Adapted from an item in Robert Whitcomb’s “Digital Diary,’’ in GoLocal 24.com

Much has been made of the dangers of living in cities in times of epidemics because of the density. Quite a few people, mostly rich folks, have, for example, left New York in the past couple of weeks to “shelter in place’’ in rural and/or summer resort places – angering many of the locals. But too little has been made of cities’ advantages during such times. 

The biggest  is having lots of hospitals and other health-care facilities,  and thus lots of health-care professionals, of which there are obviously far fewer in exurban and rural areas. Indeed, many rural hospitals have been closed in recent years. (So have some urban hospitals, such as Pawtucket’s Memorial Hospital. Can and should Memorial be reopened? Its closure has put intense pressure on nearby Miriam Hospital.) The fragmented, inefficient and astronomically expensive U.S. health-care system is a mess. The failure to have adequate testing systems and equipment in place to address the current crisis is yet another symptom of how disordered it is.
 

COVID-19 will be popping up big time in plenty of rural areas soon enough.

The failure to have enough testing kits, and protective gear for health-care professionals,  has resulted in a huge undercount in the number of people with COVID-19. So many of us have it now, but have no, or mild, symptoms. Development of  extensive “herd immunity’’  through mass exposure, is probably  well underway. The surge in reported cases probably mostly just reflects belated testing. Speaking of  “reported” cases, don’t believe numbers from China (or Russia).

Ironically, as my friend Vermont insurance executive Josh Fitzhugh noted: “New York City may be one of the first places that could reopen for business because most residents will have been infected and either recovered or unfortunately passed away.’’

In any event, with our health-care “system’s’’ inadequacies, we must focus even more on the most vulnerable populations – the immuno-compromised and the elderly – and limit our ambitions  regarding the wider population.  Eventually herd immunity  will bring the pandemic to heel, although there will be, as with flu epidemics, recurrent waves of sickness. But a vaccine, and better treatments, will probably be available within a year or so to stop or at least mitigate such epidemics. Be it “by Easter,’’ as per Trump, or later, when social-distancing rules are to be loosened, they should be  eased gradually, not all at once, so that the sudden resulting increases in real or suspected cases don’t further overwhelm health-care personnel and institutions.

Throughout the crisis, the core  emphasis  should be on tracking cases by testing so that medical resources can be most effectively  geographically deployed and the most at-risk populations isolated. Then whack-a-mole, maybe for years

Meanwhile, watch this this extended interview by an old friend at The Press and the Public Project  with Dr. John Ioannidis of Stanford University. Dr.  Ioannidis cautions that we do not have reliable data to make long-term decisions about COVID-19, and that an extended lockdown could have far graver effects than the disease itself. 

Dr. Ioannidis is C.F. Rehnborg Chair in Disease Prevention, Professor of Medicine, of Health and Research Policy, of Biomedical Data Science, and of Statistics, and is the Co-Director of the Meta-Research Innovation Center at Stanford.

To see/hear the interview, please this link. 

By the way, some major work on researching COVID-19 to develop a vaccine is being done at Boston University’s National Emerging Infectious Diseases  Institute in Boston’s South End and elsewhere in Greater Boston. Yes, it’s supposed to be a very secure location though it unsettles some of the neighbors. To read more, please hit this link.