Some Thoughts On The Coronavirus
So far what we know is that it’s highly contagious and easily passed from person to person, even when individuals are pre or a-symptomatic. Those at highest risk for mortality are older Americans, those with compromised immune systems. For many it will be mild, but for about 20%, it can be quite serious, and for 2% of those infected, it will be lethal. We don’t know if it’s going to be sticking around for a while, will it disappear in the spring, and whether it will be recurrent, is it coming back in the fall.
It looks as if it has already taken hold in a nursing home in the Seattle Washington area, which could be a worst-case scenario for mortality. It could become rampant in jails and other institutions where people are closely confined in sometimes unsanitary conditions. It could prove to be devastating for individuals who are homeless and living out of doors, on the streets, in shelters and in living conditions with little sanitation. We simply don't know and we are not well prepared.
The keys so far in China seem to be widespread testing and extensive quarantines. We don’t have enough test kits in the US; we don’t know who has the virus, and so we don’t know who, what or where to quarantine.
As Michael Hiltzik wrote a few days ago in the LA Times, our health and social safety net systems are poorly designed to meet the challenges of the new coronavirus. We lack universal health coverage; we have high patient out of pocket requirements; we have insufficient access to primary care; we also lack good, interconnected electronic medical records; we don’t have a good way to pay people who need to stay home (self quarantine) and not pass on their infections to others.
Our health system does not have much excess capacity to treat lots of new seriously ill patients. We also as a society are quite prone to misinformation, panics and victim blaming. We may lack social solidarity to deal with a pandemic, and we may lack patience in the face of the unknown; we will be tested. Some of us lack faith in science; others in government leadership, and still others may lack adequate benevolence.
Step 1, the financial barriers to testing and treatment need to be drastically reduced or eliminated so that sick patients with inadequate financial resources will go in for testing and stay in treatment. Government programs and private insurance must eliminate these financial barriers for testing and treatment of this virus, and the epidemic (if it happens).
Step 2, we will need to have widespread testing; therefore we need to quickly train and use all available health personnel to do the coronavirus tests, and we need to have competent, readily available local health labs who can rapidly read the tests and deliver reliable diagnostic results. See the US’ testing problems with shortages of test kits and insufficient lab diagnoses at https://www.cnbc.com/2020/03/02/coronavirus-new-york-city-doctor-has-to-plead-to-test-people.html
Step 3, when people are sick and contagious with the virus, they should not be going to work, school or shopping. Most of us cannot afford to be without wages during a two week self quarantine. Few of us have groceries and other essential supplies in stock for a two-week quarantine. Many employers do not offer adequate sick leave or replace employees’ lost wages. We may need to temporarily change eligibility for UI (unemployment insurance) and DI (disability insurance) so it covers the two weeks or more of lost wages from this coronavirus. We need to rapidly develop a program that covers the self-employed and the flex workforce who are not otherwise covered for their lost wages or incomes. We would need to change the methods of applying for coverage of lost wages so applications and eligibility can be done online or through a smart phone; we should not force the sick to stand in line to apply for assistance in government offices; we need them to stay home. Groceries will need to be able to be delivered to those in self-quarantine. Friends, social service agencies, neighbors, churches and others will need to pitch in.
Prepared by: Lucien Wulsin
Dated: 3/1/20