Lead With Confidence Not Fear
How Fear and Two Decisions Changed the Coronavirus Pandemic in the United States
By early April the Strategic National Stockpile of N95 masks and surgical masks were depleted, and President Trump invoked the Defense Production Act to increase the supply.
Between January and March we were repeatedly told by the coronavirus taskforce, including Dr. Fauci, that masks were not necessary.
Today the same people are begging us to use masks saying that it is a matter of life and death.
What was the reason for the initial recommendation? Fear. Fear that the American public would purchase masks in such quantities that they would not be available for hospital and emergency personnel.
Would we have needed as many masks in the hospital if we were told that wearing a face covering would reduce the spread of the virus from January through March? Probably not.
The second decision that changed the course of the pandemic in the US was made by Governor Cuomo of New York to force long term care facilities to admit patients sick with the coronavirus. Other neighboring states followed his lead and implemented similar policies.
News reports out of Wuhan drove fear into the decision-making process with tragic consequences. Pictures of people dying in the streets would not bode well for future campaigns.
Wuhan has 27 top tier hospitals and 8 beds per 1,000 residents according to 2018 data. They have some of the best doctors and most advanced equipment in the country. What they didn't have was a sufficient number of ambulances to transport people to those hospitals.
The Chinese National Health Commission policy is for one ambulance per 50,000 people. On January 24th, Wuhan had one ambulance per 194,400 people. It takes about an hour to clean an ambulance after transporting a patient, further compounding that shortage. At times, as many as 275 patients were waiting for an ambulance to transport them to a hospital for care.
People may have been dying in the street but it wasn't due to a shortage of hospital beds.
Italy also had it’s share of bad headlines. We saw scenes of hospitals overrun with patients and not enough beds regularly in the news.
By February 11th, the preliminary data from China showed the Infected Fatality Rate (IFR) rose exponentially with age.
- Age 40-49 .4%
- Age 50-59 1.3%
- Age 60-69 3.6%
- Age 70-79 8%
- Age 80+ 14.8%
Twenty three percent of the population in Italy is age 65 or older and their median age is 47.3. By comparison, the median age in the US is 38.3 years. Older people require hospitalization at higher rates.
Even though they have more beds per capita than the US, their demographics quickly exceeded their capacity.
Fearing that the NY hospitals would run out of space Governor Cuomo released a memo to nursing homes (NH) on the 25th of March. “No resident shall be denied re-admission or admission to the NH solely based on a confirmed or suspected diagnosis of COVID-19. NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.” And with that, he sent the virus into the center of the most vulnerable population.
Before the directive was reversed New York hospitals sent 6,300 patients sick with or recovering from COVID-19 to nursing homes. According the State of New York 6,487 patients in nursing homes and acute care facilities have died from the coronavirus. That number does not account for the healthcare workers in those facilities who contracted the virus and contributed to the spread.
As one nursing home in New York was working to contain the spread of the virus in their facility they were forced to take 2 additional residents who tested positive for COVID-19 on April 22nd. By June the full effect of those decisions were evident. Eighteen of their residents had died, 58 had contracted the virus and 50 out of 100 healthcare workers tested positive for the coronavirus.
Would the death rate in New York have been lower if nursing homes had not been forced to take sick patients? Definitely.
I believe that Dr. Fauci and Governor Cuomo care about the loss of every human life. Would they make a different decision today? You would hope so, but even with the benefit of hindsight, both have defended their decisions.
We know enough about COVID-19 that it is possible to responsibly function as a business and society if we stick to the data and use common sense. Instead of reacting to fear we can prepare. Instead of acting on headlines and news stories we can look more deeply at the data and make decisions that protect those around us instead of putting them at risk.