Myth 18 – We overreacted.
About 2 months ago, my partner, Dr. Clayton Roberts, contacted me and said, “Hey, do you think we ought to maybe look into this Covid thing and make sure we have a plan for it?” I have to admit my initial reaction was to think, “Well, the SARS and MAERS and even Ebola didn’t make it to Stephenville, so maybe the Covid thing will stay away, too.” (Ebola did make it to DFW a while back – but thankfully, the public health gurus and Texas Health Researchers did a great job of containing that nightmare.) But, it seemed that many countries and even larger cities in our own country were starting to notice cases of Covid-19. So I started looking into what the World Health Organization had to say so we could develop a plan for if and when Covid-19 did somehow make it to our sheltered slice of the Cross Timbers. I am very thankful that Dr. Roberts came to join Stephenville Medical Surgical Clinic last fall because he has been very proactive, forward-thinking and helpful in shaping our response. Also, Privia Medical Group, North Texas, has been instrumental in developing workflows, helping us to secure PPE and giving other guidance for the management of patients and protecting our staff and building from Covid-19. (A case of a sick patient with Covid-19 in the building could shut us down for cleaning and quarantine for several days.) All of the physician partners at SMSC were very quick to adopt new work flows; we held special called meetings attended by all providers and all were quick to provide input and guidance based on the recommendations of our medical academies for the continued provision of care for our patients. We bought a tent. Then we bought another tent. Husbands of many of our employees put up the tents on two separate Sundays. Our IT department ran power and WiFi and printers to the parking lot so we could care for you. Employees proved their flexibility, volunteering for new roles and providing invaluable suggestions. It makes me proud to work at our hometown clinic – we provided outpatient testing and a care plan for the people of Erath County even before many of our sister practices around North Texas were able to mobilize. We were truly riding the wave as it washed over North Texas.
Our community mobilized quickly as well. Your county public health official, Dr. Jeffrey Moore, and your city public health official, Dr. Kelly Doggett, have led your medical community and your elected officials with aplomb and unabashed clarity. It was clear from the beginning that the virus posed a significant threat (still does – more on that a bit later). Based on the advice of the almost unanimous voice of your medical community, the county and the city moved swiftly to protect our most valuable asset, you. A weekly meeting has convened for some time (via the ubiquitous medium, Zoom, of course) that includes local hospital officials and doctors, Tarleton State University, SMSC, city elected officials, county officials, Stephenville PD, the fire department, and many others in order to choreograph a concerted effort to respond to the very real threat. In the very first meeting, it became clear that even 200 concurrent cases of Covid-19 would overwhelm our local hospital resources and we had to do what we could to prevent that from happening.
So we did. And we have (thus far) prevented it. In March, I realized that by now (late April), there was a very real risk that thousands in Erath County could have been infected and many could have died unnecessarily. But you did not let that happen. For the most part, you stayed home. You saved lives. And for that I am grateful.
I read an article today that exactly sums up what the response to Covid-19 must necessarily be. @ThomasPueyo very skillfully describes where we are in Erath County (really, where we are as a country) and points us toward the experience of other countries around the world do see how they are faring against Covid-19. You can read the article here. (This one article is part of a series on the topic and all are great reads.) Interestingly, the one country who never had many cases to begin with and continues to manage without significant closures or damage to the economy is Taiwan. That’s very close to China! They have managed to keep infection rates low with very well coordinated (seemingly draconian) quarantine requirements. If you travel to Taiwan, you are put in quarantine. They enforce it by monitoring your cell phone to check your location, calling you many times a day, and dropping by your house to make sure you are there. And should your phone die, the police show up. If you don’t have a GPS enabled smartphone, the government provides you with one. Essentially, they take measures that, if undertaken in Erath County, would incite an armed militia to storm the court house. Now, please understand, I’m not advocating these measures – just sharing the story. (Also, to be fair, Taiwan had a practice run with the original SARS virus in 2013. Make no mistake that if the US is confronted with another pandemic on this scale, lessons learned from Covid-19 will pay off in spades.)
Other countries have not done so well. Singapore initially did well but then had a spike in cases. Their first misstep was to not ban travel from endemic areas fast enough and that allowed for a seeding of cases over a widespread area. We have seeding in Erath County, but with our social distancing and closing restaurant dining rooms, etc., we have effectively limited the spread due to those specific cases. (Good job, y’all.)
Second, Singapore has not used as aggressive contact-tracing as other countries. We count on the local health departments (ours is based in Arlington) to call and question patients identified with official cases of Covid-19 and investigate tracing contacts. But our country’s testing is still not near the level of testing that is taking place in places like, say South Korea, where you got a Covid test if you even thought you might have been in contact with someone who had Covid-19. In Erath County, there are as of yet untested family members of people who tested positive who have been told to quarantine by their doctors – but no government official is enforcing the quarantine. We now have enough tests to run on those exposed individuals but we have to count on them to self select for testing.
The testing rates in South Korea, for example, are exponentially higher than ours. South Korea is another country that also monitors close contacts through the mobile data gathered from the mobile phones and closed circuit TV cameras in public areas, etc. Singapore even launched an app that tells the public health officials if you have been around someone infected. It requires the citizenry to voluntarily download the app and thus consent to being tracked. However, in a country where the vast majority of citizens implicitly trust the government, only 20% of the population has adopted it.
Finally, Singapore has not adopted the use of masks like Taiwan or South Korea – two of the countries acing the Covid Response Test. Our county and country as a whole absolutely have not adopted the masking rates of those countries either.
Now, it is obvious to me that Americans will never submit to the invasions of privacy employed by the much more aggressive governments of Taiwan and South Korea. (I’m not necessarily saying we should, either – I like liberty, too.) I can’t imagine that any more than 20% of the population would download an app funded by the CDC for the purposes of tracking who we come in contact with. Scores of folks are already certain that Google Home and Amazon Alexa are spying on us and reporting back to Trump or Pelosi – whichever one you don’t trust. (Maybe both, I don’t know.)
The bottom line is there is enough ingrained paranoia about governmental intrusion in the US to prevent any of these protocols form working. We’ll have to come up with something else more palatable to the “You-can’t-tell-me-what-to-do” Americans.
@ThomasPueyo writes that when confronted with the Pandemic, every country must drop the hammer, then learn to dance. The hammer is the shut down. The necessary medicine we must take, the surgical excision of a part of our economy for the purpose of saving the body (hoping the part we excised will heal and grow back). The purpose of the hammer is to buy time – to evaluate medical resources, to come up with contingency plans (and, I am happy to say, through the efforts of your city and county officials, contingencies are now in place), to get a better handle on PPE and to make an overall plan for the cases that must necessarily pass through the population. We have lowered the hammer and we have bought some time. And, in true Erath County fashion, we have responded with speed and excellence to the challenge.
Now the question – can we dance? The dance is the relaxation of intense economic limitations and shelter in place orders. We slowly, thoughtfully, venture out into economic interaction, planning every step (as one does in a dance) so we can let money flow again and start to get some jobs back. Perhaps the dance is more of a boxing match with the virus, ducking and weaving and moving our feet to avoid the knock out punch of wide spread infection and an overwhelmed hospital system. To be clear, whether we dance or spar, pick your favorite metaphor, people will become infected. Vulnerable people (you should know who you are – if not, ask your doctor or check cdc.gov) should stay out of the dance. In fact, don’t even go to the dance hall. Stay home.
The hammer didn’t get rid of the virus – and it won’t. It can’t. We can’t stay home long enough for it to go away – it will be with us from now on. We are not trying to get back to normal – we are trying to define a new normal. The relaxation of tight controls must be done thoughtfully and in a coordinated way. We are so fortunate that to date we have not had cases an any nursing home in our county, no cases in large, multiple-employee facilities. As we start to get back to work, we all have to plan how we are going to live with the virus. If you are in the vulnerable population and work in a high risk job, think about switching to a different job – if you are able to – where you are more protected from infection.
Wearing a mask when in public absolutely helps prevent the spread of the virus. Now, you can say that no one can tell you to wear a mask or that it infringes your rights, etc. – I hear you. But what if, perhaps businesses will refuse to serve you if you don’t have one? Or maybe the state government will attempt to enforce mask laws. Perhaps not. But if you chose not to wear one, you are choosing unnecessarily increased risk – not just to yourself but to everyone else. The handful of countries who are beating the virus have extremely high mask use rates. Why would we not follow the advice of the smart (read: successful) kids in the class? We all must continue to wash our hands, we must be cognizant of where we put our hands. We should continue not congregating unless absolutely necessary. #socialdistancing is still the rule.
Public health personnel and your elected officials are going to do their best to teach you some new dance moves. Call it the Covid Two Step. Come to class and pay attention. In this case we can’t afford to approach the challenges of the next year with two left feet.
Dust off your dancing shoes,