Commentary, Coronavirus, Exclusives

Dealing with COVID-19: Complacency Kills

Author Justin Hunter ignored the warnings and raced his motorcycle when Hurricane Katrina was threatening the Gulf States in 2005. He’s now warning EMS providers not to ignore the warnings of COVID-19. (Photo provided by the author.)

As a I sit here at my desk job working to make sense of the sudden shift in our culture because of the coronavirus (COVID-19), I notice this picture of myself from 2005 racing motorcycles at Homestead-Miami Speedway in Florida. Yes, I used to be cool – or at least I thought I was cool. I was a younger firefighter/EMT in the Tampa Bay area, without much experience, and my racing buddies and I were at the tail end of an eight-hour drive down to Homestead to race that weekend.

It was late August and there was a hurricane that was forecasted to brush along the southern tip of Florida that night. We didn’t care and we drove right through the northern edge of the storm until we made it to our classy $30/night motel and settled in for the night. 

Early the next morning, we made our way to the racetrack to find that there was minimal storm damage to the track, the facilities and everyone’s equipment. Hurricanes, and all the stress that goes along with them, are obviously a common occurrence in Florida. Locals ignore all warnings and hysteria, and it is quite common to attend a hurricane party – or three. Once again, another hurricane-induced hysteria all for nothing.

Had there a been Facebook back then, undoubtedly someone would have posted a picture of a fallen pinecone with the caption “Hurricane Katrina – Never Forget.” Yes, that Hurricane Katrina. Many folks forget Katrina struck southern Florida and then had nearly three full days to churn in the Gulf of Mexico prior to causing all of the devastation in New Orleans.1

The scientists were clear that this hurricane could be devastating. They were clear that New Orleans was at great risk due to its low lying areas and poorly designed and outdated levy system. But, politics and a lack of knowledge and experience led to one of the worst natural disasters in American history, killing over 1,800 people and destroying large portions of low-income neighborhoods.2

Now, 15 years later, there is another hurricane headed our way with COVID-19. Paramedics and EMTs across the entire world are going to be the frontline personnel to deal with this viral threat. Part of being a medic is public service education and helping the public to understand some simple life-saving tools.3 We educate the public on hand hygiene, CPR, AEDs, and even complicated topics such as when and how to use the 911 system. Public health education is part of what we do and it has saved countless lives through our CPR and stop the bleed campaigns.4

Yet, in the past week I have read and heard countless EMS professionals talking, privately and publicly, about COVID-19 as if it there is nothing to worry about. One medic told me this is just the flu. Another said this is a cold virus. One mentioned that masks do nothing to prevent the spread of the disease. As a reminder, surgical masks to prevent the spread of droplet diseases, including COVID-19, for those who are infected.

And, HEPA N95 respirator masks do help do prevent COVID-19 from being inhaled.5 Yes, one can still get the virus by having it on their finger and then touching their eye but that shouldn’t mean we should be telling the public that masks are of no benefit. 

The most common rant I have heard is that the flu kills hundreds of thousands of people per year and therefore this is all just a bunch of hysteria hyped up by the media. Let’s put some facts out there for perspective. While there is a wide range, scientists estimate that the flu kills up to 500,000 people each year.6 Up to 500,000 people – each year – from a virus that has been around for at least 500 years, has a seasonal vaccine, and many post-infection treatments. The death rate of seasonal influenza is around 0.1%.

The most recent estimates for death rates from COVID-19 is 3.4%, as reported from the World Health Organization (WHO).7 That is a death rate 3,400% higher than the flu. It is important to note that this rate is expected to drop over time and may end up being closer to 1% once all confounding factors are accounted for. Some data even points to the death rate for COVID-19 eventually becoming much closer to a bad seasonal flu.8 Even if the death rate ends up being exactly the same as our seasonal flu, that would still be an additional 500,000 deaths each year from a disease without a vaccine and without a proven treatment plan. That’s the same as if 275 Hurricane Katrinas happened each year.

The thing about science, whether or not you believe it, it is still true. Given this data, it should be expected that every single paramedic and EMT running 911 calls in this country is going to get sick along with every emergency department physician, nurse, tech, and registration worker. Yes, 80% of those infected will get over the illness with no treatment.

However, the flu has an incubation period of just two days. That gives you two days to spread the virus before you get symptoms and go home to sweat it out over a few days. COVID-19 has an estimated incubation period for up to 14 days.9, 10 That’s two full weeks for you be symptom-free and spread the disease before you end up staying home. That’s two full weeks for you to come into contact with the elderly, with a 55 year old man with COPD, with an eight-year-old boy with respiratory comorbidities, and with everyone else in the population. 

It is not hysteria for people to prepare and get tested and ask questions. Masks do help. Disinfecting offices and equipment does help. This pandemic does not seem to threaten the existence of humanity on Earth, but it certainly has the potential to kill a lot of people and threaten our way of living. 

Paramedics and EMTs are some of the toughest and caring folks in the world. But we also need to remember that the public is listening to us. If you don’t care, they won’t care. If you don’t take preventative measures, neither will they. Life is different right now. These are unchartered waters for humanity and for paramedicine.

That hurricane is sitting offshore right now. The science is telling us to prepare and how to stay safe.  Complacency kills. Be patient, be persistent and be prudent. Oh, and buy a toilet seat bidet attachment, they last forever and negate the need for toilet paper. 

References

1. Olshansky, R.B., Planning after hurricane Katrina. Journal of the American Planning Association, 2006. 72(2): p. 147-153.

2. Knox, C.C., Analyzing after-action reports from Hurricanes Andrew and Katrina: repeated, modified, and newly created recommendations. Journal of emergency management, 2013. 11(2): p. 160-68.

3. Bledsoe, B.E., et al., Paramedic Care: Principles & Practice, Volume 1. 2016: Pearson Education.

4. Ross, E.M., et al., Stop the bleed: the effect of hemorrhage control education on laypersons’ willingness to respond during a traumatic medical emergency. Prehospital and disaster medicine, 2018. 33(2): p. 127-132.

5. Loeb, M., et al., Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. Jama, 2009. 302(17): p. 1865-1871.

6. Dukic, V., H.F. Lopes, and N.G. Polson, Tracking epidemics with Google flu trends data and a state-space SEIR model. Journal of the American Statistical Association, 2012. 107(500): p. 1410-1426.

7. 2020, W.D.-G.s.o.r.a.t.m.b.o.C.-.-M., World Health Organization. 2020.

8. Fauci, A.S., H.C. Lane, and R.R. Redfield, Covid-19—Navigating the Uncharted. 2020, Mass Medical Soc.

9. Backer, J.A., D. Klinkenberg, and J. Wallinga, Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Eurosurveillance, 2020. 25(5).

10. Lauer, S.A., et al., The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Annals of Internal Medicine, 2020.