In mid-February, I spoke with the National Institute of Allergy and Infectious Diseases director Anthony Fauci on Sirius XM’s “Doctor Radio” about the potential risk of the novel coronavirus that had just spread to Washington state. With only 14 confirmed cases at the time, he emphasized the need for vigilance and careful contact tracing to help keep the outbreak to a few examples as possible. What neither of us knew then was how wildly contagious this virus is, how common it is to transmit it without apparent symptoms, and that it already was spreading, undetected, throughout many communities in the United States. We also didn’t anticipate the massive inflammatory response and blood clots occurring in severe cases, not just in the lungs but throughout the body.
In late February, when there still were less than 60 confirmed cases in the U.S., one of the Customs and Border Protection agents at Dulles airport told me that it was too easy for travelers to hide symptoms and to cover up their entire travel itinerary when coming to the United States. I can remember the concerned look on his face even now. And I can remember thinking that a complete travel ban from China and all intermediate destinations was the only way to truly slow the spread. Of course, we know now that it was already too late by then.
I began to suspect we were in deep trouble. I visited the National Quarantine Unit at the University of Nebraska Medical Center, where I learned that the new virus was much more contagious than the flu. The Nebraska center’s great care and success at treating and containing 13 COVID-19 patients from the Diamond Princess Cruise ship gave me the false impression that the virus still could be contained when, in fact, the viral horses already were long out of the barn. The lack of testing patients with symptoms, as well as their contacts, was so anemic for so long that our public health officials missed detecting hundreds of thousands — if not millions — of cases.
Flash forward to April, when Dr. Fauci, on the radio with me again, reminded me that, several years ago, we’d agreed that one day a new, mutated virus would emerge, “come in the back door” and cause the next ferocious pandemic, just when we were least expecting it.
This threat is known as “Disease X” — an extreme disruption not just to our health care system but to our entire way of life.
We were overwhelmed quickly, and we reacted slowly. Our entire health care preparedness and response system was not adequate, especially in “hot zones” for the disease. From the beginning, we have seen a lack of widespread diagnostic testing. We needed the Centers for Disease Control and Prevention to be more transparent and forthcoming about this; it has done a poor job of messaging on everything from the constellation of symptoms to the ease of spread, to the ability to test for the virus and accurately trace those who have it and their contacts. We needed the Food and Drug Administration to put pressure on our major lab companies back in February, to roll out the kind of extensive, rapid point-of-care diagnostics and standardized immunity testing that we still don’t have even now.
Since the terrorist attacks of 9/11, fear-driven and worst-case scenarios have plagued our collective psyche and our society. The government has initiated and propagated everything from “no-fly” lists to health scares to wars in response. This time, the problem was more significant than we realized, and we were not sufficiently prepared. This time, our fear radar may have been somewhat warranted, but the feeling of being underprepared preyed on our fears and hysteria has played a major role in our response to the virus.
Fear of the virus has led almost everyone to over-personalize the risk of getting it, with a reverence for that risk bringing ridicule of anyone who appears to be downplaying it. This judgment has now been followed by a boomerang effect in the aftermath of the George Floyd murder, as protesters have confronted police without any thought of social distancing whatsoever, and with few public officials calling them out on it — beyond some suggesting that everyone wears a mask. These hypocritical leaders and their messengers were the very same public officials and news media who carried the government’s uncompromised lockdown message for close to 90 days.
The fact is that most of our local, state, and federal leaders are not physicians, and their frequent contradictions have spread more fear than facts, more uncertainty than direction. Public frustration at the continued lockdowns, coupled with anger over the George Floyd murder, has helped to fuel the protests we see now.
As a physician who has studied public health and contagions my entire career, I am encouraged to see the number of cases in New York City, the biggest hot spot, dropping dramatically to sporadic cases in early June.
The severity of symptoms appears to be decreasing as well, as a new study from the University of Pittsburgh claims.
It is a well known historical fact that new pandemics often tend to become milder as they evolve, as the virus adapts to its human host. A virus has a survival advantage if a strain emerges, which spreads easily instead of dead-ending in the host it kills. We can only hope that this is the case now. The hot, humid summer months, with more people out of doors and socially distant, may help decrease spread as well.
In the meantime, we must consider the collateral psychological and physical health damage caused by these severe lockdowns across the U.S., and we must reopen our country as carefully but as quickly as possible.
Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent.