Okay… COVID-19 cases are climbing at an alarming rate. We’re breaking records no one should be proud of. Most recently, we exceeded over 63,000 cases in a single day nationwide while other countries in Europe are seeing only a few hundred new cases per day (some even only 5-11 cases like Finland or Denmark). New Zealand has only had 70 cases since April! Florida had >15,000 cases in a single day. The military is deploying to Texas to help with the surge and hospitals in Florida are nearing capacity with considerations across the country for rationing care and employing crisis protocols. This is not media hype or fear mongering, this is reality. Friends and colleagues across the nation are living the nightmare that is unfolding once again in front of us. So what the heck is going on?

Our federal government would like you to believe that our worst days are behind us, we are fully in control of this pandemic, they have provided a first rate response, and the cases are only rising because testing is increasing. They are pushing for packed campaign rallies, further re-openings, and getting kids back to school ASAP. These are all horrendous ploys used as a measure for political gain in an election year at the cost of American lives. Cases are rising because mask wearing and social distancing was lacking in states who prematurely lifted their lockdowns. Such states include Texas, Florida, and Arizona. We have all been witness to crowded bars in Florida and Texas without physical distancing or mask wearing, packed beaches, and large parties all with the same disregard for public health measures shown on social media and most news outlets. This is not a second wave but a continuation of the first wave as discussed in my previous post. Many of these states’ leaders continue to deny the science and numbers, shifting blame, and following blind orders from a misguided federal administration without heeding the warnings of public health experts.

So why are cases sky rocketing but deaths are decreasing or holding steady at a lower rate than previously you might ask? A lot of people are sticking to the testing argument which is false. Cases are NOT rising because of increased testing; it is revealing a spreading disease. Testing capacity has not increased exponentially enough to cause such a drastic rise in cases. For instance, if you are able to perform 50,000 tests in a single state and you assume that only 1 in 20 people are infected to show a 5% controlled infection rate (which these governors and federal administrators would like you to believe), then you would only have 2500 new cases per day. Florida has already shattered that assumption with more than 15,000 new infections per day, meaning, that about 1 in 3 people are infected which is frightening (about 30% infection rate). And because you are finding more cases due to increased testing, it is just revealing what is already there. If you have 10 landmines hidden in the dirt and you find every single one, they are still landmines and can be dangerous, just now you know about them and can safely avoid them; the same goes for COVID-19 cases. If you don’t find the land mines they are far more dangerous because you don’t know how to act and where to go. The same principle applies to COVID-19. Just because you are finding these cases does not mean they still don’t pose a risk. So when Donald Trump states “slow the testing down” he is basically telling you to not look for land mines and walk blindly in the field, risking life and limb. The same goes for the ignorant Ron DeSantis, governor of Florida, brazenly stating that the only reason cases are rising in his state is because of increased testing, you can be sure he is lying and greatly incompetent.

There are a few reasons why the fatality rate is so low yet cases are the highest per day than they have ever been. The first reason is that many of these new cases are ten to twenty years younger than those who were previously infected at the beginning of this pandemic. Also, we are protecting our at-risk populations better than at the beginning of this pandemic (those in nursing homes and those with comorbid conditions). Another factor is that mortality rate tends to lag 2-4 weeks behind surges of new cases. When a group of people get sick with COVID-19, they end up on a ventilator for about 10-14 days and then unfortunately, don’t survive. This is sadly when death rates, start to rise. A likely gruesome future to which we are bearing witness. Models are predicting over 208,000 deaths by November at the current rate of incidence. Infection rates may increase as high as 100,000 new cases per day if this continues (we’re already at >63,000 new cases in the US per day). If appropriate measures are not used and large events continue to occur without masking or physical distancing, that number could be much higher as a result of super spreader events. Other models predict that if 95% of the country wore masks, over 45,000 or more deaths could be prevented. Unfortunately, so-called “Karens,” Trump supporters, and conspiracy theorists are still refusing to wear masks and socially distance. It will be because of this ignorance, that the infection continues to spread and not only affect millions of lives through health, but also continue the current economic recession.

One thing I want to talk about is the argument that the mortality rate of COVID-19 is only about 4.2% as noted by Johns Hopkins University. ONLY?! People continue to compare this to influenza which has a mortality rate of about 0.4% (that is ten times less dangerous than COVID-19). If this continues to hold true, that would mean if everyone in the US was infected (330 million) with COVID-19, there is potential to see about 14 million people die. This is unrealistic as you know because not everyone will be infected. So let’s talk “smaller,” more realistic numbers. There are about 50 million people over the age of 65 in the US, meaning that if only that population specifically got infected, there would be 2 million deaths nationwide. Okay, now not all of those individuals will get infected as they are aware of their risk and isolating as best as possible. Even if only 25% of them got infected, there is a potential to see 500,000 deaths within our senior population. No matter how you crunch the numbers, this virus is dangerous; especially given the fact that many individuals are presymptomatic or asymptomatic with this infection. If I told you to open a mystery box and there is a 4% chance that you would die if you opened it, and a 96% chance of nothing being in the box at all, would you open it? Absolutely not! So this argument falls flat very quickly. When someone says the mortality rate isn’t that high, they are dismissing the lives of hundreds of thousands of people who have the potential to die from this disease as well as the greater than 130,000 who have unfortunately already passed.

Now what about Donald Trump’s claim that 99% of coronavirus cases are totally harmless? I would love to give this “really smart person” a tour through any COVID-19 unit, especially those on a ventilator. Yes many people will survive from the disease, about 96% if the mortality rate is true. However, just because only 4% of people will die from this disease, does not mean you are spared from permanent consequences or at least a few days of physical and emotional suffering. Let’s say you have COVID-19 and get admitted to the hospital because your fever is climbing and your oxygen is dropping below acceptable limits. You are by yourself and cannot have visitors for fear of infecting others in the hospital. Like a scene out of contagion or ET, only a few people in virtually HAZMAT gear come into the room to care for you. You can’t stop coughing, you feel like a truck hit you, you’re burning up while freezing at the same time, and you might be finding it hard to do simple tasks like brush your teeth or even eat due to shortness of breath. X-ray results come back and you have a possible pneumonia complicating your COVID-19 infection and you start antibiotics. Your oxygen continues to drop, so the decision is made to intubate you and put you on a ventilator. A tube is put down your throat, into your lungs, and attached to a machine which then breathes for you. While on a ventilator, you are proned or turned onto your stomach to better help your lungs aerate. Unfortunately, you develop pressure ulcers on your face and some necrotic, or dying, patches of skin on your nose, chin, and forehead. You can’t eat, so a feeding tube is surgically placed in your abdomen. Eventually, you’ve been on a ventilator long enough you need to have a tracheostomy placed in your throat (a hole cut into your neck just below your Adam’s apple). You don’t have control of your bowels or bladder, so you have a catheter in your urethra to collect your urine and a rectal tube to collect the diarrhea you’ve had from your antibiotics. Because you have been laying in bed for days on end (up to two weeks), you lose a significant amount of muscle mass and, of course, strength. Your amazing hospital care team have now treated you with Remdesivir, maybe dexamethasone, and you miraculously begin to improve. The tube is pulled out of your throat, you are breathing on your own, days later the tracheostomy is reversed, and all the other tubes are removed. If you thought that this was the end of the road for misery and suffering, you’re wrong. The painful pressure sores on your face itch and burn as well as cause emotional damage due to your appearance and self esteem. You can barely get out of bed without using a walker. You will need physical therapy, possibly home nursing, and weeks, if not months, of recovery and medical follow up with your primary care provider. You feel hopeless and defeated leaving you with depression and anxiety. For those with serious COVID-19 infections, this is the better outcome you could hope for given the circumstances and potential fatal outcomes. Unfortunately, many are left with more serious outcomes (outside of death). Many individuals affected by COVID-19 develop strokes, heart attacks, or blood clots in the lungs which all come with permanent damage. For those with mild to moderate infections and don’t require hospitalization, the symptoms can be very uncomfortable, limit all daily activity, and force you to isolate from the world, even those you love in your own household. Not to mention, the fear of whether or not you will take a turn for the worse or improve based on your infection and overall health prior to COVID-19. We in the medical and scientific community still don't know what permanent lung damage this virus may cause in even those with mild to moderate infections. So when you hear politicians ignorantly state that most infections are harmless, ignore their biased rhetoric and think about that poor old woman, by herself, tubes in every part of the body, fighting to survive. At this point, many of us know or have heard of someone being infected and either dying or being admitted to the hospital as a consequence of COVID-19.

I know this post seems all “doom and gloom” but our country is falling apart. Here in Massachusetts and many of the northeast states, we are luckily seeing dwindling infection cases and falling death rates. We are fortunate to have sensible leadership who values the expert opinion of the medical and public health community. I BEG YOU…WEAR A MASK. This simple act can save tens of thousands of lives and slow down the spread of infection wherever you are. While your state may be open in Phase 3 or 4 and your governor has not mandated masks, take it as a social responsibility to your fellow Americans to do so.

Be safe and stay well!