The Other Side of the Curve

Summary

A surgeon on the frontlines reflects on the current state of the COVID-19 pandemic in New York, questioning whether the curve has been flattened and emphasizing the importance of widespread testing to truly understand the situation.

Abstract

The article, written by a surgeon working in the emergency room, discusses the recent decrease in COVID-19 cases in New York, with a current patient count of twelve, only nine of whom tested positive for SARS-COV2. This is a significant improvement from the peak of the crisis, where all patients in the ER tested positive. The author suggests that the situation may be entering a lull, but warns that this could lead to complacency or a false sense of security, potentially causing a resurgence of cases in New York or in other states. The surgeon highlights three possible scenarios for why the numbers might be decreasing: universal infection, comprehensive testing, or widespread immunity. The author argues that without widespread screening and antibody testing, it's impossible to know which scenario is accurate, and therefore, to predict future surges. The article calls for improved testing capabilities, including the need for reagents, and criticizes the lack of federal leadership and FDA approval for necessary tests.

Opinions

The author believes that the current lull in COVID-19 cases in New York could be misleading and may not signify the end of the pandemic.
There is a concern that the decrease in cases could lead to other states experiencing a surge in cases.
The author suggests that the true extent of the pandemic's progression can only be understood through widespread screening and antibody testing.
The article points out that without knowing who has had the virus, who has tested positive, or who has developed immunity, it is difficult to make informed decisions about the pandemic response.
The author criticizes the current state of testing, particularly the shortage of reagents and the lack of federal coordination and FDA approval for tests.
The surgeon emphasizes the importance of continued vigilance and testing, urging the public to advocate for nationwide, standardized testing to move forward effectively.

“Are we there yet?” Explorations from a Surgeon on the Frontlines

Sunday morning in the emergency room, we had twelve patients sitting on stretchers, and nine of them didn’t test positive for SARS-COV2. I breathed a sigh of relief and took a short ten minute break to give a lesson on reading chest x-rays to the young medical assistant who had been deployed with me. With aspirations to get a Masters in Public Health or go to medical school, she was grateful for the opportunity. I mentioned to her: your experience in this crisis is going to be crucial in your career.

The numbers are down; there is no disregarding that. As of yesterday, we had 478 deaths in New York State, down from the peak of 799 in early April. The numbers of hospitalizations and ICU admissions are downtrending as well. The question is, did we flatten the curve? Are we really on the other side?

Two weeks ago, there were 90 patients in an emergency room that was made for 30 people. All of them tested positive for SARS-COV2. One week ago, there were 40 patients, and now and then, one or two people a night would test negative. Just from my personal experience, I think we have hit a lull in this pandemic.

The problem is, and there are two: a lull here means that other states will experience a surge. And that a lull can lead to another surge here.

The reason being: ‘Peaked’ means one of three things, right? Either everyone who is going to get the virus got it, or everyone who is going to test positive has tested positive, or everyone already has it. If any of those things aren’t true, then we haven’t peaked, or there will be other, smaller peaks. Intuition would indicate that none of those things are true yet — we don’t have evidence of any of it. If any of those things are true — then there’s only one way to find out. Test everyone. Widespread screening. Because if it’s it the first scenario (unlikely), then we would know who’s had it and who hasn’t. If it’s the second scenario, then we’re in trouble because that means there are people out there who tested negative and have the virus. And if it’s the third scenario, then we need to know who has antibodies (immunity) and who doesn’t.

The discussions today have been about testing capabilities and the lack of reagent (what we put the testing swabs in) for various testing machines. We seem to have nasal swabs now. We seem to have the desire to test and trace. But we’re still lacking the third component, and frankly, after examining the news this morning, it seems that part of this is a lack of federal leadership and FDA approval of tests that we need. So if there’s anything you want to do from your couch today — continue to raise the cry for nationwide, standardized, SARS-COV2 PCR as well as antibody testing. That is the only way we will get out of this.

(Image my own, from Central Park, April 2020)