I feel like I am living in the Twilight Zone. Despite the CDC pronouncements about the actual number of cases, it seems that every decision, every statement and every official action is based on "identified" cases. We continue to be told that identification of infected people through testing is the key to success. But we know that the "identified" cases are only 10% of the real number of cases. It's as if we have a TSA system in which the agents only screen those passengers who volunteer to be screened. Once screened, the agent segregates the infected offender and may even try to determine if they have had contact with accomplices who might themselves be infected. The agent then pats themselves on the back and smiles about the wonderful job they are doing in preventing disaster in the air. Meanwhile, 90% of the total number of infected passengers just walks through the gate area and onto the plane. Seems incredible, doesn't it? Yet, that is pretty much what is happening. If we were really convinced that knowing if someone were infected was important or critical, then we should be testing everyone or at least large, representative samples, not just symptomatic volunteers.
When a high profile person, like a Governor, tests positive, many are incredulous. Didn't he/she social distance, wear a mask, get tested? Oh yeah, they did get tested. Well, they must have gotten too close to someone who wasn't wearing a mask. They must have broken some rule, they must have done something wrong. People don't just get infected because it's a highly contagious virus that is asymptomatic in 80+% of infected people. Or do they. Well, yes they do because restriction doesn't kill the virus, it slows or delays the inevitable spread to the general population. The media and public health officials use the correct words but they and their listeners think they are saying that we can prevent the spread by restriction. It is no surprise that states that had hard lockdowns are now seeing increases in identified cases because what they accomplished by the lockdowns was delay, not prevention. Curiously, those states are blaming their residents for not following the rules well enough and are now considering truly draconian, punitive measures like shutting off electricity and water to offenders who sponsor large gatherings.
All of this is based on bad assumptions, in my opinion, and a basic misunderstanding of the virus and its contagion. While I have steered clear of politics in my previous articles, I do think it is interesting that the States with the hardest lockdowns, like NY, CA, CT, NJ, MA and RI, are all run by Democrats or Democrats in Republican clothing as in MA. Their philosophy of government is very much in line with establishing rules to live by ( or else). In fact, the clinician in me wonders how much many of the politicians and public health officials actually like the power that the pandemic has given them to control other people's lives. Antibody testing would seem worthwhile but is not in favor among public health officials and the media. They say that people who test positive for antibodies might become overconfident and endanger others if their immunity declined and they became reinfected. Maybe but it hasn't stopped anybody from using plasma from recovered people to treat others. I wonder if people who tested positive for antibodies might be harder to control as well.
My last point is a kind of follow-up on my comments about how we approach end of life in the US. The number I learned somewhere a long time ago was that we spend about 50% of the healthcare dollar on patients who will not be alive in ten months. Despite living wills and DNR's, families often tell the doctors to "do everything possible" to prolong the life of their loved one. Damn the cost, you heartless SOB! Those heartfelt efforts are usually futile and prolong suffering more than they do life. With the frail elderly, a fractured hip often is the straw that tips the balance and then pneumonia finishes the job. COVID is the fractured hip for a very, very large number of the deaths in the 75+ age group of frail elderly, the group that accounts for 60% of all COVID fatalities. It is tempting to say that, were it not for COVID, they would have lived much longer and higher quality lives. Tempting but, most probably, not true.
I do not know if you see what I see or hear what I hear. And Rod Serling isn't coming down for breakfast. Let me know your thoughts.