Dr. Dabbs: Possible COVID-19 Outcomes & Why Testing Isn’t the Answer

This is Part 9 in our “Front Lines” series with Dr. Will Dabbs. Before reading on about COVID-19 outcomes and testing, be sure to check out the other parts in the series.

Do you remember Near-Earth Object 2019 OK? This rogue asteroid was about 100 meters across and screamed past Earth last summer some five times closer than the moon. We detected it a mere 24 hours prior. Had it connected, 2019 OK would have punched a crater 50 miles across and wreaked incalculable mischief with the atmosphere.

How about the famed Yellowstone earthquake swarm of January 2010? Over the course of about one month some 1,620 earthquakes shook the Yellowstone region. The last Yellowstone caldera-forming eruption purportedly occurred 640,000 years ago and was 2,500 times more powerful than the Mount St. Helens explosion. These volcanic episodes cycle roughly every 600,000 years, so we’re due.

And then of course there was the Gorakhpu Japanese encephalitis outbreak of 2017 in Uttar Pradesh, India. This vile pestilence claimed the lives of 1,317 children. A total of 30 kids died when the BRD Medical College hospital’s oxygen supply was exhausted over unpaid bills.

You likely haven’t heard anything about these horrible things; that’s because none of them exploded into something like COVID-19. Every single day our species faces some potential existential threat. If we threw a zillion dollars at every grouchy volcano, transient asteroid, or dread disease we’d soon be squatting in caves wearing animal skins. There is no way government, any government, could really protect a freedom-embracing society such as ours from the ravages of SARS-CoV-2. Sometimes life just sucks.

Peering Into the Darkness

We wrecked the economy of the entire planet and sat quivering at home for three months. Along the way, 20 million Americans lost their jobs. Meanwhile, 100,000 died; that’s one in every 3,200 U.S. citizens thus far. In less-developed places folks could quite possibly starve. Now what?

We Americans never do anything half way. As I type these words, lakes, beaches, and parks are packed for Memorial Day weekend. People sort of socially distanced, but their hearts weren’t in it. What might tomorrow hold?

As today’s topic is predicting the future I’ll take a shot. I see two possible outcomes. The first outcome is that nothing much happens. Most of the folks out doing stuff are young and healthy. This cohort is disproportionately spared by this creepy disease anyway. If a month from now our hospitals are not unduly challenged and we’re all wondering what all the fuss was about, then great. I guess we should have sequestered the elderly and the sick but left everybody else to go about their business, albeit carefully.

The other, darker possibility is that we’re all doomed. If two weeks from now we are inundated with new COVID cases even in rural spaces then it is indeed the End of Days. We do live in interesting times.

There’s Something Big Here That We are Still Missing

Why did the two octogenarians on dialysis develop COVID-19, run fever less than 24 hours, and then walk out of the hospital? By contrast, why did the 45-year-old triathlete spend two weeks clinging to life in the ICU on a ventilator? Why does this thing bypass children like the Death Angel at Passover?

How come SARS-CoV-2 slithers into nursing homes and gets absolutely everybody whether they are young or old, staff or patients, healthy or sick? It’s like tornadoes and trailer parks. Something about this feels strangely illogical. However, really smart folks will be studying this accursed thing for decades to come.

N95 Nightmares

An epiphany recently hit me: I might spend the rest of my professional career rocking that wretched N95 mask. I absolutely despise that thing.

I have tried maybe five different sorts thus far, but I am cursed with a big head. Only one of the lot doesn’t feel like it is going to burst my nugget like a grape. I can do any of them for an hour. However, pulling a full shift is pretty hideous.

Forget waterboarding. The next time we need information from some excessively hirsute terrorist we should just strap one of those soul-sucking rascals to his snout and wait patiently. He’ll sell out his own mother to be rid of that thing.

Is COVID-19 Testing Really the Answer?

As I type these words, COVID is just finding its stride in Yemen. Five years’ worth of civil war in Yemen have already resulted in 100,000 deaths, as well as a proper famine. The WHO’s immediate suggestion was more COVID-19 testing.

It’s not that these folks don’t have ventilators. The Yemenis don’t have Band-Aids. What difference is half-a-million COVID tests going to make? They need running water and soap, not a truck convoy’s worth of nasal swabs.

In the U.S. we tested 43 out of every 1,000 Americans. By contrast, in Japan they tested two per 1,000. About 30 Americans out of every 100,000 have died from COVID-19. In Japan that number is 0.66. I can’t see testing as the limiting reagent here. Where I live and work COVID-19 testing is simply a distraction. Symptoms or known exposures equal quarantine; that’s what works.

COVID Hindsight

I would love to have been able to draw from some massive national stockpile of PPE in the opening weeks of the COVID epidemic. I’d like to have bought Amazon at $18 per share back in 1997 as well. Hindsight is invariably acute.

We had this splendid opportunity to rally against a common enemy. However, SARS-CoV-2 had the poor grace to show up during an election year. The grass hasn’t sprouted atop all the fresh graves, and the partisan hacks have made political hay out of this disease.

Wonderful folks sent us cookies, handmade masks, face shields, and what PPE they could spare. A sweet lady sewed the coolest headbands with buttons so our N95’s don’t gnaw into our ears. People are awesome.

By contrast, the political reptiles who have weaponized this crisis not so much. I’m not sure what the right answer is here, but it is definitely not congressional hearings — that’s distracting for those of us who have real work to do.