Testing Resilience in the Game of Existence

by on March 31, 2020 · 0 comments

in Health, Ocean Beach

Jeoffrey B. Gordon, MD, MPH in his former OB office. Photo credit: OB Rag.

By Jeoffrey B. Gordon, MD, MPH / March 24, 2020

We know of only two crucially important rounds remaining in the game of human existence on earth. This round – THE CORONA PANDEMIC -has been more like a rapid play, rough and tumble, basketball game. During pre-game warm up drills, most everyone felt strong and invincible.

Like past pandemics, the corona virus burst on the scene suddenly, but not quite unexpectedly, to start the round.  Nonetheless, as we entered the early minutes of the first period we have already lost the game. Asian countries, forewarned by past challenges such as SARS, had plans, staff, capacity.

China, stunned by a sudden surge and massive morbidity and mortality, was able to rapidly, scientifically identify the germ down to its DNA underwear and take comprehensive public health and medical care actions and in a powerful “Hail Mary” effort sacrificed its economy to shut down the threat in merely two months.

Singapore and Taiwan, close by in the circle of danger, activated a playbook of well thought out, previously planned, well manned and scientifically based public health programs with sophisticated leadership curtailing the epidemic on their court.

The World Health Organization, knowing that there would be no immediately available effective treatments rolled out massive numbers of diagnostic tests to promote case finding and isolation: the only winning strategy to contain the threat. Winning this round was possible.

But not in the West.

Given 2 months – 8 weeks – 60 days of golden, never to be regained, lead time while the explosive harm of corona built up its silent but exponential infiltration, national leadership, especially in the United States fumbled the opportunity. Preening in a false sense of security, arrogance and ignorance, the past structures of response having been defunded or atrophied; wise and experienced managers and scientists having been let go; there was no on-call team and no one to lead it.

The playbook was to ignore it, then deny it, then belittle it, then magical thinking, then competing, confused messages. With arrogant incompetence (or to support devious political ends) testing was not developed nor acquired, then it was faulty; then it was limited to certain obvious diagnostic needs, and it is still not adequately available to play the epidemiologic  capture strategy.

National strict case finding and isolation/quarantine has yet to be instituted. States and cities were left to figure out a playbook by themselves.

The game was lost early. The economy is shut down. Families, now with unemployed parents, are sheltering at home with frustrated kids excluded from their closed schools and isolated from their friends for uncertain and extended periods of time are set up for frustration and stress.

The virus is going wild on the field of play.

The limited, profit oriented “lean” and mean corporate medical system has no coordination, excludes many needy people and has limited surge capacity. Now we are left to remedial tactics, high tech band-aids like ICU care, and ventilators albeit with likely shortages of medical teams which, like first responders, remains exquisitely vulnerable to infection due to neglectful shortages of PPE.

Tens of thousands of Americans will die. Game lost. Even so the coach is about to claim victory and open up the field of play for business.

It did not have to happen.

The second round is just around the corner.

The first round was a massive threat, almost unprecedented in human memory –invisible, no immunity, high death rate, global – no place to hide. It does, no doubt, cause considerable angst, anguish and anxiety. Economy is in free fall.

Nonetheless, this game of existential threat and our fears and anxieties are limited by the knowledge that the epidemic will burn out, will come to an end. Among the players – the whole population – people will fall into three groups: infected and recovered, infected and dead, resistant.

This epidemic will die out. Then the game is over.  There will be recovery. This will not happen in the second round –GLOBAL WARMING.

The second round is more like baseball; its innings have passed slowly over the past 20 years, and mostly quietly until the atmospheric storms and fires recently. Incredibly we have entered the arena with the same play book we used in the first existential game: arrogance, ignorance, obfuscation, denial, basking in invincibility.

There has been false information, magical thinking, misdirection, sharp denial of scientific data, general popular passivity, lack of political leadership, fear of loss of power and wealth. The threat is very similar as well: existential, invisible, no immunity and global – but in this second round there is one major difference: the challenge is not self-limiting but will escalate to the catastrophic level.

Game over; civilization over; human existence over.

So, let us take heed from the first round of existential threat. There is a golden opportunity to learn from the current catastrophe.

We are in the midst of two major challenges.  In the first game wise public servants in a few thoughtful countries successfully won the game of public health epidemiology.

There are a myriad of strategies for the ongoing game of global warming. This cannot remain a spectator sport. We must demand good leadership and public policies that serve humankind and create the play book that will mitigate and stop the accelerating momentum of the second round.

We must learn from today. There is no alternative.

Jeoffrey B. Gordon, MD, MPH is a retired Ocean Beach family doctor.

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