Social Distancing feels like overkill, but isn’t
I usually only write one blog and one newsletter each month, but I see the need to respond to these unprecedented times, to the confusion, fear, and frustration around the social distancing policies.
Friday, both my daughter and I found ourselves care-worn by the sudden changes around us due to coronavirus. On Thursday, Alberta’s Chief Medical Officer recommended cancelling all large gatherings for the purpose of social distancing, when only 23 cases of COVID-19 had been confirmed in Alberta. I had just spent Thursday trying to put measures in place to responsibly host a reception at a choir concert planned for Saturday, only to turn around that evening to cancel the event – I was exhausted from the effort, and the disappointment of canceling was still raw. My daughter, on the other hand, was tired of reading about the novel coronavirus, about everybody’s panicked reactions, and was understandably wondering why such restrictions are being put in place – after all, Alberta only has 23 cases! And if she catches the virus, it will probably be trivial because she’s young and in good health.
I fully acknowledge that, right now, these measures create a great deal of inconvenience, not to mention disappointment. This situation is lousy! But I agree that these are the right steps to take, and I even worry that they may not be enough in the long term.
Like my daughter, I’m not worried about what will happen to me. I’m not worried about what will happen to 80% of the population. As I wrote last week, most of us would experience infection with the novel coronavirus with mild symptoms. But about 20% of the population will experience severe symptoms – these will be the elderly, and people with underlying respiratory and cardiac conditions, and who are immunocompromised. These are the ones who will suffer greatly, and who are at great risk of death, and so these are the ones that we need to protect via responsible action.
I recognize that on the surface, it still looks like overkill: on Thursday, there were 23 confirmed cases of novel coronavirus in Alberta, and we’re starting social isolation measures already. Excellent articles by Tomas Pueyo (lengthy and technical) and by Dr Siouxsie Wiles (an easier read) explain why this is reasonable behavior. The highlight messages that I took from these articles are:
We will not stop the spread of coronavirus, but our actions – what we do and when we do it – will determine how rapidly it spreads. How long we continue our actions will be important to prevent a resurgence.
We will keep our mortality rate low if we keep the number of daily cases of COVID-19 low, because it depends on whether our healthcare system can stay on top of treating the severe cases. In environments where the health system has been effective because the number of cases has been contained, the death rate has been around 0.5%. In environments where health systems have been overwhelmed and find themselves with insufficient resources to effectively treat critical patients, the death rate has been around 5%. (For comparison, the death rate due to influenza is ~0.1%.) We are talking about the ability to provide intensive care beds, and especially ventilators, so that doctors don’t have to triage who gets that high-level care – triage decisions are what make the death rate spike.
The number of cases will increase exponentially, so while the case load seems gradual at first, before you know it the number of cases will dramatically jump. Waiting for the cases to jump will make it much harder to contain the spread of virus. It’s so important to act early to “flatten the curve”!
The confirmed cases are an underestimate of the number of real cases in the community – you can probably multiply the number of confirmed cases by 10 to 100 to get the true number of cases. In Alberta, as of Thursday, that means we probably had 230 to 2300 actual cases. You probably didn’t interact with one of the documented 23, but what about the undocumented ones?
After containment has failed, the only way to slow the spread of the virus is through considerable social distancing. We lost the ability to contain the virus, because, even though all our new cases were travel-related, the newest cases are in travelers from parts of the world that we hadn’t been monitoring. These travelers had been circulating in our communities, unaware of their risk of spreading the virus to others – isolating after symptoms emerge is poor containment. How many other unknowingly infected travelers are there in our community?
Flatten the curve: take early steps to slow the spread of virus early, to avoid overwhelming the healthcare system with severe COVID-19 cases.
Gif by Siouxsie Wiles, Toby Morris is licensed under CC BY-SA 4.0.
It’s true that the number of cases in Alberta is still low, but acting now is how we can hope to stay ahead of the virus, to flatten the curve, to limit infection of our vulnerable populations, and to make sure any infected vulnerable individuals have access to effective treatment! It’s still important to keep washing your hands, to cough or sneeze into your elbow and to avoid people when you feel sick, but these actions alone will not flatten the curve.
These are still unpleasant changes to our society. Change and uncertainty are hard, but that’s our global community’s current reality. So it’s okay to not like it, and to feel unsettled. But history – both past and recent – tells us this is the path to prevent a healthcare crisis amid this pandemic. For this reason, I agree that it’s important to embrace these changes, and to find new ways of coping and interacting for this interim. Feel free to call or email us at Navigate Your Health, to speak to a trusted health navigator and advocate to help you figure out a new temporary normal.