In a time where everyone is looking for answers, I see a lot of health care workers, pundits, sports figures, and talking heads presenting a lot of in-flux data as immutable fact. I’ve seen phrases like “If you go outside, you’ll kill your grandma,” and “Going out to get groceries makes you part of the problem.” I wish people, including my own colleagues and fellow front line health care employees, would be more comfortable with saying, “I don’t know.”
In medical school, before your clinicals, every one of your professors tries to impress upon you the importance and the power in these three words. Every lecture and every mentor pushes you to say, “I don’t know” when things are still unclear. Then, somewhere along the way, when patients or families look to you for answers (like in a pandemic), these words become forgotten.
Data on COVID-19 is in flux. The CDC hasn’t even finalized their 2019-2020 flu season numbers yet, much less has anyone nailed down a true mortality, hospitalization rate, or ICU rate for the current coronavirus pandemic. The only thing we know is this disease is very contagious; no one knows how deadly it is. Will it look like the Spanish flu of 1918 that infected 33 percent of the world’s population but only had a fatality rate near 0.1%? Or will it look more like the last SARS pandemic in 2003 that infected much less but carried a nearly 10% case fatality rate? No one knows, and no one will know until this is examined years from now with the power of hindsight.
Because everything is in flux, no one knows the cost-benefit of social distancing. Social distancing is a well-intentioned intervention that is the best option we have right now to prevent spread. I see everyone posting this “broaden the curve” graph, trying to mitigate the impact on health care. This graph posits that a similar total number of people will still be infected, but will happen over a longer period of time to not overwhelm the health care system. What I don’t see is anyone posting the alternative to this graph, where the health care system is still overburdened, but now for a much longer period of time, with the same amount of people infected. All the while, economically taking a hit as many people are laid off, businesses closed, and supply lines disrupted. This is to say nothing of the psychological burden of social isolation. For an individual, what good was it to avoid the coronavirus if it meant losing your house, your job, your chance at retirement, etc.?
My point here isn’t to disparage social distancing. I think it’s a well-meaning policy adopted by people doing the best that they can in an uncertain time. What I do want to discourage is the alarmist reactions and lashing out at those going to get their groceries for the week, or going on a run, or walking their dog. No one knows if social distancing is the best policy for the country overall, no one knows the benefit of “broadening the curve” versus the cost of broadening it.
I am not an epidemiologist. I am just a hospitalist. An opinion piece by John Ioannidis, an epidemiologist at Stanford and professor in disease prevention, puts it much more eloquently than I can.
I would encourage my colleagues and fellow health care workers to hearken back to their innocent medical school days when we were small fish in a very big pond. I would encourage us to, in this time of uncertainty, once again adopt the phrase “I don’t know.”
David Young is a hospitalist.
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