Given the current pandemic the images are concerning. Tens of thousands of people going to the beaches, walking the boardwalks, filling city parks, returning to restaurants and bars, and getting a haircut, and most without wearing a mask. And these are not the demonstrators who have come out and marched in front of city halls to protest shelter-in-place orders issued by mayors and governors. Are they brave, reckless, feed-up with being cooped-up, or do they know something we don’t know? To understand what may be motivating people to ignore health care warnings, we need to learn more about the COVID19 virus, something researchers have been doing at breakneck speed.
Three things should interest us in regard to reopening America and getting our economy restarted, while staying safe: risk associated with contagion, acuity/severity, and mortality. Regarding infection, we know that the virus is primarily transmitted by air and secondarily by physical contact. Thus the emphasis on wearing a mask, washing hands frequently, and social distancing. We also know that the chance of getting the virus increases based on the amount of time you spend around people with the virus and the number of people you are exposed to who have the virus. That’s why contained spaces, such as cruise ships, nursing homes, and food production plants have been hotbeds for spreading the disease and why activities that involve large crowds such as sport and music events and packed bars and restaurants are a bad idea for now.
A factor that influences the way people perceive risk is uncertainty, and one of the biggest unknowns is the true scope of the virus. Depending on the source, it’s estimated that two to ten times as many Americans may have the virus compared to the number of confirmed cases. And because the number of confirmed cases continues to climb (just over 2 million as I publish this article), that means that 4 to 20 million Americans may be infected. Obviously, the more people infected, the more likely it will continue to be spread.
It also doesn’t help that so many different tests have been developed and used to confirm cases, as we now know that some are more accurate than others. Thus, even though the CDC reports confirmed cases, these numbers include false positives and false negatives due to testing error. Data collection is a field of study unto itself and one that the CDC has a lot of experience with; therefore, they are working hard to standardize reporting procedures. Nonetheless, when people read that there may be problems with the numbers, they may lose confidence and assume the disease is not as prevalent or dangerous as medical experts contend. And of course, the problem is exacerbated when the President of the United States creates seeds of doubt by questioning the work of the CDC.
As regards severity, it’s estimated that roughly 80% of people infected by the virus are either asymptomatic (have no signs and don’t know they have it or can spread it) or have a mild case, such as fever, chills, muscle soreness, headache, sore throat, and diarrhea. Since these are also symptoms of seasonal flu, some people may believe or indeed have seasonal flu rather than COVID19. More serious cases, about 15% of those infected, will have severe muscle ache, fatigue, high fever, and shortness of breath. Additionally, the virus may attack other parts of the body, other than the respiratory system, and may cause blot clots resulting in heart attacks and death. If the symptoms continue, these individuals may need to be hospitalized. To put that into perspective, of the 2 million confirmed cases, about 1.6 million Americans will be asymptomatic or will have mild infection and about 300,000 will have a severe case. That leaves 100,000 potentially fatal cases.
That brings us to the risk of mortality. The actual percent of fatal cases is unknown as it changes based on the spread of the virus and the number of confirmed cases. That’s why the mortality rate has ranged between 4% and 6%. In the above example of 2 million cases, a 4%, 5%, or 6% mortality rate translates into 80,000, 100,000, or 120,000 deaths, a difference of 40,000 people between the low and high estimate. As I publish this article, with 118,000 deaths, the mortality rate, based on confirmed cases, is closer to 6%. However, if there are many more cases than are currently confirmed through testing, the mortality rate may actually be lower. For example, if there are 4 million rather than two million cases, then 118,000 deaths produce a mortality rate of 3%.
The term “herd immunity” refers to a population acquiring immunity when the majority have been exposed to and survived the disease, leaving few individuals left to contact the disease and possibly die from it. However, herd immunity doesn’t come into effect until 70% to 90% of the population has survived. If 90% of the U.S. population acquired immunity in this way (about 300 million Americans) it would come at the expense of 9 to 18 million deaths (assuming a mortality rate of 3% to 6%). That’s three to six times the number of deaths from all causes in the U.S. each year.
Sweden is one of the few countries allowing its citizens greater freedom to mingle, preferably with, but also without taking precautions in hopes that the population will acquire herd immunity. However, Sweden also has a much smaller population and fewer urban centers where people are rapidly exposed to the virus. Thus, the virus might spread, affording herd immunity, without creating a mortality rate as high as in the United States. In other words, it’s not an experiment we should be trying, at least in large cities and suburbs.
This gets us back to how people perceive risk. In a nation of 330 million people, 118,000 deaths are less than one half of one percent of the entire population (.0003). Additionally, whereas 6% of confirmed cases have resulted in death, 94% of people who have contacted the illness have not died. Thus many people may minimize the threat and believe that the stay-at-home orders and other preventive measures, such as wearing masks, are unnecessary. However, given how easily the virus spreads, epidemiologist see the problem differently. If precautions are not taken now, millions more Americans could contact the virus. This is worrisome because the contagion could happen rapidly, even faster than it has occurred so far and it would overwhelm the American health care system, probably resulting in an even higher death rate.
We’re at a unique turning point in fighting the virus and opening the economy back up. We can do it, as long as we’re committed as a nation to do it together. This will take three things. First, the majority of Americans must adhere to the CDC’s safety precautions of frequent, thorough hand washing, wearing a mask, and maintaining at least six feet from each other when in shared spaces outside the home. Unfortunately, too many Americans are not heeding this advice. While the area you live in may not have a lot of reported cases, the more these guidelines are ignored, the more likely these safer areas can turn into a virus hotspot.
In part, the problem is that people want their individual freedoms but are unwilling to take responsibility for those rights. I like to think of wearing a mask and social distancing as an act of patriotism, because you’re doing it for yourself, your family, your community, and ultimately, for the health, safety, and progress of our country: the health of a nation is dependent on the health of its people.
Second, businesses must take responsibility for providing their employees and their customers with safe environments. That’s happening more and more as companies realize it’s good for business. For example, although Walmart is often criticized for its business practices, the company has taken a number of actions to make its stores safer including spraying carts with disinfectant, requiring that their employees wear masks, reducing occupancy, and marking the floors to encourage social distancing.
Finally, we need effective leadership from the executive branch. That of course, has not happened as Trump has responded erratically, making many decisions based on partisan politics; decisions which are rooted in his mental disorder. Fortunately, an increasing number of Americans are recognizing the need to follow the guidance of medical experts and not a mentally unstable television celebrity and real estate mogul.
We are at war against a virus that is killing our citizens and crippling our economy. That requires working together to defeat the enemy. So far, we haven’t been too good at this as the United States has become the country with more cases and more deaths than any other nation. Many Americans still don’t think the COVID19 pandemic is a significant problem and are unwilling to accept personal responsibility for their actions. That could be very costly.
 The majority of Black Lives Matters protesters appear to be wearing masks.