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Monday, Sept. 21, 2020

Knowledge Over Fear

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What we have learned from COVID-19 brings hope for 2021

The scientific method has been the foundation of many of the great discoveries made over the past century. It is a method that rechecks assumptions and logic as more information is available. This allows us to adapt as we learn. In the COVID-19 pandemic, we are filling in our gaps of knowledge every day. What we have learned should replace a lot of our anxiety and fear with confidence – confidence based on knowledge and not false bravado and unrealistic expectations.

Over the last few months, the treatment of COVID-19 has substantially evolved. Management of fluids and ventilators has completely changed over the last few months. Remdesivir has been shown in a large study to have a significant positive effect. Dexamethasone has improved outcomes of the most ill patients. There has been a positive trial result with convalescent plasma when treatment is initiated early in the course of the illness. Use of full-dose anticoagulant therapy has reduced blood clot complications.

Compared to March and April, there has been a 40% reduction in COVID-19 mortality and an even greater reduction in the elderly. Lengths of stay in hospitals for COVID patients are a third of what they were at that time. The development of multiple treatments is the key to living with the virus more on our own terms.

Over the last six months, pharmaceutical companies across the world have worked 24/7 to develop a safe and effective vaccine for COVID-19. This work’s results have been nothing short of miraculous, with various reports from health leaders indicating we are not long from having multiple safe and effective vaccines. There are nine potential vaccines with well-funded research and development currently in trials. The expected dates of availability for these vaccines are in late 2020 and early 2021.

In the area of prevention, we have enacted common-sense strategies of physical distancing, facial covering when inside around people, frequent hand washing and staying home when ill. We have learned the importance of avoiding large indoor gatherings with the potential of exponential spread of the virus in crowded and enclosed spaces.

The importance of diet and exercise to reduce the American epidemic of obesity is a less-discussed prevention effort for COVID-19. This risk factor for COVID-19 complications threatens all age groups, but especially young and middle-aged adults. This is just another reason to challenge ourselves to think about weight loss as we are putting on our masks.

We learned a vast majority of major complications with COVID-19 are in the elderly with chronic health problems such as obesity, diabetes, COPD and heart disease. Upward of 50% of COVID-19 deaths have been in nursing home patients, 30% in people over 65 living at home, and the other 20% from the rest of the population.

We learned the hard way about the unintended consequences of shelter in place lockdowns. After only weeks of lockdown, our country went from record low levels of unemployment to Great Depression-like numbers. There were substantial small business failures with estimates ranging from one-fifth to one-third of small businesses closing for good in 2020. Domestic abuse, substance abuse and depression increased substantially while those with heart disease and cancer were unable to fully access health care.

We learned the hard way about the enormous harms associated with closing schools to children. One study estimated a 30% drop in reading ability and 50% decline in math skills with substitution of distance learning for in-school learning. The mental health and social development of children and employment of parents has been negatively impacted by school closure.

Data from the COVID experience in the U.S. and Europe support reopening schools as a realistic goal. The complications of COVID in children are rare, and transmission of viruses from children to adults is also uncommon. European nations have gone ahead of us and been able to successfully open schools over the spring and summer.

When we view the pandemic through the lens of the most important metrics of hospitalizations, ventilator use and mortality rate, we can be encouraged that our policies are steering us in the right direction. Hospital capacity has generally not been severely threatened any more than it sometimes is during the regular influenza season. The number of COVID patients on ventilators is dropping.

With these scientific breakthroughs and lessons learned, the assumption would be our country would be living out Franklin Roosevelt’s statement during World War II that “all we have to fear is fear itself.” However, this has not been the case.

Instead of being comforted by advancements in knowledge and scientific discovery, we are inundated with news stories that continue to cast aspersions on any positive news. Data is used only when it serves the end of a political narrative of blame. If the data does not fit the political narrative, data is replaced with rare happenings and anecdotes disguised as science.

This is why news stories about a school with some students or teachers becoming ill with COVID-19 or someone developing an adverse reaction to a coronavirus vaccine are likely to gain headlines. It is almost inevitable in an election cycle built on negative news stories about the incumbent. Study data on the thousands who take the vaccine and millions of children who return to school safely get less attention.

The truth is scientific discovery gives us hope and confidence this virus won’t rule our lives forever. We have a combination of treatment options for the virus, and there are others being studied. We will soon have multiple effective vaccines. We have learned some simple prevention strategies that are effective and not difficult to do. We know not to lock down our economy again. We will successfully open our schools. We are ready for Phase 3, which will be a game changer for our state. There is no need to let fear and anxiety overwhelm us.

National columnist Kathleen Parker noted in The Times, “Children need to be in school, parents need to return to work, and the world needs to keep turning.” Except for the most vulnerable, the advances in knowledge of the last few months should encourage us to do this as well as venture out of the house and support the small businesses in our community.

The COVID-19 pandemic is a dual health and economic crisis. The crises are connected, and so are the solutions. If we don’t have a healthy population and a healthy economy, we won’t have either.

When the politics of assigning blame is less acute after the election, we can hope all our political leaders can deal better with this dual crisis by letting empirical evidence inform personal perspective. By doing so, hope and confidence will overcome anxiety and fear.

Dr. Phillip Rozeman is a practicing cardiologist. He is past chief of staff of the Willis-Knighton Health System and past board chair of the Shreveport Medical Society. He is the second recipient of the John Miciotto Lifetime Healthcare Achievement Award.


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