In the HBO miniseries Chernobyl, there’s a scene where one of the supervisors, Dyatlov, is told there has been a breach of the nuclear reactor. When he hears that their radiation detectors are maxing out at 3.6 Roetgen, he casually responds, “3.6 Roetgen … not great … not terrible.” He was obviously wrong. The United States is currently in a 3.6 Roetgen moment with the novel coronavirus (COVID-19) pandemic. We need to face the reality: a Chernobyl-like disaster awaits if we do not act more drastically right now.
Doctors and epidemiologists have been warning about the impending tsunami facing America for at least one month. We’ve discussed the need for ubiquitous testing, more Personal Protective Equipment (PPE), increased ventilators, and expanding ICU capacity. We have called for social distancing to flatten the exponential infection-rate curve. Our pleas for help were first met by derision, as rumors of a deep state, politicizing a pandemic, and “it’s just the flu, bro” sentiments circulated in response. The fact the main conductor of the “fake-news” choir happens to be the president hasn’t helped, but even President Trump has finally acknowledged the seriousness of the COVID-19 pandemic by stating six days ago “we have 15 days to control the spread.”
I am an emergency room physician, and I can’t help my patients anymore because I’m under quarantine with my family. It didn’t have to be this way. Despite having seen and diagnosed multiple COVID-19 patients one week ago, my county health department rejected my SARS-CoV2 PCR testing even though I became symptomatic. My PCR-swab was instead sent to California to be tested. Seven days later, I still do not know my results. The fact I’ve had fevers, chills, dizziness, shortness of breath, and a cough cements the diagnosis in my mind. Thousands of Americans are currently quarantined at home without a diagnosis — apparently, only NBA players and congressmen are capable of being quickly diagnosed in our country. This is the reality in which health care providers and millions of Americans now live.
Yet just as the days following Chernobyl’s nuclear meltdown, kids continue to play on playgrounds while many Americans ignore the deadly invisible pathogen that will suffocate them. Firefighters, paramedics, hospitals, and cities are ill-equipped to handle the viral spread of a lethal, undetectable antagonist. Instead of asking firefighters in ill-equipped suits to pick up lethal radioactive debris off the ground, we are asking doctors and nurses protected by flimsy surgical masks to treat potentially lethal infectious patients carrying a disease, which is more infectious and deadly than the H1N1 flu.
This week the CDC released guidelines admitting N95 masks should be worn whenever possible, but surgical masks are essentially better than nothing. They published comical guidelines that “scarves and bandanas” can also be used when we run out of masks, which unfortunately is not a line out of a Peter Seller’s movie. The same country that spends $3.5 trillion a year on health care — more than the GDP of Germany (who is handling this pandemic much better than the U.S.) — is telling its health care providers to use bandanas to combat a pandemic. We are now living in a Kafkaesque-nightmare, and it’s quickly giving PTSD to all our frontline health care workers.
Unfortunately, we’re only in the first act of this three-part play. We need only look at what is happening to Italy — full country shutdown, mandatory quarantine, rationing of ventilators, allowing elderly to die due to lack of resources, multiple dead health care providers — to see where we are heading. California and New York are at very least leading the way in mitigation — we need even stronger measures, particularly in cities, to flatten the curve and avoid becoming a larger-scale Italy.
We need PPE, quicker in-house tests, and mandatory social distancing. Every subsequent day we have soccer games, church gatherings, or playdates in the park means thousands of more deaths, and tens-of-thousands more hospitalizations. That’s how the math works. In Florida, where I live, you can no longer receive elective-surgery, so if you have had a bad gallbladder or knee you were waiting to get operated on, you now have to wait. In weeks, if you have anything but a life-threatening illness, you will not be able to be seen in a hospital in the United States. Lacerations, broken bones, undifferentiated pain, mild asthma attacks will all have to wait. If we become like Italy — or worse — thousands to millions will die, with ten-times more being hospitalized (and if current numbers are correct, that includes 40 percent of people under 54).
“Not great … not terrible.” It’s a great line because it ironically foreshadows the abject horror of an inevitable disaster. In America, only scientists and healthcare workers seemed to understand this a few weeks ago. The U.S., Congress, and President Trump are (slowly) waking up to the devastation that awaits us. We must do everything in our power to stop it right now, or else in 30 years, China will make a sub-titled movie depicting the foolish response of the U.S. government in the face of its biggest disaster.
We can be great, or we can be terrible. We have nine days.
Damian Caraballo is an emergency physician.
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