Response to taking a critical look at Covid-19

Editors Note: This letter by Dr. Rutherford appears in this weeks, Sept. 30 issue of the Lake Chelan Mirror

In your article published in the Sept. 2, 2020 edition of the Cashmere Valley Record, you make some good points in that case numbers can be misleading, particularly when comparing results from the United State with other countries.  I would like to expand on this, and to add some perspective from our local experience in the health care delivery system. 

Without doubt, this pandemic has been extremely difficult for many, if not most of us.  One of the most challenging aspects has been the degree of uncertainty and the speed of change in what we know about this virus and its effects.  Things that we knew or thought we knew when COVID-19 cases first came to our region in early March, have changed as we have become more prepared and as we have learned more from our and international experience.  For example, initially we knew there was a shortage of masks, so we needed to conserve masks so that hospitals would have what they need.  Now that situation has improved, and we want everyone to wear a mask in public, because we have learned by observation that it appears to significantly reduce the risk of person to person transmission. 

It is still difficult to accurately determine the number of cases in our country and in our community.  There are several reasons for this, including the fact that many people spread the disease without showing any symptoms, and the fact that testing materials until more recently have not been available to test everyone who should be tested.  Because it’s not possible to test everybody, the raw numbers tend to underestimate how many people have had the disease.  In the future, tests to detect COVID-19 antibodies may be helpful to determine how much of the population has had the infection.  For now, however, there have been 6,426 confirmed cases in the Okanogan, Grant, Chelan and Douglas County region, or about 2.5% of the population overall.  Results of antibody testing in other regions suggests that that the total number infected here is not more than double that, so we estimate that at most 5% of the North Central Washington residents have been infected  This is far less than the number needed to achieve generalized “herd” immunity, which is estimated to be 60-70%.  So, there are plenty more of us who could become infected between now and when an effective vaccine is widely available. We also do not know if the immunity is lifelong.  It is not for other subtypes of Coronavirus.

We also know that so far, Central Washington Hospital has admitted over 200 patients for treatment of COVID-19, again given an estimated infection rate of 5% of the population over the last 6 months.  We have had up to 29 COVID-19 positive patients admitted to the hospital at one time. Our ICU is built out for 20 patients, although we often are limited to caring for less than that number due to the limited availability of ICU trained nurses.  There have been so many patients critically ill with COVID-19 requiring ICU care, that we had to expand our Intensive Care Unit and Progressive Care Units and to divert well trained and specialized staff from other necessary patient care areas to help care for them.  This has occurred at great cost in terms of time, stress and both physical and emotional exhaustion of our nurses, respiratory therapists, medical assistants, laboratory staff, pharmacy staff, and other health care providers and support staff.  We are also fortunate to have at Confluence Health two physicians who specialize in Infectious Disease, which enables us to provide the most effective, up-to-date care possible.  We are extremely grateful to all these staff for their contributions.  However, we are acutely aware and concerned that it is not humanly possible to continue this level of effort for very long.  And because this is the case all around this country and the world, it is not feasible simply to hire more people to help us get through this.  It is because of these staff members and physicians that the hospitalized patient mortality rate here is only about 10%.  Given the severity of the illness of those admitted, I estimate that half of those admitted would not survive without hospital care (no survival of ICU patients without needed ICU care).   This would increase the total deaths in the area from the 30 noted in your article to 130.   By the end of a time to achieve “herd immunity” at 60% of the population infected, that would be 12 times that or 1,560 people. We have had patients in our region, from various age groups, who have recovered enough to be discharged home from the hospital, but who have continued to require oxygen therapy for months afterward.  The long-term consequences of COVID-19 are only beginning to be seen and understood.

From a medical economic perspective, care for patients is modeled based on QALYs (Quality Adjusted Life Years).  These are defined as the amount that this country has decided it is willing to pay for an additional year of an individual’s life.   There is debate but the number is at least $100,000 per QALY (many currently accepted treatments for genetic diseases and cancers are significantly above this).  If one says that the average age of death of an individual who dies with COVID-19 is 10 years younger than the age of death would have been and 2 Million people die  (330 M population X 60% infected before herd immunity is attained X 1% death rate), then the economic modeling suggests $100,000 X 10 years X 2 million people = $2 Trillion just in the deaths, not including the morbidity suffered by those who survive. 

Meanwhile, the care of patients with the types of conditions we routinely care for has been affected by the changes required by COVID-19 and there will be an unknown number of deaths from that care delay. In addition, there have been emotional health impacts.  Our visitor policy has been severely restricted and this affects many people negatively, but is necessary in order to prevent the spread of COVID-19 within our facilities, which would be unacceptable.   We have also had to send critically ill or injured patients to other hospitals because we have been too full, which is a disservice to people from our region who need care.

So, while the numbers are somewhat uncertain and reasonable people may disagree about them, we do know that they are high here.  We know that people are suffering, and some are dying, and that they cannot have visitors like they would in normal times.  We know that our hospitals have been too full, that our health care workers are being overwhelmed, and that this is affecting people with other conditions.

So, what can we do about all of this?  Continue to wear a mask when you are in a public place.  Take physical distancing recommendations seriously.  Do not congregate closely with people, especially for more than a minute or two.  Please do these things to protect yourself, but at least do them to protect others around you, and to protect our health care and other “essential workers”.  Also remember that the more quickly and completely we get this under control, the sooner we will be able to do get back to many of the things we miss, such as resumption of schools, religious gatherings, in-person services and social events.