There are far more qualified, experienced, and articulate people who can communicate this message better than I ever could–some have even written excellent articles on this subject–, but I can no longer keep silent amidst the flat-out foolish and blithe attitudes that some people are having about the advice to engage in social distancing in the age of a small but demonstrably powerful virus. So, this is me adding my voice to the chorus of experts and well-informed citizens urging all of us to CANCEL EVERYTHING and STAY HOME.
But first, a story.
There is a story in the book of Genesis in the Old Testament about a man named Noah who received a warning from God that the earth would be destroyed by floodwaters and that, to prepare, he should build an ark for him and his family and all the living creatures of the earth. In Genesis, Noah is described by the writer as “a righteous man, blameless in his generation“, which led ancient interpreters reading the story many, many years later to conclude that Noah must have been a prophet. Ancient interpreters reading the text also concluded that Noah must have warned people other than his family about the impending flood because of a passage early in chapter six that said God’s Spirit wouldn’t always “abide” with humanity and that “their days shall be one hundred twenty years“. In other words, Noah had to have been a prophet who told his people that they had 120 years to get their act together or (cue diabolical music) TUN-TUN-TUN! Why else would the writer have described him as “righteous” and “blameless”? The text gives nothing else away about Noah’s life.
(Interestingly, a plain reading of the text shows that the writer of Genesis does not refer to Noah as a prophet at all. Neither does the writer state that Noah warned his community about the flood. In fact, the passage about 120 years precedes the story of Noah himself and there is nothing in the text to indicate that God communicated the 120-year deadline to Noah at all. Those two ideas–that Noah was a prophet and that he preached a message of warning to his people–were inferred by ancient interpreters like the writer of Hebrews and Clement of Alexandria, and this way of reading the story of Noah has persisted to this day.)
A lot of Christians read this story literally. I am not one of those Christians, but that is a subject for another day. However, briefly, I will say this: I do not need this story to be historically accurate to believe in God or to be a Christian. I also think that if you need God to be as wrathful and malevolent as He is portrayed in this story in order to believe in Him (and, no, I don’t think His mercy toward Noah cancels any of the “angry God” stuff out), that says a lot more about you than it does about Him. But I digress.
Back to the story.
Some years after God’s warning to Noah (and, presumably, Noah’s warning to his community), the floodwaters came and destroyed every living thing on the face of the earth–just like God said it would.
I share this story not to be an alarmist or to tell you that God has sent us the coronavirus to punish us, but to stress that we are living a similar predicament today. There is a flood of infection of meteoric proportions that is coming for us—that will drown us in preventable deaths and probably greater social and economic collapse—if we do not get in that ark now, so to speak, and socially distance ourselves from each other. We are being warned by doctors on the ground, by experts in epidemiology and infectious disease, by the World Health Organization, by our public health officers, by statisticians, by our governments about the horrifying but very real consequences of going on about our lives like everything is normal in the middle of a global pandemic that is threatening to destroy the very fabric of our societies.
Everything is NOT Normal
It is NOT normal for over 4,000 Italians to die of infectious disease from a virus in one month. On February 20, 2020, there were three confirmed cases and zero deaths in Italy. As of the date of this writing, on March 20, 2020, Italy stands at 47,021 cases and 4,032 deaths due to Covid-19, the disease caused by SARS-Cov-2. Just five days ago, on March 15, 2020, Italy had 24,747 cases and 1,809 deaths, which means the numbers have nearly doubled in less than a week (with no signs of plateauing). To put this in perspective, according to data collected by the Italian Association of Biotechnologists, there were 812 cases requiring Intensive Care Unit (ICU) hospitalization and 205 deaths in the span of 33 weeks in Italy between October 8, 2018, and May 20, 2019, due to influenza. If you want to talk about scale, there is virtually no comparison between Covid-19 and the seasonal flu in terms of hospitalization and mortality rates.
In the Province of British Columbia, where I live, we now have 348 confirmed cases as of today and 22 hospitalizations. Just last week, on March 13, 2020, we had 64 cases. Only three days ago, on March 17, 2020, we had seven hospitalizations. What this means is that in just one week, the number of cases in our province has grown over five times and that the number of hospitalizations has increased by three times in just three days. When you consider that these are only official cases reported by the provincial health authority and not true cases, I would hope that these numbers would have a sobering effect on people.
B.C. started reporting new daily cases in the month of March. Below is what has been reported to date:
March 3 – 12
March 4 – 13
March 6 – 21
March 7 – 27
March 9 – 32
March 10 – 39
March 11 – 46
March 12 – 53
March 13 – 64
March 14 – 73
March 16 – 103
March 17 – 186
March 18 – 231
March 19 – 271
March 20 – 348
Every day since the beginning of March, the number of cases appear to be growing by an average factor of roughly 1.3. That might not seem like a big number, but when you consider that we are now working with triple digits, it won’t take long before we are into the thousands. At his rate, we will have 13,702 cases ((1.3^14 days) x 348 cases today) by April 3, 2020. That is two weeks from now. Today, we are where Italy was one month ago. (In fact, if you look at Italy’s numbers, it took them two weeks to go from 322 cases on February 25 to 12,462 by March 11.)
Some people will point out that the majority of Covid-19 deaths in Italy and elsewhere are among the elderly, an already at-risk and vulnerable population susceptible to disease, and that healthy, younger people shouldn’t worry. In other words, tell the high risk people to engage in social distancing and self-isolation, and leave the rest of us to our regular lives to keep the global economy going. (Excuse me while I ignore the fire burning my house down.)
It is an understatement to say that this misses the point entirely. Working as a paralegal in litigation, I am constantly thinking about second-order effects. In other words, whatever I do on the file now–how I manage the documents, what documents I ask for, how I analyze the evidence, etc.–has consequences, usually for trial. As a result, my job requires me to think ahead in addition to thinking about what is happening now.
People who compare coronavirus to the flu and downplay its severity focus a lot on individual mortality rates. Yes, a bunch of people die of the flu each year, usually the elderly, and the coronavirus seems to be no different in following the pattern of excess mortality among the aging population. You’re young. You go to the gym. You’re vegan, for crying out loud, so your risk of dying is low if you catch SARS’ evil cousin. The thing is, mortality rates, although important, are not the numbers to be focusing on when we talk about social distancing in the age of coronavirus. Hospitalization rates are. The impact of coronavirus on hospitalization rates are the second-order effects we must pay attention to.
Data from China, the first site of infection, shows that 20% of Covid-19 cases are severe enough to require hospitalization. Currently, less than 10% of Covid-19 cases in B.C. are in hospital ((22/348)*100 = 6.32%), but that number is bound to grow. (In the US, the hospitalization rate now stands at 12%, according to the Centers for Disease Control and Prevention.) If, in two weeks, 20% of 13,702 cases require hospitalization, that means 2,740 people will need beds. According to the Province, there are 2,398 acute beds right now, and that is after the government cancelled non-urgent elective surgeries a few days ago. (And this is just hospital beds we are talking about, not even essential medical supplies like masks, personal protective equipment, and ventilators.) That leaves almost 350 people in hallways, makeshift hospital rooms, etc. Let’s not forget that there are many non-Covid-19 patients already occupying hospital hallways at any given time and that people obviously have non-Covid-19 related reasons for requiring medical attention in the hospital, like being involved in a major car accident or cancer. A surge of Covid-19 patients in our hospitals exposes those in hospital without Covid-19, both workers and patients, to infection. It also exposes healthcare providers to burn-out, increasing the risk of medical negligence (because nobody can get any sleep and they’re all stressed to the max) and even death, among Covid-19 and non-Covid-19 patients alike. If Italy is any indication of what we can expect here (and we should hope not), our healthcare workers will be forced to make morally difficult and traumatizing decisions about who and who not to treat. The Hippocratic oath of “First, do no harm” will be reserved for younger people and those without underlying conditions. As a result, the increase in hospitalizations combined with scarce medical resources will have the unintended consequence of increasing the rate of death. Anyone who thinks that this is our hospitals’ problem doesn’t know what it means to be socially responsible or realize that overrun hospitals will only contribute to the problem of viral spread within our communities, leading to a public health crisis that inevitably drains the workforce and workforce productivity. (And, no, herd immunity is not a good strategy, not when we still know very little about this virus and our knowledge of SARS-Cov-2 keeps evolving.)
To the Coronavirus, You Are Not Special
Even if you are young and healthy and have mild symptoms of Covid-19 (or what you self-diagnose as “just the flu“), and you feel like you can kick this virus in the ass in a week, that doesn’t mean that you won’t unknowingly or accidentally spread the virus to someone who cannot fight it like a rock star like you when you do not engage in social distancing. That person may not be elderly. They could be a young waitress serving you food at a restaurant (that shouldn’t be open right now) with an underlying condition neither of you know about, likely pre-disposing that waitress to critical care. They could be a physically fit client in their 40s with diabetes and asthma diagnoses they haven’t told you about because nobody broadcasts their medical history like it’s the six o’clock news. They could be your spouse, who has no underlying medical conditions but, for whatever reason, will become part of the (smaller) group of individuals who die of the virus anyway. And of all the people you infect under the age of 55, 40% will require hospitalization. When you consider how many people are infected through your transmission of the virus and how many people those people infect and so on and so forth, and the percentage of people requiring hospitalizations across all age groups, you begin to understand why it is absolutely imperative that we appreciate the pattern of exponential growth that is at play here. At this point, it is not a stretch to say that the burden on our already understaffed, underprepared medical systems would be colossal, with catastrophic results. Think about the last time you were in the emergency room and how long it took you to receive medical care. That was life without Covid-19. Just last night, I was speaking with my cousin who is a doctor in Los Angeles and he was telling me how his hospital has precious few medical supplies to support a surge of Covid-19 patients. This is not hyperbole. Without social distancing, the breakdown of our hospitals is a very real probability.
But what if you don’t have symptoms? Why should you be mandated to stay at home when you are perfectly fine? OK, what if you don’t have symptoms and decide to party like it’s 1999 on a beach in Florida, but then you connect with someone who doesn’t disclose they have mild symptoms because they think it’s “just a cold” and their “freedom” is more important to them, and then you are infected? Or what if you are out in a bar or a club or a church, throwing caution to the wind, and you catch the virus from someone who is growing it in their system but they don’t even know it yet. (Recent reports indicate that asymptomatic transmission may be contributing to viral spread. In fact, in Iceland, everyone of its citizens can get tested for Covid-19 and current results indicate that half of the people who have tested positive reported no symptoms.) How many times have you caught the cold or the flu and knew exactly who you caught it from? My point is that just because you don’t have Covid-19 now, doesn’t mean you won’t get it when you don’t socially distance yourself from other people. There is nothing about you that makes you immune to this virus. It is novel precisely because no one has gotten it before. (Of course, except for those who have it now or have had it since this all started.) And when you do get it, you may have already infected an untold number of people by the time you self-isolate. Don’t be Patient 31 in South Korea. Nobody is going to think you are a hero. In fact, they’ll probably want to sue you.
Get Over Yourself
Maybe you’re one of the people who thinks that there are one too many “what ifs” and you can’t live your life in fear. I totally hear you. The thing is, this is not about you or me. It is not about my stock portfolio or my cancelled trip to California for my cousin’s now cancelled wedding or the fact that WestJet didn’t even give me a refund, only an airline credit. It is literally about us. It is about our friends, our parents, our grandparents, our families, our communities at large, our healthcare workers, our society as a whole. It is about reclaiming our lives before Covid-19 started using all of us as photocopy machines, by making the extreme sacrifices now. I do not doubt that there has been a flood of disappointment and anxiety because of what this virus requires us to do—to stay apart and stay away, even from the jobs that pay us the money to live—, but the cost of staying together right now in our petri-dish-like communities is proving to be much greater. If there is anything that China, Iran, South Korea, and Italy should have taught us by now, it is that mass contagion is very real when people don’t take aggressive action to mitigate spread. Consideration for the risk of systemic collapse (because we truly are all in this together) must take precedence over our individual risk levels. And, in these unprecedented circumstances, consideration for the system also requires our governments and business leaders and employers to step up in ways like never before.
I suppose we will never really know if all of the quarantines and lockdowns and social distancing guidelines are “overreactions” (although, history, biology, and math suggest they are not), but do we really want to find out? Do we really want to wait until we’re past the edge of the precipice to make these drastic changes? Do we really want to wait until the rain falls and it’s too late to get in the ark?
Don’t wait. Cancel everything now. Listen to the people who are telling you to wash your hands with soap for 20 seconds fifty million times a day while you sing ‘Happy birthday’. Don’t ignore the experts who say that social distancing is the best way to mitigate the spread of SARS’ evil cousin.
And stay away from each other until we flatten that curve. If there was any time for social media to shine and to keep us connected while staying apart, it is now.
P.S. Everybody needs to stop hoarding and panic buying, especially toilet paper. We are not being quarantined in the woods, folks. Please think about your neighbours. And remember that our neighbours include the brave healthcare workers going into battle against this virus and that they could use essential supplies, too–maybe more than the rest of us.
UPDATE: As of March 21, 2020, B.C. now has 424 confirmed cases and 27 people are now in hospital. When I calculated the average daily growth factor of 1.3, I came up with 452 cases for today. To my shock, the math was not far off. This is not math that anyone wants to be right about. I understand there is a testing backlog that apparently explains the spike in cases. Only time will tell if the number of cases continue to rise at this rate even after the backlog is cleared. In any event, please take this seriously and engage in social distancing NOW.
Comment Rules: This post contains some content and reflections that may be disagreeable to some. By sharing online, I recognize that I am making myself vulnerable to all sorts of responses. If you disagree with any of today’s content and wish to comment, you are welcome to do so, but please be respectful. – J.