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COVID 10.0

The COVID epidemic is proving to be very hard to stop. I was not real sure we had a good shot at it. This is related to its ability to spread from the mostly mildly ill or even non affected to the more vulnerable or more rarely healthy young people to cause sometimes severe harm. A tragic irony really. One we saw coming as the reports of majority mild illness were reassuring while being ominous in the minds of epidemiologists everywhere.

COVID is a lot like RSV (Respiratory Syncytial Virus) in that regard though its much harder on children than COVID. RSV is another viral enemy lost in the COVID narrative that some people have never even heard of before. In the US alone the CDC estimates there are 100-500 deaths, 57K hospitalizations, 500k ED visits and 1.5 million office visits yearly in children under 5. It hits adults too, 177k hospitalizations, 14k deaths. This is all in addition to flu deaths. The CDC goes on to say ” a better understanding of who is at risk can help identify populations to target for interventions”. We have identified our high risk group. They are premies and babies w heart disease. We use a weapon called Synagis. It is a monoclonal antibody that protects them from the virus. It is expensive and impractical to use on the entire population. In theory we could eliminate those 14 thousand deaths from RSV every year by giving it to everyone. Instead we just use it on the most vulnerable and protect them, realizing we will lose some people we could have saved.

Like COVID, RSV spreads easily because in most children and adults it presents as just a cold and resolves. In others it kills. We don’t do mass testing to find it because we know it’s here every year. We don’t ever close anything for it. We do the best we can, care for the sickest among the infected at whatever level they need and pray they do not succumb. We see them routinely in our offices w no PPE and take on that exposure thousands of times in our careers. I never worry that I will be a victim of RSV, its just part of the life of a primary care provider.

Each of those deaths from RSV is a tragedy no less than a death from COVID. Their families are equally devastated. No dire descriptions of their ICU ordeals. They are there in the ICUS every single year along side similar flu victims. RSV and flu kill in a similar way to COVID, It’s just not new.

There are no ” think you are safe because you are young you must watch this ” posts on social media. Has anyone ever seen one for flu or RSV? The stories from the current epidemic are horrible and real. They frighten us us to the point of not wanting to go near one another. Once we start finding more of them (my niece now among them) we need to post stories of those that recovered in far greater numbers than those who have had bad outcomes.

Please, again this is not trivializing. Just introducing the concept of acceptable risk. At some point we need to acknowledge there is another microscopic demon here to hurt us that we must fight but accept. I think we are getting to that point. This wave of illness will be big and temporarily overwhelming because of its rapid spike that our unprecedented response will tamper. There seems to be hope for treatments and vaccines. They are fast tracked but it still will take time. The reduction will happen, it has to. Watch for it as the incubation period from the start date of the intervention hits the 3 and 4 week mark. It will not be in just case numbers, it will be in lowering hospitalizations, severity and deaths. Hopefully in a way as dramatic as the intervention.

Acceptable risk of death is a brutal concept. We do it for many things without much thought really. We could eliminate MVA deaths and injuries by eliminating driving, 30-50k deaths per year, 2 million injuries. We do it for alcohol, 88k deaths per year w an estimated 2.5 million years of life lost. Anyone talking prohibition? Cigarettes contribute to 480k deaths per year including second hand smoke, we still sell them.

We accept risks of harm because we believe the benefits they give us outweigh them. for other respiratory infections the risk offset is being social in all its forms. We enjoy each others company at closer than 6 feet. We cherish warm greetings, hugs, kisses, firm hand shakes. We congregate together for meetings, sports, school, business, religion, celebrations, concerts, plays and everything else we are not doing now. Now when we really need each other. Those things are immeasurably beneficial. We don’t think about suspending any of that for a cold, but a cold in one person could be an RSV infection that kills someone else. Just as a mild case of flu just getting going can do the same. You would never know that happens or who it happens to but it does. Every fatal infection was transmitted by someone else. Most times the victims have no idea where it came from. We call it “community acquired”. We accept that risk to enjoy the benefits of being in a community.

For driving there are many benefits. We visit each other for social gatherings where we may enjoy a drink or two. Goods get delivered all over the country to fuel the economy.

The tobacco industry provides jobs and people enjoy their products I guess that’s some benefit. Its a little harder to see from a doctors standpoint.

This effort against COVID is valiant, incredible, life altering and temporarily necessary. It has shown to be devastating to many, hopefully temporarily also. At some point soon though need to look at the risk of harm the interventions are having versus the benefits we get from disease prevention. We need to stop being so terrified of this disease and implement some more common sense approaches that protect the most vulnerable. There will be casualties in non vulnerable people among us, just like w flu and RSV. With what we know about who this hits the hardest our hope is that will be a rarity. We may have to accept that risk but continue to use the personal interventions to keep it as rare as possible.

We have to recognize that the risk/benefit ratio has swung hard the other way. Maybe we have to shift to an intervention strategy that tips it back again. More like we do with RSV.