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When Will the Chaos End?

  • Joseph S. Alpert
    Correspondence
    Requests for reprints should be addressed to Joseph S. Alpert, MD, 1501 N. Campbell Avenue, Tucson, AZ, 85724-5037.
    Affiliations
    Professor of Medicine, Department of Medicine, University of Arizona, Tucson

    Editor in Chief, The American Journal of Medicine
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Published:November 25, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.11.004
      Here in the United States and throughout the world, we are engulfed by a crisis bigger and more devastating than anything that has occurred since the Second World War. The death rate from coronavirus disease 2019 (COVID-19) infections and their complications in the United States, alone, is today (November 23, 2020) more than 250,000 and rising rapidly. Before long, we will pass the number of Americans who died in World War II. In that conflagration, 405,399 of our countrymen and women died as a result.

      United States military casualties of war. Available at:https://en.wikipedia.org/wiki/United_States_military_casualties_of_war. Accessed November 15, 2020.

      Given the current COVID-19 mortality rate in the United States, we should exceed the latter number sometime in the coming months. Thus, we are engaged in a war that is every bit as deadly and as terrifying as World War II. Heroes are rising on all sides: health care workers, police, fire fighters, sanitation crews, and a whole army of support personnel in every field of endeavor throughout the land. They show up for work, keep their masks on, wash and squirt their hands frequently, and hope that we will soon see an end to the misery and death that surrounds us. As noted in a previous editorial, I have spent much of my time this past 7 months in the hospital caring for patients who do not have COVID-19.
      • Alpert JS
      Life imitates art: the physician in a time of plague.
      ,
      • Alpert JS
      • Juneman EB
      We will never give up.
      Other diseases do not hibernate just because the COVID-19 is here, and many patients try to “tough it out” at home before being overwhelmed by their illness. At the hospital, we understand why sick patients are trying to recover at home. The answer is simple: fear of the contagion that is housed on our special COVID-19 floors. However, our staff has remained healthy without a case of hospital-acquired COVID-19 so far because of the meticulous employment of safety measures. I tell my patients that they are safer here in our hospital than when they go to any restaurant where a casual contact with someone could result in the virus being transferred to them.
      In the midst of the greatest world crisis since World War II, our country has suffered from remarkably poor leadership. The COVID-19 epidemic here has been attacked with a number of haphazard measures, opposed by many, with the result that the United States leads the world both in COVID-19 cases and COVID-19 deaths. As my friend, David Gergen, who worked for four different presidents, has said, “Presidents [need] to exercise wisdom and . . . help us to move steadily forward. They must work to keep the world on a stable, upward course, even as they fight off bouts of isolationism at home and resentment of American power overseas. They must manage a dynamic economy with a light hand, even as they seek to ensure that people left behind have more equal opportunities in life. They must be good stewards not only of the United States, but also of earth itself. Increasingly, they must make difficult decisions about technology and science that will transform the way we live.” I believe that future US historians will confirm that our current leadership has failed in the tasks outlined by Professor Gergen.
      • Gergen DR
      Eyewitness to Power: The Essence of Leadership, Nixon to Clinton.
      In the current state of chaos in the United States, what can be done to slow and eventually contain the evil forces of the COVID-19? Recently, professor of law at Georgetown University law school, Lawrence O. Gostin, JD, suggested 7 critical lessons to be taken seriously if we want to end the current tsunami of agony and despair.
      • Gostin LO
      The great coronavirus pandemic of 2020—7 critical lessons.
      First, build a resilient health care system that is responsive to independent public health officials with whom they work closely. And the system needs to be resilient enough to be able to expand rapidly in the face of health emergencies such as the current COVID-19 pandemic. Second, Gostin points out that, as already stated, informed leadership and public trust are essential to successful containment of an epidemic. I have already noted the immense failure of this factor here in the United States. Third, public health and science need to play a major role in informing leadership and assisting with plans for containment of the epidemic: “Despite remarkable, albeit incomplete, scientific discovery, populist political leaders have sown doubt about the value of science and have undermined public health agencies.”
      • Gostin LO
      The great coronavirus pandemic of 2020—7 critical lessons.
      The result of these policies has contributed to the deaths of thousands of our countrymen and women. Fourth, investment in biomedical research and development is constantly needed to fight the current plague and to prepare for the next one, and rest assured there will be a next one. Fifth, it is important for our country, containing a huge variety of diverse citizens, to reduce social, economic, and health inequities that have led to remarkably increased mortality rates in a variety of racial and low-paid minorities. Sixth, we need to adopt and accept evidence-based public health laws and safeguard the enforcement of these laws. Widespread refusal to adhere to these rules has led to uncontrollable spread of the COVID-19 in our country. The United Nations has opined in a Rule of Law project on COVID-19 that emergency health powers and rules should be based on evidence and used only when there are no less restrictive alternatives. And finally, seventh, the United States must fund and support robust global institutions that will work in concert to contain current and future epidemics. Withdrawal of the United States from the World Health Organization works directly against such global efforts to contain the pandemic. This withdrawal is not beneficial to any of us living in the United States today. Gostin concludes that we need to choose “science, the rule of law, and equity as core values” to fight effectively against the forces of the COVID-19. I could not agree more with Professor Gostin's comments. They are informed, rational, and based on what we currently know about the pathophysiology and epidemiology of COVID-19.
      It is my fervent hope that the new administration taking charge of our great nation in January will heed Professor Gostin's suggestions so that we can finally contain this terrifying viral onslaught and prepare ourselves for the next attack, whenever that might be.
      As always, I welcome responses to this commentary at [email protected] or on our blog, website, or Facebook venues.

      References

      1. Coronavirus (COVID-19) statistics. Available at:https://www.bing.com/search?q=What+is+the+current+COVID+death+total+in+the+US&form=ANNTH1&refig=6e42b28bfc5349ea98fb2b0d32151e2f&sp=-1&pq=what+is+the+current+covid+death+total+in+th&sc=0-43&qs=n&sk=&cvid=6e42b28bfc5349ea98fb2b0d32151e2f. Accessed November 15, 2020.

      2. United States military casualties of war. Available at:https://en.wikipedia.org/wiki/United_States_military_casualties_of_war. Accessed November 15, 2020.

        • Alpert JS
        Life imitates art: the physician in a time of plague.
        Am J Med. 2020; 133: 651https://doi.org/10.1016/j.amjmed.2020.04.001
        • Alpert JS
        • Juneman EB
        We will never give up.
        Am J Med. 2020; 133: 1111-1112https://doi.org/10.1016/j.amjmed.2020.07.002
        • Gergen DR
        Eyewitness to Power: The Essence of Leadership, Nixon to Clinton.
        Simon & Schuster, New York, NY2000
        • Gostin LO
        The great coronavirus pandemic of 2020—7 critical lessons.
        JAMA. 2020; 324: 1816-1817