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Community Voices (Pyatt): We’re all in this crisis together; citizens, leaders must show restraint

I worked as a health risk expert for almost 30 years and edited several textbooks on risk assessment and risk communication. People are generally uncomfortable with uncertainty. Most eventually figure it out, but it takes considerable time and effort. Some never get there, by the way. And many will overreact and sanitize everything.

Yes, Virginia, there is a serious pandemic. And yes, Virginia, I will work effectively with state and local governments to prioritize things for everybody.

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This is the speech we ideally should have heard from the White House and didn’t. Yet Gov. Hogan nailed this one, and I think Maryland is as prepared as possible.

This pandemic will alter our lives. Health experts — and there is considerable uncertainty from expert to expert — project it could last from a few months to a year and a half. One-third to one-half of us could eventually “catch” the COVID-19 virus with a wide range of symptoms from slight sniffles up to death. There seems to be more agreement on the widespread spread of this infectious disease than on the number of deaths. Many (most?) of us will not be tested since there will be such a mismatch of available COVID-19 tests compared to the large number of “infected people.”

An important parameter is how many cases are officially “reported” because of testing vs. the number of actual cases at any one time. As a group, experts tracking the spread of COVID-19 think only 12%, per fivethirtyeight.com, of actual cases are being reported. This is a composite average of these various experts and is not a scientific record, but certainly very telling.

We will have to face restaurants closing, leading to employment, occasional interruptions in vital supplies, and perhaps serious cutbacks in leisure travel. We may actually have to learn to like and live among ourselves harmoniously.

There will be many challenges in learning to live without knowing if you have or have not contracted COVID-19 — just assume you eventually will get it. Maybe it’s a coin toss, 50/50. But it’s safe without undue overkill to assume you will eventually develop symptoms.

Once you come to terms with this fact, then “flattening the curve” makes much more sense — possibly in a different way than you first thought. And you should be “all in.” If you don’t contract it somebody in your family will.

The strategy is to hope that a conservative estimate of 1 in 5 odds of needing a ventilator — or perhaps a more realistic 1 in 10 or 1 in 20 (there is wiggle room on this) to avoid serious permanent injury or possibly death will have one at their disposal by “flattening the curve.” We all don’t want to be in intensive care at the same time if indeed projections come true on the number that will be infected, but stretch it out over a year or perhaps longer and it should be tolerable.

The tricky part is still unfolding, and that is to find the social distancing strategy that flattens the curve adequately to minimize impact on health care fatalities, allows some growth in our economy, but doesn’t lead to financial chaos and is agreed to by most Americans. Mutual citizen buy-in is essential if this is to work. At the same time, we need assurance necessary that critical ventilators will be available.

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Successful curve flattening requires considerable restraint on citizens and leaders, e.g. not taking tests to determine if you are infected with COVID-19, listen to your symptoms, and only call emergency services if you have considerable trouble breathing. How hard to breathe is enough? Some physicians say using 10 seconds to hold your breath is a good criterion to use to determine the need for a ventilator.

The current White House strategy to get the economy on track and open things up almost dooms us to future yo-yoing of the crisis if we ease restrictions too early. My fear is that the president will obtain key ventilators and hold states hostage — possibly including Maryland — unless they kowtow to his strategy. This might be part of his master chess game. If so, it’s a very shrewd political move but an extremely dangerous one from a public health perspective. We need far more information before easing restrictions.

The American citizens and leaders must all be on the same page. Everybody has a stake in this. All have to make some sacrifices — many will perish (fatality estimates range to about a million Americans give or take, and most will be elderly) and many more will become seriously ill, and many more will suffer financial hardships.

Failure to act appropriately and sensibly by the White House could eventually cost thousands or possibly hundreds of thousands of lives.

Dave Pyatt writes from Mount Airy. Reach him at DPyatt2@verizon.net.

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