IS IT SAFE to end Shelter in Place?
Recently, two former emergency physicians who are now practicing Urgent Care at several Urgent Care Clinics they own in Bakersfield, CA, came to national attention by comparing COVID-19 to Influenza and recommending an end to the Shelter in Place Orders issued by the Public Health Department in their community. They appeared on Fox News two days in a row and their YouTubeVideo went viral, no pun intended.
These two physicians seem to be comfortable with their recommendation based on the results from their testing for COVID-19 at their Urgent Care Clinics. They state their belief that their results from the ~5000 people they have tested at their Urgent Care Clinics can be scaled up and be applied to Kern County — applied to the State of California — applied to the United States as a whole.
These Emergency Medicine Specialists claim no post-graduate training in Epidemology or in Public Health and Safety Science. But, they appear to be very comfortable assuming such training is irrelevant and even betting the lives of their patients on their conclusions.
As of May 1, 2020, Kern County Public Health stated they have 939 active cases and with 8 deaths. Of the ~920,000 people living in Kern County, the vast majority have not been tested.
Comparing this to Santa Clara County which has had 2,179 active cases and 113 deaths as of May 1, 2020. There are ~1.928 million million people living in Santa Clara County and most of these have not been tested either.
So while Kern County seems safer than Santa Clara, is it really safe to return to pre-covid behavior?
Can we scale up the results of these COVID-19 tests on 5000 Urgent Care Patients and assume they will accurately represent the truth for the ~920,000 people living in Kern County — for the ~39.51 million people living in the state of California — for the ~328.2 million people living in the United States of America.
I don’t know. And I don’t think these two Emergency Physicians know either.
Maybe they are correct. If we return to pre-covid behavior and DO NOT GET a bounce in new cases nor an increase in new deaths, then they may get nominated for the Nobel Prize in Medicine.
However, if we DO get a bounce and there is a second wave of new cases and a spike in new deaths, then what are these physicians going to tell the families of their patients?
I think the question that we all have ask ourselves is how much risk are we willing to tolerate? Is money really more important than human life?
The wisest public health and safety scientists that I know suggest that a community needs to achieve a steady falling in new cases of COVID-19 for 14 days as well as a steady falling in deaths per day for 14 days as the minimum requirement to lift Shelter in Place Orders.
In addition, we must embrace a comprehesive solution which includes Moving from Universal Containment to Smart Containment, universal testing, tracking, prevention, and intelligent treatment for those who become infected.
Friday, May 1st had the highest death rate from COVID-19 in the United States yet recorded.
The following quotation from CNBC and the World Health Organization was published May 02, 2020:
The United States just had its deadliest day on record due to the coronavirus as states across the country begin to ease restrictions meant to curb the spread of the virus, according to data published by the World Health Organization.
The U.S. saw 2,909 people die of Covid-19 in 24 hours, according to the data, which was collected as of 4 a.m. ET on Friday. That’s the highest daily Covid-19 death toll in the U.S. yet, based on a CNBC analysis of the WHO’s daily Covid-19 situation reports.
Before May 1, the next highest U.S. daily death toll was 2,471 reported on April 23, according to the WHO.
I too was trained as an Emergency Medicine Specialist and am currently practicing Urgent Care Medicine in Monterey, CA. The first rule of medicine that all physicians are taught is: Do No Harm!
Based on that rule and these latest statistics, I would recommend that these Emergency Specialists leave the decision of rescinding the Shelter in Place Order up to the Epidemologists, Public Health and Safety Officers working within their Public Health Department.
