Living in interesting times

Let’s start with good news. Even assuming that the numbers coming out of China, and specifically from Hubei province and its capital, Wuhan, the epicenter of the coronavirus pandemic, reflect incomplete data because of the impossibility of universal testing, it is clear that “locking down” the populace to fight coronavirus and COVID-19 works even if these public health actions have been delayed by initial blindness on the part of authorities.

Hubei has about 60 million people – about 50% more than California. The initial spread of the virus was rapid. As with our federal government in Washington, at first the reaction from Beijing was to minimize the dangers, but as reality kicked in, ultimately, after wasting weeks, measures were implemented in late January to shelter in place.

The impact came rapidly. First the rate of infection and then deaths peaked in Hubei by the middle of February. Meanwhile China implemented quarantine policies over nearly the entire country. Last Thursday the government claimed that there were no new cases in China that originated in China.

There are still fears that the rest of China outside of Hubei will suffer a wave of the virus much like the rest of the world. The number of reported cases in China, about 80,000, is, however, many orders of magnitude fewer than the 25 million cases Gov. Gavin Newsom has predicted could occur in California alone if people do not quarantine and isolate. While the number of reported cases depends on the vagaries of testing, even if there were ten times as many cases in China as have been reported, the numbers are dramatically different from what models show would have been the case without quarantining.

Prompt action in countries and places like South Korea, Taiwan, Hong Kong, Singapore, Vietnam, and Japan have greatly slowed even the initial spread of the virus, but there are even more countries, including the U.S., where authorities minimized the risks, ignored scientific advice, and wasted valuable time. However, the experience in China hopefully shows that it’s never too late to take action.

Italy is another country where the government’s early messages were mixed. The lack of quick action led to rapid spreading of the virus starting in mid-February. The government did not implement a nationwide lockdown until March 9, about two weeks ago. Since then, infections and deaths are still rising. Let’s hope, however, that we will see, in the next week or so, that those measures lead to positive results as they did in Hubei.

Bringing the issue home, during the week of March 9 individual Californians began to self-isolate in large numbers and institutions began shutting down all public gatherings. The first government-mandated lockdowns, in seven Bay Area counties, did not begin, however, until last Tuesday, March 17. On Thursday Gov. Newsom, for the whole state, and L.A. County on its own, issued orders to stay home. With little direction from Washington, localities around the U.S. are only haphazardly realizing that they need to lock down. At this time fewer than 25% of Americans have been ordered to quarantine.

That’s going to have to change. As these measures come online, one hopes that as in Hubei they can tame the beast in three weeks or so. Because, however, these stay at home orders are coming late, typically right as the incidence of infection is exploding, those three weeks (the next three weeks here in California) will be horrible, with, as happened in Italy, an overwhelmed local healthcare system.

During these miserable weeks expect despair and cynicism from some, but expect life-affirming solidarity from most. If we emerge as Hubei has emerged, with a fraction of the illnesses and deaths that were predicted, then you can expect to hear a chorus of naysayers saying, “see, it wasn’t so bad; it was all overblown.” That is, ironically, the sad fate of all great public health victories. Once the battle is won, ignoramuses will say there was no battle to fight. (Typically, they are the same ignoramuses who said before the battle that there was nothing to worry about, that everything was “perfect.”)

If the Hubei model is real, and if it is implemented elsewhere, the containment of COVID-19 won’t be a victory of medicine over disease; rather, it will be another great victory for public health. No miracle cures will stop COVID-19; why anyone, let alone President Trump, believes there will be a cure for COVID-19 when there aren’t cures for the flu, the common cold, or other viral diseases, is beyond me. Doctors and nurses and their colleagues will do their courageous best to prolong the lives of victims long enough for their immune systems to defeat the virus, but what will contain and control the disease are tried and true public health measures of sanitation and quarantine, and ultimately, a vaccine.

The development and expansion of public health has been one of the great achievements of the past 200 years. Public health has been so successful and is so ingrained in our way of thinking, that people take clean water, sanitation, trash collection, vector control, etc., for granted. Nonetheless, the public by and large understands and cooperates with the concept that for their own good and the good of the public they must cooperate with public health orders. (I would include vaccinations in the list of public health achievements that we take for granted, but, unfortunately, we no longer can take vaccinations for granted, since a large segment of our population believe they can live without them.)

(By the way, let me use this opportunity to plug a book written by a Santa Monican. Longtime local Michael McGuire is one of the world’s experts on water. A few years ago, he wrote a wonderful book, The Chlorine Revolution: The History of Water Disinfection and the Fight to Save Lives, that recounts the history of treatment of water with chlorine. Chlorination is widely acknowledged to have save more lives than any other single health practice. The book is a good read for the quarantine.)

There is a proverbial curse (possibly, but not likely, Chinese) that goes, “May you live in interesting times.” All I can say is, if you’re living in interesting times, better for you if you’re doing so as part of a community that believes in public health.

Thanks for reading.