POWELL: Overlooked telling details invite virus policy rethink

Published on Wednesday, 25 November 2020 20:02
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By CHRIS POWELL

Amid the growing panic fanned by news organizations about the rebound in the virus epidemic, last week's telling details were largely overlooked.

First, most of the recent "virus-associated" deaths in Connecticut again have been those of frail elderly people in nursing homes.

Second, while dozens of students at the University of Connecticut at Storrs recently were been found infected, most showed no symptoms and none died or was even hospitalized. Instead all were waiting it out or recovering in their rooms or apartments.

And third, the serious case rate - new virus deaths and hospitalizations as a percentage of new cases -- was running at about 2%, a mere third of the recent typical "positivity" rate of new virus tests, the almost meaningless detail that still gets most publicity.

Recognizing that deaths, hospitalizations, and hospital capacity should be the greatest concerns, Governor Lamont last week recalled that at the outset of the epidemic he had the Connecticut National Guard erect field hospitals around the state and that 1,700 additional beds quickly became available but were never used. This option remains available.

The governor's insight should compel reflection about state government's policy on hospitals - policy that for nearly 50 years has been, like the policy of most other states, to prevent their increase and expansion.

The premise has been the fear that, as was said in the old movie, "if you build it, they will come" - more patients, that is. The demand for medical services, the policy presumes, is infinite, and since government pays most medical costs directly or indirectly, services must be discreetly rationed - that is, without public understanding - even if this prevents economic competition among medical providers.

So in Connecticut and most other states you can't just build and open a hospital; state government must approve and confer a "certificate of need." Who determines need? State government, not people seeking care.

Of course this policy was not adopted with epidemics in mind. Indeed, in adopting this policy government seems to have thought that epidemics were vanquished forever by the polio vaccines in the 1960s.

Now it may be realized that, while epidemics can be exaggerated, as the current one is, they have not been vanquished and the current epidemic - or, rather, government's response to it - has crippled the economy, probably in the amount of billions of dollars in Connecticut alone.

That cost should be weighed against the cost of hospitals that were never built. Maybe they could have been built and maintained only for emergency use, and an auxiliary medical staff maintained too, just as the National Guard is an all-purpose auxiliary.

Also worth questioning is the growing clamor for virus testing. The heightened desire for testing in advance of holiday travel is natural, but testing is not so reliable, full of false positives and negatives. Someone can test negative on Monday and on Tuesday can start manifesting the virus or contract it and be without symptoms.

Testing may be of limited use for alerting people that they might well isolate themselves for a time even if they are without symptoms. But people without symptoms are far less likely to spread the virus than infected people who don't feel well.

Only daily testing of everyone might be reliable enough to be very effective, but government and medicine are not equipped for that and it would be impractical anyway. Weekly testing of all students and teachers in school might be practical and worthwhile but terribly expensive, and only a few wealthy private schools are attempting it.

Contact tracing policy needs revision. Nothing has been more damaging and ridiculous than the closing of whole schools for a week or more because one student or teacher got sick or tested positive. As the governor notes, because of their low susceptibility to the virus, children may be safer in school than anywhere else.

Risk for teachers is higher but they also are more likely to become infected outside of school. They might accept the risk in school out of duty to their students, whose interrupted education is the catastrophe of the epidemic.

Meanwhile the country needs two vaccines - one against the virus itself and one against virus hysteria.

Chris Powell is a columnist for the Journal Inquirer in Manchester.



Posted in New Britain Herald, Columns, Editorials on Wednesday, 25 November 2020 20:02. Updated: Wednesday, 25 November 2020 20:04.