We Are At The Mercy Of Our Own Behavior
November 19, 2020
Ricardo Maldonado, M.D.
by Ricardo Maldonado, M.D.
With Thanksgiving just a week away, we need to remind ourselves that we are in a very dangerous situation this holiday season. As a country, we are at a breaking point in the COVID-19 pandemic. In the past few weeks, there were several days in which we lost over 1,300 Americans every 24 hours. That is like four 747 passenger planes c crashing to the ground every day. Obviously, whatever we are doing as a country to stop COVID-19 is not working.
Most experts are warning about a deadly winter season. We must understand that COVID-19 has set records in many ways lately. The number of cases has increased most days as has the number of hospitalizations. Mortality from COVID-19 has even increased in the past few weeks. And our nation’s health care system is fragile heading i into the holidays.
Meanwhile, at EAMC, we have had a COVID-19 census of over 30 patients for 8 days straight, including 34 today which is the most in more than a month. The difference now is the unknown that lies ahead. Will people be gathering with extended family and friends for Thanksgiving, and then for Christmas parties? If so, we’re surely looking at continued increases in community cases followed shortly thereafter by an increase in hospitalizations. Is that how we want to remember the holidays of 2020?
The race for a COVID-19 vaccine has been an unprecedented and incredible effort, and we already have two vaccines showing better than 94 percent effectiveness. Hopefully, they will receive Emergency Use Authorization (EUA) from the FDA in the next weeks. Many steps in the vaccine process took place concurrently, so that is how we have arrived at this step faster than normal. It’s not because steps were skipped.
This is great news, but by the time vaccination begins—likely no sooner than mid-January—it will be too late to make much of a difference for this winter. We vaccinate for the flu in October and November so that our bodies are prepared to protect us over the peak of the flu season.
Medications and other therapeutics for COVID-19 are somewhat better now than eight months ago, but so far we do not have a true “game changer” treatment available. Basically, we are at the mercy of our own behavior to avoid another peak. It is up to us to control the pandemic in this crucial moment.
The big difference now for EAMC, compared to the first peak when we started at zero COVID hospitalizations and jumped to 54 in less than a month, is that the peak we are expecting in December or January, is starting with our census already in the 30s. If we do peak again—as some hospitals elsewhere are already doing—it could be devastating to our local health care system. And it could be devastating to our family, friends, schools, and the economy, even if the economy is not mandated to shut down.
Our COVID-19 positivity rate at EAMC was 12.6 percent last week, and is at 13.2 percent so far this week. Those are the highest positivity rates we have seen since late September, and that’s concerning. If we mix those with the current hospital census, we are brewing a recipe for a potential disaster this winter that could be even worse than April or July when we had COVID peaks of 54 and 62 patients, respectively.
This holiday season could be the deadliest in our nation’s history if we do not make good decisions in the days and weeks ahead.
People continue to talk about herd immunity as a possibility for reducing the pandemic’s power. Herd immunity is thought to be achieved when between 50 - 70 percent of the population have been infected with the virus. Our nation’s hospitals—or, more specifically, hospital staff members and physicians—have been overwhelmed with the relatively small number of COVID cases compared to our U.S. population of 300 million.
We are nowhere near herd immunity and it is unrealistic to consider. Increasing cases only means more hospitalizations and more deaths. We don’t want to lose our parents and grandparents this holiday season, so it is really up to us what happens next. Using good behavior and making good decisions will save lives. And the opposite is true as well.
Many hospitals in the U.S. are already overwhelmed. Here at EAMC, we have been in a red census for many days over the past few weeks. A red census means that many of our units are full and other units are near capacity. Our healthcare workers have seen the devastation of COVID-19 for months and they are more than tired; they feel discouraged at times, as if their efforts in the earlier peaks were in vain because we appear to be headed back to square one.
As I have mentioned in previous updates, we went from a sprint race to a marathon in April without catching a break and now we expect an even more challenging situation—going from an exhausting marathon into a sprint race. It is coming and we are preparing mentally and logistically for it.
We need everyone’s help now more than ever. We have allowed politics to divide us during the worst pandemic of our history. The election is behind us, but the challenges we face are not. It’s time for our response to this pandemic to bring us together again.
Ricardo Maldonado, M.D. is an Infectious Diseases specialist and is the sole practitioner with East Alabama Infectious Disease. He joined the medical staff at EAMC in 2009. Dr. Maldonado is leading the clinical response to COVID-19 at East Alabama Medical Center.
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