How Do We Defeat Covid-19?

 Like everyone else, I was very pleased and impressed to see Joe and hold yesterday’s ZOOM with the new task force that has assembled to deal with Covid-19. The group appears to include the medical and scientific experts that together can really develop and implement the proper and long-overdue plan.

There was, however, one member of the group whose presence was somewhat interesting precisely because he’s a physician who doesn’t happen to have any real experience or expertise in infectious disease. I’m referring to Atul Gawande, who holds a professorship at the Harvard School of Public Health, but in fact has spent most of his career writing some very interesting books about medicine and how we deliver medical care.

Back in 2012, Gawande spent a week or so hanging around the kitchen of a Cheesecake Factory restaurant and then wrote an article about how and why medical care could be improved and made cheaper if hospitals purchased equipment and managed their operations with the same degree of diligence which The Cheesecake Factory used to turn out all those lovely meals.

A couple of years later the Cheesecake Factory filed for bankruptcy, and it looks like the chain is about to go under again. I didn’t notice Dr. Gawande ever updated his idea that hospitals might learn better business practices from how these restaurants cook and serve their meals, nor did he say anything on his Twitter when Consumer Reports said the Cheesecake Factory serves the unhealthiest meals of any national restaurant chain.

I guess Atul Gawande has been added to the Covid-19 task force because someone needs to write an authoritative account of how this country did and didn’t deal with what may ultimately turn out to be the worst pandemic of all time. And if this is what Atul or anyone else is thinking of doing, let me give you a little tip.

The truth is that we don’t need a vaccine. We don’t even need a federal task force, as important as such a strategy appears to be. All we need (as if this is possible which it probably isn’t) is a culture which doesn’t regard public authority with a combination of fear, loathing and mis-trust. The idea that government should not be telling us what to do didn’t just start with Reagan in 1980 or Goldwater back in 1964.  We are the only industrialized country, perhaps because our industrial growth was so successful, that doesn’t take the role or responsibility of government seriously at all.

The one time that most of the country felt that a great crisis could only be solved with government intervention was when Roosevelt got elected in 1932. Despite Hoover’s claim that the economy was rolling along, industrial production was below 5% of capacity, local banks were all closed, and in parts of the country people were facing famine, the worst threat of all.

By 1936, however, the economy had recovered to the point that the GOP refused to endorse the New Deal in its political platform, setting itself up as a party that opposed every government program until the government started spending money to arm the country and its allies for World War II. The first Social Security check was issued in 1940. The last legal challenge to the Social Security Administration ended in 1949.

Countries like the Czech Republic, Ireland and Denmark have successfully controlled the virus because their populations have responded positively to lockdowns and other management program to maintain public health. These countries have also mounted energetic and sustained surveillance campaigns to make sure that social distancing rules and regulations are being observed.  

I live in a state, Massachusetts, which has tried, albeit with limited success, to impose comprehensive social distancing rules. But lately, Covid-19 cases have started ticking back up, and average daily death rates while low, are also moving back up.

This may sound rather draconian and hard to take, but I would have no problem finding some way to enforce a mandate against not just public, but large private gatherings as well. And both the flu vaccine and an eventual Covid-19 vaccine should also be required, personal choice be damned.

And if Atul Gawande wants to write another article about how we can learn better public health management practices from the private sector, he can go right ahead.

Is COVID-19 Social Distancing A Template For Dealing With Gun Violence?

For all the talk by physicians about gun violence, the only doctor in the entire United States who is actually doing something tangible to reduce this public health threat is Mike Hirsh, a pediatric surgeon at the University of Massachusetts Medical School in Worcester. He has been running a region-wide gun buyback which is now in its 18th year. The city of Worcester is now into its third year without having suffered a death from penetrating trauma, and while the buyback is certainly not the only reason for the city’s lack of gun violence, what Mike has really achieved is a remarkable degree of coordination and respect between physicians on the one hand, and uniformed services on the other.

If there is one thing about the public health and medical response to gun violence which I find wrong to the point of absurdity, it’s the refusal of both groups to talk about the fact that more than 80% of all gun injuries happen to be crimes. What I hear the gun-control medical groups and public health folks saying again and again are variations on the theme of ‘we need to do more research.’ What I never hear them saying is ‘we need to work with the cops to deal with the illegal use of guns.’

The story in Worcester is very different. The story in Worcester is that every year there is an active collaboration between doctors and cops to spread the word about gun risk which now occurs not just in the city of Worcester, but in more than 20 surrounding towns. It didn’t happen overnight. It wasn’t just a one-shot deal.  It took a year-after-year commitment on the part of white coats and blue coats to bring this about.

This year Mike Hirsh was named Medical Director for Worcester and has found himself in the middle of a new threat to community health which still doesn’t seem to be understood as a threat by Schmuck-o in the White House. But at least in Worcester and surrounding towns, a coordinated effort is being done to make sure that everyone who has to play a frontline role in responding to the COVID-19 virus knows what they have to do. Whether it’s responding to emergency calls, or organizing and coordinating facilities, or getting the word out via social media and other communication venues, the bottom line is that the Worcester hospitals have not experienced the kind of patient ‘crush’ that is happening elsewhere and creates serious roadblocks for dealing with this disease. In other words, the degree of citizen compliance seems to be having a positive effect.

Yesterday, the State Board of Health updated their numbers on viral infections and mortality and reported 8 new deaths in Suffolk County (Boston) and 2 new deaths in Worcester County. The population of both counties is roughly 800,000 and of course these number could change. But Boston doesn’t have anyone coordinating the activities of all medical and uniformed first responders, even though the city has 1,200 employees working for its Health Commission, Worcester has 28.

The more I think about how to implement and manage a social distancing strategy to deal with COVID-19, the more I think it’s what we should be doing about gun violence as well. After all, social distancing simply means that we take it upon ourselves to behave in a certain way based on an informed awareness of what needs to be done. Isn’t that what everyone should be doing in response to gun violence – behaving in a certain way with guns based on an informed awareness that guns represent a risk to health?

If the latest estimates are correct, the COVID-19 virus will begin to disappear after we suffer some 60,000 deaths. We suffer more than 100,000 deaths and serious injuries from guns, year after year after year. Maybe what Mike Hirsh is doing in Worcester for COVID-19 could become a national template for dealing with guns.