My nine-year-old son has been coughing for a week. No significant fever. No other symptoms beyond a bit of rhinitis. Ordinarily I would have assumed this was just another virus making the rounds, but these are not ordinary times. I am always loathe to suppress symptoms, since they are often just a consequence of a healthy immune response, and, given the fact that he was not particularly tired or miserable, I just kept him home from school for the week, feeding him orange juice, soup, and lozenges. Yesterday, I decided to step up my game and went out to buy some cough syrup. That was an education.
Target was packed. I didn’t make much of it and just headed to the pharmacy section. The first aisle looked like this:
What are these people thinking? Either they have no ibuprofen or Tylenol at home (in which case, seriously?) or they are planning on a month of monster headaches from hell. Or they just see an empty aisle with three boxes left on the shelf and think, I better grab one before they’re gone. I actually needed cough suppressant and had visions of visiting empty aisles in drugstores all over town. The Big Box God’s must have been smiling, because, in the next aisle, I found the last bottle in all of Target. Apologies to whomever came next.
I was just running errands and had honestly not realized I was supposed to be out shopping for the apocalypse. In the next section over, I encountered this.
At first, I couldn’t even tell what it was I was supposed to desperately need in my bomb shelter and had arrived too late to get. According to the signs, it was toilet paper. Apparently, the apocalypse involves a lot of defecation.
Among the advice floating around out there is the suggestion that everyone should stow away everything they will need to survive for two weeks at home. I assume that is in case you get sick and require quarantine. I don’t get it. This sounds like a recipe for panic and the craziness I saw in Target. What is the scenario where you need this? You are quarantined, have nothing in your cupboards and either have no friends or neighbors who will bring you food, all the stores are closed, the entire city has been ordered to shelter in place for two weeks, Wuhan style? Aren’t these people like me with a cupboard full of random stuff I overbought at Costco and haven’t really wanted to eat? I have always figured, when it gets bad, we’ll finally have an excuse to work our way through that extra 40 pack of Ramen noodles.
This is a bad virus, but it is not strip-the-stores-of-toilet-paper-and-Tylenol bad. Heck, are there really that many people who don’t have a two-week supply of the stuff? Do they buy TP a roll at a time on an as needed basis?
Exactly how worried should we be. Let’s look at this risk objectively. The data from China show that, for people under the age of forty, the case fatality rate is 0.2%. Roughly the same as the flu. Not to be taken lightly, but no cause for panic. In children it is a relatively mild disease. No one under the age of ten died. In South Korea, no one under thirty has died. That is why this will not be like the Spanish Flu, which was killing healthy, young soldiers. If my son is still coughing tomorrow, I will try to get him tested, more to protect others then out of a sense he is in peril. For the elderly and those with serious chronic disease, the story is very different. The death rate in people 70-79 is 8.0% and in people 80 and over, it is a staggering 15%. In Washington, 14 of 19 deaths occurred among nursing home patients. These are the people we should be scrambling to protect. This should have been the focus of our efforts from day one. We should not be building bunkers in our homes, we should be building fortresses around our grandparents, around the infirm, and, most especially, around nursing homes.
So, today’s news from Washington is particularly horrifying. According to the AP, this past week, the CDC submitted a plan for controlling the outbreak that included a recommendation elderly and physically fragile Americans be advised not to fly on commercial airlines, but White House officials ordered the air travel recommendation be removed. Trump administration officials have since suggested certain people should consider not traveling, but they have stopped short of the stronger guidance sought by the CDC.
Once again, an administration more interested in spin and protecting the beautiful economy than in aggressively protecting the most vulnerable. I have to wonder if the two cases that were diagnosed yesterday at a nursing home here in Issaquah and at a retirement community in Seattle, might have been prevented if aggressive precautions to protect the elderly had been implemented.
Bottom Line: It is time to circle the wagons around those most likely to die from this disease. Rather than hoarding paper goods, focus your attention on anyone you know who is old or chronically ill. Make sure they are taking all possible precautions. Avoid crowds, minimize physical contact, wash hands, and monitor any symptoms. If they are in a nursing facility, make sure that facility is implementing the strictest possible controls on staff and visitors. For them, it is truly a matter of life and death.
One THOUGHTS ON “Day 8: How Not to Prepare”
Thanks for this important public service, Dr. Bob. Keep it up!
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