Dr. Richard Feldman: There’s a horrific price to pay for reopening too early


Dr. Richard Feldman“The biggest business question before the businessmen of today is the business of public health.” This was written over a century ago by the father of Indiana public health, Dr. John Hurty.

Hurty was the Indiana state health commissioner who shepherded Hoosiers through the 1918 influenza pandemic and other outbreaks. His words are as applicable today as then. Health is the foundation of our nation’s strength. Without health, we have nothing.

The Trump administration’s scientific experts formulated excellent guidelines for reopening the economy. But President Trump encourages anti-shutdown protests. Elected officials and others who place business interests and individual liberties before the public’s health and press to prematurely reopen the economy should heed Hurty’s words.

Mitigation through stay-at-home orders and other related strategies are essential and currently our only defense against COVID-19. We must stay the course until it is reasonably safe to reengage in some semblance of normal life and business. We lack a functional coordinated federal-state partnership and federal leadership in advancing adequate testing and personal protective equipment procurement and distribution.

There are three end-of-crisis scenarios: First, the virus fades away with warmer weather, much like influenza, giving a much-needed reprieve until other medical advances are developed. This will probably not occur with an extremely infectious virus for which humans have no experience. Also, the virus has proven to spread with facility in foreign countries during warm weather.

Second, the pandemic eventually ends when there are enough COVID-19-recovered people to provide “herd immunity” protecting those nonimmune. This scenario would be costly in human life—a certain result of prematurely relaxing shutdowns.

Third, although 12 to 18 months away (possibly sooner), a vaccine is developed. It’s a far-off horizon given our current situation. Then, massive production and tiered-risk-group administration will be necessary. It’s astonishing how much of our society is vaccine-apathetic or anti-vaccine. People might better appreciate vaccinations after this crisis.

Reopening the economy should occur only after a sustained period of dramatic downward levels of disease activity and when wide availability of rapid testing exists for both current infection and immunity. This will enable us to feasibly move from mitigation to containment through testing, contact tracing and isolation/quarantine of those affected.

Some concerns: Many states are simply reopening too early. There could be a horrific price to pay with deadly viral resurgences resulting in greater human and financial losses. Wide COVID-19 testing availability, the lynchpin to safe economic reopening, is still extremely limited and reliability of the results is questioned. Contact tracing is labor-intensive; local health departments don’t have the financial or human capacity to perform this function and will need unprecedented levels of support.

Hopefully, elected state officials have learned a lesson and will increase the cigarette tax and adequately fund public health programs and infrastructure.

The reopening of our economy and return to normalcy will be gradual, regional and business-sector specific. Additional natural waves of disease are likely. Also, as mitigation is relaxed, there will certainly be increases in cases and mortality again.

What is an acceptable level of increase? Are we emotionally prepared to venture into our world with a continued significant COVID-19 threat?

This crisis will resolve with development of an effective vaccine. Meanwhile, what we desperately need is a good dose of competent, rational, compassionate, consistent and intelligent presidential leadership.•

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