Roger Daniels, one of Philadelphia’s most respected physicians, just retired after nearly 60 years as an internist. He served in a MASH unit in Korea and has worked at teaching hospitals all of his life.
And he’s never seen anything quite like this coronavirus situation.
While knowledge continues to evolve regarding just how contagious and lethal coronavirus is, Daniels is troubled by his profession’s lack of preparedness for an infectious event of this magnitude.
“This is pretty obviously an indication of the failure of American medicine,” he said. “Because public medicine and public prevention medicine has not been part of the formulation of medical care in the United States for a number of years. Because of that and because of a very slow response on the part of personnel, we are well behind schedule of where we would have wished to be based on information available Feb. 1.”
Years ago, Daniels said, there was a philosophical shift in terms of how much emphasis American medicine should place on thinking about the logistics of dealing with a pandemic.
While the country has some of the best and most capable virologists and infectious disease specialists in the world, Daniels believes many of them have likely been frustrated for years by an underdeveloped emergency infrastructure to handle a virus, absent a vaccine, that spreads this quickly.
Daniels was similarly dispirited and perplexed by how South Korea, with just a fraction of our population, was able to do in no time what the U.S. seems to be struggling with.
“Here we are with 323 million people, and we don’t even know — with the exception of the 40,000 people who’ve been tested — what the hell is going on,” he said. “Which is the reason there’s been so much fear and anxiety.”
“The effort effectively to carefully examine and evaluate patients who had symptoms or contact … was so limited in this country, and the availability to doctors and hospitals of the testing modalities were so limited that even if the test was done, it took three days to get the results back. It was a very poorly operating system. Very ineffective in an emergency setting, which this represents.”
Response in terms of infrastructure — the availability of tests and beds and gloves and sterile quarantine units — is one thing, but most Americans are still trying to ascertain just how sick the coronavirus makes you and just how
lethal it is.
“The view of a number of infectious disease people who have studied this by looking at SARS and MERS is that they’re probably comparable,” Daniels said.
“And yet, it would be difficult to say that’s true in a more detailed and accurate sense. But there’s no question that elderly patients, especially those with underlying chronic illness, have a much greater probability of demise.
“The Chinese figure on this was terrifying. Elderly Chinese, particularly past age 75 to 80, and all the more if they were afflicted with underlying illness, had a 15% chance of dying (after contracting coronavirus). That’s one in six. On the other hand, anybody in their 20s, 30s, 40s, 50s, the probability is certainly no greater than 1%.”
Another thing to remember, Daniels said, is that age as a number, in the abstract, isn’t as important as the underlying processes that an age represents, and the concomitant “decrease in the ability to have antibody competence.”
“The elderly usually have some sort of underlying illness — either one or another of chronic lung disease, heart disease, congestive heart failure, hypertension, diabetes, chronic liver disease — they’re all possibilities and not uncommon among elderly people … like me.”
“So I’m very mindful that I would not like to get this. It would not be a very good thing.”
The elderly are not the only ones who need to be concerned. Even though younger people without underlying medical conditions are not nearly as susceptible to getting severely ill from the novel coronavirus, they are still getting it.
And, Daniels said, asymptomatic carriers passing the virus onto others who may be at greater risk is still a major concern, especially in the medical field.