Yesterday’s post generated some good comments.
Two emergency medicine specialists felt that I was both wrong and insulting in saying that hospitals were not overwhelmed.
What I meant in the word ‘overwhelmed’ is the notion of not being able to support a sick patient in the ICU or on a vent. That didn’t happen, but both doctors make important points.
First I mean no insult to my frontline colleagues. It’s the opposite really. As a specialist who deals mostly on the treatment side of things, I’ve held those who must make diagnoses in the highest regard. Their work in the pandemic has only increased that respect.
Second, the point that there were consequences to the “massive and costly” efforts to shift resources is valid. Data in our (cardiology) journals hint at the fact that heart attacks and stroke admissions were way down during the height of the pandemic.
But it’s hard to believe that heart attacks and strokes stopped happening during this stressful period. Post-pandemic reviews will likely show that the efforts to care for patients with COVID19 will have increased unnecessary non-viral deaths due to lack of care. (The counter is that the pandemic also stopped a lot of low-value, potentially harmful care.)
Nonetheless, “overwhelmed,” was a poor word choice. Sorry.
2. My Twitter friend, Dr. Mike Johansen (who is a super-sleuth when it comes to critical appraisal) pointed out that my comparison to NZ and Australia is problematic.
Dr. Johansen’s first point about not using the dichotomy between NZ and the US is well-taken–especially given the surprise of vaccine development.
Response to the pandemic has clearly been on a continuum. As he wrote, countries such as Canada, Germany, Denmark, Finland have done better than the US. And now that we have vaccines, countries that did better with pandemic control will end up with less death due to COVID19.
It’s interesting, too, that the countries mentioned above all have better safety nets than the US. Though, there are many other factors in a country’s response to the pandemic.
This country has to figure out a way to improve our safety net. I realize that people differ on how to get there. But no one can disagree that it is an existential problem.
3. An anonymous commenter pushed back on my assertion #6.
What evidence is there that reductions in IFR are due to masks and distancing?
My thinking is not that masks or distancing affect the IFR directly, but that delaying getting the infection will reduce one’s chance of dying. For two reasons:
It was a novel virus; it took time to learn stuff. So it is clearly better to get the virus in December than in April.
And now there are vaccines.
For a person with risk factors, therefore, it makes sense, now, to stay hunkered down for a few more months. There is an end in sight.
If you have the means, you use online shopping, you avoid weddings and large gatherings, get an N95 mask, do Zoom Christmas and take the vaccine.
But my commenter is right: Social distancing and masks do not affect the severity of illness–though there is a theory that a mask might lower the severity of illness by reducing the amount of virus that gets in your body.
The pandemic forces everyone to think. This is a good thing.
JMM
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