Wednesday, September 30, 2020

Unintended Consequences


The other day I attended yet another Zoom meeting.  

In my province the Ministry of Health acknowledged from the beginning that there while there may be an outbreak of viral infection (COVID-19)  in the province and that the province believed that the province may be required to take some action, there was the probability that some "unintended consequences" may occur, and the province had an obligation to monitor  them and their potential impact.

One can take this at face value or consider it as some obscene rye joke.  To be fair and give credit where credit is due, I think you have to give them points for good intention and for having the foresight to acknowledge that there may be some negative (and maybe some positive) unanticipated outcomes when you decide to shut down a jurisdiction of some 5 million peoples. 

So we are now into the ninth month of this outbreak, and it has spawned what I think many would call the most egregious Satan’s baby of all times.  

Public Health folks and the Politicians and the media decided to focus on the weakest of all catchphrases of all times, clearly not understanding what any of it meant.  Flatten the Curve.  Surely someone understood that “Flattening the Curve” means “don’t let the caseload  peak, even if we have to extent the period of activity”. I know with absolute certainty that the docs understood this.   Probably so did some of the politicians.  But for politicians it is easier to sound wise that to actually be wise, and so off they ran with “Let’s Flatten the Curve… We’re all in this together” and not bother to know, explain or understand the downside risk of pushing too early.

So I argue the First Unintended Consequences of trying to Flatten the Curve, was the tragic shutting down the province, killing business and community spirit, all the while ensuring, indeed  guaranteeing that the outbreak would stay on and on. 

And what about Unintended Consequence number 2?  How about when you try to pretend that you can treat the whole province like a big hospital and use precautions (the other catchphrase that politicians love - PPE) that are intended for intensive care units.  By using them in all shops and in the streets of all the villages and cities, you end up finding that, just as they barely work  in the hospital, they don’t work at all in the street. 

What the public is apparently unaware is the tragic reality that every intensive care unit (ICU) in the world bounces from one outbreak to the next.  Despite all the gowns and gloves and masks and booties and caps, the secondary infections happen in ICUs all the time.  Infection spreads all the time.  They never stop.    C. difficile, MRSA, VRE, Klebsiella, Pseudomonas, pneumonia, diarrhea, …. over and over and over.  

So if all this protective gear barely works when used by knowledgeable, experienced healthcare professionals in confined specific spaces of single purpose, why would anybody think they would work just fine in the hands of uninformed amateurs?  

As for Unintended Consequence number 3, when you shut down businesses, and travel, and communities, and religious gatherings, people become isolated and scared, and angry and depressed.  Some people get into bad activities like drinking too much alcohol, taking too many drugs, watch too much television, get into fights, harm themselves, harm others, over-eat, don’t exercise, gain weight, don’t take care of their health.   And children (of ALL age groups)  stop learning. 

Did our leaders really think this through at all, or are all these just more unintended consequences?

So here is where we are now.  In this province of 5 million and 9 months in, we had about 8500 people who tested positive of which 880 ended up in hospital and 229 people died, most of who were elders living in nursing homes (another place where society has NEVER been able to contain outbreaks).   

Of the people who died the median age was 85(!) with a range of 44 to 104 years.  This is sad but the number is no greater than other years.  If they had not died from COVID-19, many would have died from strokes, or falls, or common colds, or influenza, or depression, or senescence because it was their time.   

To put the 229 number into context, over the same period we have had 1600 deaths by drug overdose, and 600 deaths by motor vehicle accidents.  And then there are some 23 deaths from avalanches and about the same for swimming pools deaths.  Maybe our leaders should require all people going into swimming pools wear goggles and water wings.  Probably as effective as wear an N95 mask.

So here is what we have learned. 

1.    People LOVE catchphrases, like superbug, flatten the curve, PPE and second wave and LOVE to scare themselves tragic.  Catchphrases allow people to sound so learned without actually having to know anything

2.    Leaders love to show how much they are in charge and how forcefully they can use their catchphrases, seemingly to no positive avail.

3.    People who are terrorized and traumatized by fear can be driven to show how compliant they can be,  but seemingly without much positive benefit.

4.    Pandemics can and do considerable harm to elderly vulnerable people, but no where in the scope of the damage that people  do to everything and everybody else with all their good intentions and forceful actions. 

5.    Hopefully we have learned that whatever we do the next time, let’s NOT do this again.

So I wonder if the first question is NOT what were the Unintended Consequences of our COVID actions, but rather, what were the INTENDED consequences and why did they fail so badly?