The Viral Divide

The Viral Divide
(Gilead Sciences via AP)
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This is the current situation in the US: The two coasts are focused on fear of the virus while the rest of the country is focused on reopening the economy. Where you stand depends on where you sit.

The COVID-19 risk/benefit calculation is very dependent on a person’s economic condition and political predilection. Supporters of President Trump tend to support a swifter and broader return to normalcy while those in opposition feel that continued quarantining is the appropriate strategy for the foreseeable future. But the viral divide, driven by “quarantine fatigue” and exacerbated by warmer Spring weather, isn’t just political, it’s geographic.

What’s different now from one month ago is COVID-19 infection rates in large population centers along the American coasts are trending down and the crisis of hospital resources is abating. On the other hand, less populated states never reached the same levels of infection or healthcare resource constraints — so they haven’t been as psychologically scarred as those in New York City and other major urban centers. Big city “elites” sneer at their country cousins, believing they are not acting responsibly as they move to reopen their economies. The middle of the country thinks the coasts are out of touch with their economic realities. That’s Part One.

Part Two is that we have a better, more science-based understanding of how to deal with COVID-19. We can identify the 10-15% of our communities at high risk for serious viral manifestations (older, with respiratory and other serious underlying health conditions population) and we now have a new therapeutic to help them — remdesivir. Not a game changer, but some good news — with hopefully more to come (repurposed use of heparin shows some early promise). We also understand that about 85% of those who contract the virus will either, (1) be asymptomatic (about 20%) or (2) ride it out at home through liquids and bedrest. 

Part Three is testing. We must embrace the « 3Qs of testing » – Quick. Quality. Quantity. We need tests that deliver swift and accurate results for all Americans on demand. Testing will be the foundation of decision-making, driving the timing, strategies and tactics to re-open the economy. One issue that is particularly germane to testing are the risks associated with viral re-infection rates but, as we generate more test-driven data, we will be able to assimilate that knowledge into our planning for the “new normal.”

Coordination is essential. The United States is a big country (by both density and size). While we must certainly develop federal guidelines, we must implement strategies and tactics city-by-city, state-by-state, region-by region. “Think nationally, act locally.” The good news is that we have the knowledge and resources to radically reduce viral death rates, so why not reopen the economy while maintaining smart policies such as wearing masks, smart social distancing practices (staggered work hours, lower capacity limits for office buildings, restaurants and cafes, movie theaters, beaches, pools, recreational facilities, etc.) and enhanced personal hygiene? COVID-19 must not be viewed as an all-closed or all-open proposition.

And then there’s the issue of a vaccine. It’s very possible we’ll have an approved vaccine (or more than one) in 10 months to a year. That will certainly be a game changer, but we must also plan for manufacturing capacity, distribution and inoculation prioritization (healthcare workers, police officers, fire fighters, teachers, other “essential” workers). Also, we should prioritize vaccinating students so that schools can reopen safety and swiftly.

According to Nobel Prize winner Daniel Kahnerman, humans struggle to think statistically. In his best-seller, “Thinking, Fast and Slow,” he documents a variety of situations in which we either arrive at binary decisions or fail to precisely associate reasonable probabilities with outcomes. As we develop our path forward from virus-mitigation to containment, from a closed to an open economy, we must embrace the facts but respect, understand and contextualize the emotions of those with whom we disagree.

“What’s true of all the evils in the world is true of plague as well. It helps men to rise above themselves.”   ― Albert Camus, The Plague

Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest and a Visiting Professor at the University of Paris, Descartes School of Medicine.

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