The coronavirus cost that no one can count


On December 31, 2019, the world changed as we knew it, but the future implications for the United States were not apparent at the time. On that day, the World Health Organization (WHO) China Country Office was informed of new cases of “pneumonia of unknown etiology” originating from Wuhan City, Hubei Province of China. The cause of pneumonia was eventually identified as COVID-19, a new type of coronavirus that had not previously been diagnosed in humans. It became apparent in a short period of time that human-to-human transmission was possible, and the widespread nature of the virus became apparent when other countries started finding cases of COVID-19, including the United States, which had diagnosed its first case on January 20, 2020, in Snohomish County, Washington. As further cases were discovered globally, the WHO weighed in, declaring the COVID-19 outbreak a “public health emergency of international concern” on January 30, 2020, and it was “characterized as a pandemic” by the WHO on March 11, 2020.

As of this writing, there have been over 136,000 confirmed COVID-19 cases globally, according to the Coronavirus Resource Center at Johns Hopkins.  Over 69,000 patients have recovered from the virus, but there have also been over 5,000 deaths. In the U.S. alone, at least 1,663 people in 46 states and Washington, DC have tested positive for COVID-19 with 41 deaths, according to the New York Times. The presentation of the virus can vary drastically, from people having mild symptoms to patients presenting with pneumonia leading to respiratory failure requiring advanced support, including mechanical ventilation. So far, it is known that elderly people and people with chronic medical conditions are at the highest risk. With the rapid evolution of knowledge regarding this virus, the Centers for Disease Control and Prevention (CDC) is providing frequent updates to the public.

Due to the concern for potential rapid spread in the United States, significant changes have occurred, ranging from travel restrictions to cancellations of sporting activities and performances. Along with concern about people in the general public testing positive for COVID-19, well-known celebrities have also tested positive for the virus. U.S. governors are making decisions to limit large gatherings and close schools temporarily in order to reduce the likelihood of spread. Testing for the coronavirus is also in high demand, but currently, the supply of tests is unable to meet the current demand, and per the CDC, commercial labs are in the process of developing tests to increase the supply so that rapid diagnosis can occur.

With all the discussion about coronavirus, it is apparent that there is a desire for certainty, and part of that certainty is helped by providing concrete numbers. People are looking for a frequently updated number of cases to get a sense of how widespread COVID-19 is, since it can impact how people go about their daily lives. So far, various health organizations are trying to provide updated information, but given the novelty of the virus, the information is currently incomplete, and it is not clear if the numbers provided give a full sense of how prevalent the virus is at this moment. Add to that the sudden changes in people’s way of life, and there is an increasing sense of anxiety that can never be fully quantified but is currently palpable.

Understandably, there is a lot of focus in the media about how many confirmed cases of COVID-19 exist currently around the world, but there needs to be a recognition about the number of people who are becoming anxious about how their lives are being affected by the coronavirus. From discussions that other health care providers and I have had with our patients, there is genuine concern about the risk of being infected, and there is increasing frustration about the limited number of tests. By extension, family members are expressing concern about their loved ones potentially becoming very sick if they contract the virus. Even within the medical community, given the novelty of this virus, we are actively adopting measures to reduce our likelihood of being infected by COVID-19, but there is still that concern that we may end up being infected in a way that could seriously hinder our ability to care for those who come to us for treatment and potential reassurance.

Along with these concerns, there is a real concern about the effect on social interactions that needs to be acknowledged. Per the CDC, one of the recommendations is social distancing, which involves “remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible.” This, understandably, has led to things such as the cancellation of sporting events and the closure of schools. These gatherings are where significant social interaction takes place, and the limiting of these events can create anxiety with regards to maintaining relationships. Add to this the concern about inadvertently contracting the virus from other people through routine activities, such as getting the groceries or just walking down the street, and you have people who are second-guessing routine actions in a way that could lead to further isolation. With these changes, the potential for anxiety can increase, and this potential needs to be acknowledged as we learn more about how to care for patients who present with symptoms suggestive of COVID-19.

There is no database out there that can track the number of people who are anxious because of the virus, but based on the amount of attention being given to COVID-19 and the rapid change in how we are living our lives, we need to take that anxiety into consideration as we present information and provide guidance in terms of controlling the viral spread.  The public is looking for answers, and we in the medical profession need to be cognizant of how the information we present about COVID-19 is being received. For the general public, this is uncharted territory, and that uncertainty can contribute to anxiety that could affect how people process new information about COVID-19. Our responsibility as medical providers is to present the information we know honestly without raising undue panic and to assure the public that we are doing everything we can, through advising the public and recommending changes that we believe will control the spread of COVID-19. It is our hope that in due time, the number of confirmed cases will stabilize and subsequently fall off, and ultimately this anxiety will subside in a way that can help us to return to normal lives.

Chiduzie Madubata is a cardiologist.  

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