How do you describe that feeling of watching numbers climb and realizing that you’re watching in real time the most global example of what you’ve studied and taught your entire adult life?
Dread? Excitement? Existence?
When teaching about pandemics we teach students to look retrospectively at the data on the numbers of those that have recovered versus those that have died. At about 6:00PM on 27 March 2020 twice as many people had died of covid-19 in the United States as have recovered. Seeing those numbers broke my heart for a moment, so I had to talk it out to myself somewhere.
It’s too early to call what it will look like in the United States in terms of our final numbers with covid-19. At this time these numbers are skewed by post-mortem testing and testing criteria that limits test accessibility to those already in need of medical intervention over home care.
Things might look scary, but don’t give up hope. Update 30 March 2020: and reporting started coming in of recoveries!
The criteria most are going by: 2 negative covid-19 swabs with a minimum of 24 hours separating the tests. The reason for this standard is that there is a very high false negative rate with the rt-PCR based test. If anything goes wrong along the way – say there’s a bad reagent, too low of a sample of viral particles, or something goes wrong that invalidates the test it will come back negative. This is the bane of every graduate student that has ever done rt-PCR. They will tell you their horror stories, especially if they were from poorly funded labs.
For some additional hope.
There’s this amazing power of graphs.
Even as we have expanded albeit limited testing across the United States the overall rate of growth of total cumulative cases is slowing. While this hope is based on very limited data, could it be that we may actually be flattening the curve?
We’re able to see the slope change as the day to day number change. We can see when our efforts are working. This is part of why we need accurate reporting above anything else. The numbers that only require home care matter to retrospective numbers and for accurately understanding the danger of a disease. This influences anticipatory healthcare planning decisions for patients and facilities.
We can be hopeful. It’s not the fault of our healthcare workers and everyone needs to show massive gratitude. Diagnostic testing has massive barriers – Point of Care rapid testing is a luxury afforded us over the past century to strep throat, influenza, drug screenings, and other common “ailments” that bring you in to say hello to someone like me (only using quotes because I included drug screenings).
I’ll do a better analysis of my numbers as we get better testing, but for now, can I even trust that data? How many people are dying at home untested? Remember that across America we have incredibly diverse customs about death and dying. In the American South (where I’m from) families conduct home hospice even during severe illness out of pride and the cost of healthcare. Once the family member has died they will contact the local mortician. While it might no longer be legal to do home embalming and many states have prevented home burials, this has never stopped families from caring for the dead. Caring for the ones we love as a final act is one of the most essential acts as a family member that is often robbed of Americans elsewhere across the United States. In twenty to fifty years will we need to do go all paleovirology/anthrovirology (actual fields!) on disinterred bodies to get the actual numbers? Or will we go the route of China and the US during 1918 – burn it all.
Other questions I hope we answer as we roll out Point of Care testing:
Are healthcare workers on PReP faring better?
If people are interested in hearing me rant about the topics I’m actually an “expert” (by degrees and academic research/teaching background only) in let me know. If you are I’ll actually go back and edit this rant and dress it up a bit.
Thank you to anyone reading this. Without you this is just a shout into the ether.