We Have Met the Enemy: It May Turn Out to be Us and Not a Virus

[dropcap]I[/dropcap]’m writing this article from my home in Montgomery County, PA, a large suburban, exurban and rural county of 900,000 people which is kind of wrapped around three sides of the city of Philadelphia. At the moment, we are in “lock down,” after PA Gov. Tom Wolf announced that MontCo is the “epicenter of the pandemic.” 

Wolf yesterday ordered all elementary and secondary schools in the county closed effective today for at least the next several weeks, and ordered all colleges, including Montgomery County Community College and the Ambler campus of Temple University to end classroom teaching, switching over to online teaching. He also asked all retail stores to close their doors for a few weeks, with the exception of food stores, pharmacies and gas stations.

The suddenness of the lockdown caught residents by surprise. Parents have been forced to scramble to make arrangements for their young children — not easy since child care institutions are also being shuttered, and help or sitters can be hard to find, especially on no notice.

There is an element of panic, since it’s becoming clear that this once-in-a-lifetime pandemic is looking potentially much worse than people up until now had been led to believe. In this so-called “epicenter,” for example, the number of “presumptive” cases of COVID-19 infection is currently 17 (since testing kits are scarce in the US, only six of the PA cases have been tested and they were all positive). That’s just about half the state’s total of 33 as of today. One MontCo resident has died so far, in a hospital in Philadelphia.

What is finally being made clear in the media is that because the Trump administration cut staffing for epidemic control at the Center for Disease Control (CDC) over the last two years, making the CDC very slow to develop and start producing COVID-19 test kids, only 5 people per million have been tested nationally so far. (That compares to 3600 tests per million in S. Korea!). Since then testing has been rationed, with many who report symptoms and ask to be tested being turned away by health care providers. Tests can also cost more than $1000 while in Montgomery County, as across the nation, about a quarter of the population is either uninsured or has a cut-rate insurance plan that doesn’t pay any benefits until the insured person has paid the amount of the annual deductible. Those deductibles can often be thousands of dollars or even as high as $10,000.

As a result we are only now learning that the true number of infected people in a state the size of Pennsylvania, rather than being tallied in double digits, could be as high as 100,000 already as in Ohio, with the vast majority of those infected not knowing if they have, or are contagious with, the disease. State health officials in Ohio and Washington have stated this openly, but most states are not being so forthright, perhaps fearing that being honest will sow panic.

As in indication of how widespread the virus spread is, when we were shopping in our local Giant store today, we learned from a woman in the checkout line that her friend, a nurse, had learned three people who had been in that store earlier had later been diagnosed with Coronavirus infections. You wouldn’t get that kind of thing happening if the whole county only had 17 infected people!

For this reason, it seems clear that the restrictions being imposed now in MontCo will not be temporary, ending in a few weeks, but will if anything become stricter and much longer-term.

Until test kits are readily available it is impossible for residents of the county to know if they have contracted the virus, or if they are a asymptomatic carriers and a risk to the others in their household or at their workplace.

For now my family, which includes five people, aged 7 to 70, are hunkered down, trying to keep our house as sanitary as possible and washing hands after every excursion outside, whether to shop for food or to take in the mail from the mail box.

It’s nerve-wracking because, for example, I’m  approaching my 71st birthday and according to the CDC, my chance of dying if I contract the disease in my 70-79 age bracket is 8%,. That’s disturbingly bad odds. Moreover, I have a lung condition that makes me more prone to complications if I get a case of pneumonia or even bronchitis, so probably my risk level of a fatal lung infection is significantly higher than just 8%.

In Italy, nurses and doctors are reporting that hospitals are just letting some older patients with breathing difficulties die of the coronavirus because the country’s hospitals simply don’t have an adequate number of ventilators for those whose breathing becomes significantly impaired. They are giving the ventilators available to younger patients in a kind of unofficial triage.

The US is almost certainly going to end up doing much worse. At least Italy, with a nationalized health program, offers health care free to all its residents. That means everyone has ready access to primary care, even if the supply of specialized life-saving equipment may be in short supply.  In the US, in contrast, we have a system that almost seems to have been constructed to make dealing with a pandemic impossible. If it had been done deliberately, it would have looked like it does! : A quarter of the population of 320 million has no insurance or inadequate insurance. Another fifth of the country is covered by Medicaid, a health program for those with an income of less than double the poverty level. Medicaid is okay when it comes to going to an emergency room or an urgent care center, but when it comes to seeing a primary-care physician, it gets difficult. Most physicians don’t accept Medicaid because the reimbursement rates for an office visit are so low — typically 25% or less of what their billing rate is and what insurance companies pay them for seeing an insured patient.  As a result it is often hard for people on Medicaid to find a doctor in their area who accepts Medicaid patients, and those that do are hard to get an appointment with.

If people think things have gotten bad quickly in Italy, where the whole country is currently on lockdown in an attempt to try and slow the coronavirus pandemic’s spread, wait until the disease really gets going here in the US, where it arrived later. We ain’t seen nothing yet! 

The Novel Coronavirus disease is spreading at a rate that doubles the number of victims and carriers every week or less. If it’s true that there are actually over 100,000 cases in Ohio, a state of 12 million, then there are close to 2.8 million cases already nationally. Even if the official number of diagnosed cases, which is 1872 as of today, were correct, at a weekly doubling rate, that number would exceed that 2.8 million number in 11 weeks!  This is why the CDC is warning that through the course of this pandemic, as many as 160-214 million Americans could ultimately be infected. That’s half to two-thirds of the total US population! 

We’re in chaos now and this thing’s just beginning!

So for now, we’re at home in our house. It’s a sunny day, 69 degrees outside and the buds are swelling and starting to pop open — apple leaves, forsythia flowers, daffodils and the flowers on the maple trees. We’re all feeling healthy, but we get nervous every time one of us sniffles and blows a nose or coughs. There’s a feeling of constant foreboding that despite our best efforts to avoid contagion, this new deadly virus will slip past our defenses and get down one of our tracheas, and then we’ll all end up infected.

Everyone has this disquieting sense of doom just around the corner.

So far, there’s a lot of community camaraderie. The crowds packing and stripping the stores are friendly, despite the urgent desire to make sure they and their family get the supplies they need. But as we get to a more severe stage of the pandemic, with hospital beds, physicians, ICU rooms and ventilators in short supply as they all inevitably will be (US hospitals in total only have about 330,000 available beds above those normally in use for other reasons according to the American Hospital Association), and as it gets harder to get services as more and more people are laid up sick, that sense of solidarity is likely to fray.  This is especially so when the leader of the country these days is all about promoting an “I got mine” philosophy. Let’s remember too that it is urgently important in confronting a pandemic that the poorest people — the homeless, the immigrants, legal or not, the poor and uninsured, white, black or brown — all get the care and treatment they need. Again, although it should be common sense that if there are people not getting tests and treatment, they will spread disease among the rest of us, this argument will be a hard sell with a president and Senate Republican majority that have both been calling for cuts for the poor and deportation of the immigrants.

I’m not optimistic at all.

The lockdown of my community seems like a pathetic gesture really, though it does bring home the reality that this is really happening. We are all living in a Stephen King horror novel. We have met the enemy but it may not be the COVID-19 virus. It may be ourselves and the unequal, disunited and dysfunctional society we have created.