Politicization of a disease

Rep. John Fuller’s perspective (March 29, “A problem more destructive than disease”) that we’ve “abandoned one’s own responsibility” in trying to reduce the rate of infection by a virus that everyone is susceptible to, reminds me of a phase from my grandfather who said he wouldn’t let facts get in the way of his opinion.

While Rep. Fuller had the government restricting personal liberties in mind when he wrote “Acting upon incomplete and inaccurate information …” these words could equally be applied to his characterization of the effort to slow down the rate of infection.

To be clear there are some things only a government can do, one of which is to protect its citizens from major threats, which they can’t do alone. Public health comes to mind.

Knowing the difference between the flu, which only infects 10% of the population and Covid-19 that can infect everyone in the country (334 million) unless controlled. Knowing that 0.1% of those who had the flu, died from flu associated illness (34,000 people last year) and that number could be even lower. Knowing that Covid-19 is not influenza, the numbers from South Korea (as of March 27) show an overall Covid-19 case fatality rate (CFR) of 1.4%, but this doesn’t tell the whole story.

Case fatality rates from other countries are not as low. The percent of the population over 60 in both the U.S. and Korea are approximately the same at 22.8% vs. 22.7%. These are people most at risk if public health directives aren’t taken seriously.

Knowing that the virus basic reproduction rate (R0) is 2.0-2.5 people infected by a single infectious person. Recognize that this is an exponential increase. Understand that it isn’t until R0 is < 1 that the pandemic goes away.

Vaccines and antiviral drugs usually are the most effective way of limiting an epidemic, but those aren’t available at the beginning of a pandemic. The next best tools to reduce the rate of infection is to identify those that are infected with symptoms or a test and isolate them from those that are susceptible.

Since the assay to distinguish infectious people is scarce and that 50% of the confirmed cases didn’t initially show fever as a symptom, means that infectious people look like susceptible people, until they develop more symptoms. Having public health professionals perform contact tracing to further isolate people a person may have infected, works well with lots of testing or self-quarantining until there are more infected than public health employees. Infection keeps spreading.

Given a part of the population can be infectious with mild symptoms and not have a high case fatality rates means a subset of people won’t take it seriously to stay home for a multiplicity of reasons. The exponential growth in infected people continues. This leaves “social distancing” and “stay at home directives” as the tools to separate infected from susceptible and decreases R0 for a time. It is the main tool left to avoid overwhelming medical resources and rationing care.

Decreasing the rate of infection also allows more time to identify anti-viral approaches and if possible, a vaccine. Only a government could plan and coordinate this. The only other remaining choice is to let the pandemic run its course, which is infinitely scarier if you do the math, than being asked to seriously limit contact by a stay-at-home directive.

An epidemiologist in 2002 asked, “which of five goals should get top priority during a pandemic: reduce disease, reduce deaths, ensure that essential services continue, limit the economic impact, or ensure “equitable” distribution of scarce resources.?”

I would vote: “reduce deaths.” The answer to this question effects which solutions are available, what resources are needed and what the outcomes are when the pandemic is over. Epidemiology models are well developed and can be fine tuned with recent data to show likely outcomes for various choices.

Another epidemiologist wrote in 2004, “We need a national debate now about these questions, when you have a pandemic, it’s not a good time to have a discussion with your doctor about the ethics of rationing.”

Clearly this didn’t happen. When it comes to people’s lives shouldn’t looking at all the data be better for making and supporting a solution than narratives and hyperbole?

— Bob Bridenbaugh, Ph.D., spent his career in biotechnology process development and consulting. He is retired and lives in Columbia Falls.