low, maybe 10% of the cases with symptoms that test positive.
Applying what we know from a very population dense county to a much less dense county of 20,000 in Texas, if we use the number 1:1000 persons testing positive, about 18 people could test positive at a given time. At most there would be 2 people in the hospital at one time, assuming the hospital did not transfer any critical patients, as is the practice currently for many rural hospitals. A 35-bed hospital would not be overwhelmed. Many counties this size across the nation have no deaths, or very few, due to the very low number of cases. Even if the highest estimated case fatality rate of 6% is applied, a small county of 20,000 could expect 0 deaths or possibly 1. The fatality estimate ranging between 0.04% to 0.4%, which is found when the asymptomatic cases are counted, would make it unlikely that small counties would have deaths due to COVID 19. It is even less likely when testing error and falsely reported cases on death certificates are considered.
Focus efforts where the need is apparent
Another important factor is the high number of deaths that are occurring in nursing homes and senior living facilities, underscoring again the need to properly focus our efforts to protect the vulnerable. Protecting the elderly and the frail should be practiced without banishing them from fellowship and the comfort of their loved ones. Atul Gawande, in his book Being Mortal, observed “It is not death that the very old tell me they fear. It is what happens short of death—losing their hearing, their memory, their best friends, their way of life…” We must be careful, lest we as a society be found guilty of condemning our beloved seniors to death of any cause in lonely isolation.
Put down the bully club
Hospitals should be open to ALL patients who need care. The medical profession can handle a contagion, given the freedom to do so, and will do a much better job than any governing official, elected or appointed.
Due to known inaccuracies and the irrelevance of attempting to apply testing outcomes to the liberty of the citizenry, mass testing should not be used to continue to close businesses and restrict freedoms. Unattainable and meaningless benchmarks imposed by public health agents, paid to perpetually threaten businesses and individuals “for their own good”, divides and terrorizes communities. It is time to give people a chance to face the reality of the risk of living in community with other human beings, engaging in commerce and serving each other, sharing sorrows and joys, while caring for the sick and protecting the vulnerable.
