A Med School Professor (And Doctor) Looks At The Remainder Of 2020 & Probably Most Of 2021 — And Offers This New Reality: We Must Mask, Distance, & Restrain Ourselves For The Foreseeable Future Or Face The Reality Of More Deaths In TheThousands

Today, Indiana University Med School professor, Aaron E. Carroll, MD, offers hard truths about our lives in the remainder of 2020 and likely, most, if not all of 2021. Compare the experiences of nations where mask-wearing is required, social distance rules are enforced, and large social gatherings do not occur with the United States where none of these precautions are uniformly observed. The prime example of poor leadership is The *ILK (*Impeached But Not Removed) Lyin' King who encourages his followers to avoid masks, does not respect social distance requirements, and stages "rallies" of large crowds in enclosed arenas. If this is a (fair & balanced) recipe for thousands of additional deaths, so be it.

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[x YouTube]
"The Liar Tweets Tonight" (Parody of "The Lion Sleeps Tonight")
By Roy Zimmerman and The ReZisters, featuring Sandy Riccardi

[x NY Fishwrap]
Stop Expecting Life To Go Back To Normal Next Year
By Aaron E. Carroll


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Dr. Anthony Fauci warned us last week that COVID-19 is likely to be hanging over our lives well into 2021. He’s right, of course. We need to accept this reality and take steps to meet it rather than deny his message.

Many Americans are resistant to this possibility. They’re hoping to restart postponed sports seasons, attend schools more easily, enjoy rescheduled vacations and participate in delayed parties and gatherings.

It is completely understandable that many are tiring of restrictions due to COVID-19. Unfortunately, their resolve is weakening right when we need it to harden. This could cost us dearly.

The unrealistic optimism stems in part from the fact that people have started pinning their hopes on a medical breakthrough. There have been promising developments. Remdesivir holds potential for those who are hospitalized. Convalescent plasma might do the same. Antibody treatments might improve outcomes for some or prevent infections in those at highest risk.

But most cases don’t benefit from these treatments. Further, none of these therapies can prevent infections or hospitalizations on a broad scale. The concern over an unflattened curve isn’t just about death, although that’s certainly a concern. It’s also about an overwhelmed health care system where so many beds are filled that we can’t get care for the many other conditions people experience. Untreated or undertreated heart attacks, strokes, cancer and more will also cause a spike in morbidity and mortality.

Americans are also overestimating what a vaccine might do. Many are focusing on whether approval is being rushed as a campaign ploy, but that’s almost beside the point. It seems likely that a vaccine will be approved this fall and that it will be “effective.” But it’s very unlikely that this vaccine will be a game changer.

All immunizations are not the same. Some, like the measles, mumps and rubella vaccine, provide strong, nearly lifelong benefits after a few doses. Others, like the influenza vaccine, produce limited benefits that last for a season. We don’t know yet where a Coronavirus vaccine will fall, although something along the lines of a flu shot seems more probable. We don’t know how long whatever immunity it provides will last. We don’t know whether there will be populations that derive more or less benefit.

Because of all these unknowns, we will need to continue to be exceedingly careful even as we immunize. Until we see convincing evidence that a vaccine has a large population-level effect, we will still need to mask and distance and restrain ourselves. Too many of us won’t. Too many will believe that the vaccine has saved them, and they will throw themselves back into more normal activities.

That could lead to big outbreaks, just as winter hits at its hardest.

Even this assumes, of course, that we can distribute the vaccine widely and quickly (which is doubtful), that most people will get it (many won’t) and that we will succeed in prioritizing distribution so that those most at risk will get it first (flying in the face of decades of disparities in the way health care is distributed).

The approval of a vaccine may be the beginning of a real coronavirus response; it certainly won’t be the end.

It is much more likely that life in 2021, especially in the first half of the year, will need to look much like life does now. Those who think that we have just a few more months of pain to endure will need to adjust their expectations. Those thinking that school this fall will be a one-off, that we will be back to normal next year, let alone next semester, may be in for a rude awakening.

As Dr. Fauci told MSNBC’s Andrea Mitchell, “If you’re talking about getting back to a degree of normality which resembles where we were prior to Covid, it’s going to be well into 2021, maybe even towards the end of 2021.”

We wasted our chance in the spring to get a better summer. We wasted our chance in the summer to plan for the fall. We’re wasting time again now. Next year isn’t that far away.

We still need to figure out how to live in this new world, now, and that means embracing, finally, all the strategies for fighting the virus that many of us have resisted.

It’s not too late to invest in testing both symptomatic and asymptomatic people. Back in the spring, I estimated that we might need a million tests a week to manage the virus. That estimate assumed that America would drive the prevalence rate of the disease into the ground, much as other countries did. We failed in that respect. We left shelter-in-place too early, letting cases grow once again.

Because of this, we can no longer rely on just symptomatic testing and contact tracing. We need much more than a million tests a week. The only way to get there is through ubiquitous, cheap, fast tests that can be distributed widely to identify those at risk who don’t even know it.

Identifying cases is only the first step. Those who are infected need to isolate, and their close contacts need to quarantine. Too many Americans cannot do so adequately because they need to work, or their housing is inadequate, or they need food and supplies delivered to them. We have failed to address these gaps. Those who need the most assistance are often those at highest risk for getting and spreading the Coronavirus and for having the worst outcomes, and our government has not provided for them.

We need to normalize mask-wearing. It’s a tragedy that this has become politicized and that this simple, safe and effective measure is in dispute. It’s about protecting others even more than ourselves. That such an action is now viewed as weakness is horrific.

Finally, we need a functioning scientific infrastructure to provide detailed and specific plans on how schools, businesses and institutions can open and operate safely. We also need a functioning Congress to fund whatever it takes to put those plans into practice. That may cost a lot of money; it’s likely to be still less than what continuing to flail about will cost

None of these ideas is a complete solution, but just because they’re individually insufficient alone doesn’t mean they aren’t necessary.

Colder weather will force us indoors, closer together, removing the benefits of being outside. Influenza is coming. Those drawing comfort from the fact that many countries in the Southern Hemisphere had mild flu seasons need to recognize that those countries were also engaging in the behaviors that controlled the spread of the coronavirus. It’s a mistake to assume that we will reap the same rewards without committing to the same sacrifices.

Too many are relaxing because they think that salvation is just around the corner. That’s possible, but certainly not probable. It would be better to prepare for a difficult 2021 and be surprised by its being easier than to assume things will be easier and find life is still hard.

This is a marathon, not a sprint. Both, though, require running. ###

[Aaron E. Carroll is a contributing opinion writer for The New York Times. He is a professor of pediatrics at Indiana University School of Medicine and the Regenstrief Institute who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. He is the author of The Bad Food Bible: How and Why to Eat Sinfully (2017). Carroll received a BA (chemistry) from Amherst College (MA) and an MD from the University of Pennsylvania School of Medicine. Thereafter, he completed both an internship and residency in pediatrics at the University of Washington and also received an MS (health services research) as a Fellow in the Robert Wood Johnson Clinical Scholars Program.]

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