(Guest contributor, Dr. Ben Chouake, M.D.)

President Donald J. Trump looks at diagrams and photos during his meeting with Florida Gov. Ron DeSantis Tuesday, April 28, 2020, in the Oval Office of the White House. (Official Photo by Shealah Craighead)

From Reaction to Informed Action

New, more accurate information on the prevalence of Covid-19 has changed the way America needs to approach the Pandemic.

Covid-19, like other coronaviruses and most other viruses, currently has no cure. There is also no vaccine; the earliest we might expect one is a year from now. And that is not a conservative estimate.

As of today, Covid-19 has no definitively effective treatment other than support for the symptoms. The “care cure” does its best to ensure, through the expertise of medical professionals and availability of lifesaving medical devices, pharmaceuticals and technology, that every person who can survive a virus like Covid-19, does survive.

Until now our best information was that the disease had a fatality rate of between 2–5% with a hospitalization rate about four times that.

It was this projected hospitalization rate of people needing the “care cure” that caused panic in the medical community due to lack of enough ICU beds, ventilators, and protective supplies.

Due to this immediate shortfall in medical facility capacity, the strategy was to slow the dissemination of the disease by social separation and a general shutdown of activity.

Fortunately the medical systems have quickly ramped up and are currently adequate to handle larger patient loads. Thus there is less need to restrict economic activity.

The virus, which is highly contagious, will eventually affect the vast majority of Americans. The ultimate solution to this disease is either the development of a vaccine (probably at least a year away) or herd immunity.

Recent random antibody testing gives us a better insight into the prevalence and complication rate of Covid-19. It appears that the real mortality of the disease is between 10–50 times less than originally modeled.

This means a morality rate of between 1 in 200–1000 and a hospitalization rate of 1 in 50–250. The original models of 1–2 million deaths in the United States were widely inaccurate and the current numbers are closer to the H1N1 flu of 2009.

Now that we have adequate medical facilities, no lives are being saved by restricting activity. However many lives are being lost by restricting activity. Best estimates are that every 1% increase in unemployment causes approximately 37,000 deaths per year.

Covid-19 is a terrible disease but our approach has to change given the new information and our enhanced medical capacity, lest our cure hurt us more than the disease. A cure can kill you if you take too much of it.

The morbidity and mortality of stalling the economy at this point is far greater than letting the disease pass through the system, which we are now able to handle as well as it can be handled. There is little benefit and enormous harm to keeping America closed for business now that every patient afflicted with Covid-19 will receive adequate medical care.

We now have several models to examine.

Of particular interest is Sweden. This country has kept its industry and economic engine intact and restricted activity for those at high risk while the rest of the population has been active and working. Allowing the working low-risk population to continue activity is making the nation as a whole less contagious.

The estimate is that herd immunity in Sweden is between 2–4 weeks away and the unemployment rate remains steady. They have social isolation only for the most vulnerable (the elderly and those with comorbidities) in the interim.

Random antibody testing in NY indicates 10–20 percent of the population in NYC has been exposed and is presumably, though not certainly, immune.

This means that activity except for the most vulnerable should resume and the sooner the virus passes through the system the better off we are. It will be painful in the short-term. But it may be better to endure short-term pain than delay the inevitable short-term pain with increased death rates from long-term unemployment.

We also need to continue working to improve the survivability rates for those most at risk of dying from Covid-19. We must discover why some patients do well while others become gravely ill.

For instance, the FDA needs to look at the relationship between Covid-19 and ACE inhibitor (angiotensin converting enzyme) medications and their close derivative ARBs (angiotensin 2 blockers).

An astounding 31 percent of fatalities occur in patients with either hypertension, diabetes, or cardiovascular disease. One common denominator in these three groups is this class of medication they almost all universally take. It is possible that the medication may open a body chemical site for Covid-19 infection.

Given the strong possibility these medications are making patients more vulnerable, further analysis should be initiated. Pending the results of further research, the FDA may wish to issue a recommendation for patients to discuss with their doctors the advisability of an alternative medication. This can in most cases be very safely done for at least 1–2 years until a vaccine is available or herd immunity established.

Press conferences can emphasize that no lives will be saved by stalling the economy now that the medical system is prepared for the disease. There will be some short-term increases in the disease, but in the long-term, many lives may be saved. The ability for America to thrive depends on our strength in adversity. We must push proactively through this with the best new scientific data available.

Many more lives will be lost by standing still than by forging through this as America has done since our founding.

(contributing writer, Dr. Ben Chouake, M.D.)

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