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The Need of Private Sector for Taking the Lead in Defeating COVID19 in the US.

Coronavirus outbreak

On March 17, 2020, there are close to 200,000 cases and 8,000 deaths reported from 162 countries due to COVID19. The disease devastated China causing over 80,000 cases and 3,226 deaths before slowing down, in the past 24 hours China reported just 21 new cases. Currently, Italy, Spain, Germany and France in Europe are most affected. Over 8,000 cases and 81 deaths have been reported from S. Korea. Iran has over 16,000 cases and close to 1,000 deaths. The first case of COVID19 was reported on January 23, 2020. Since, close to 6,000 cases and 99 deaths have been reported.

The data from the Chinese Centers for Disease Controls suggests that the mortality rate in children below the age of 10 years is zero, between 10-39 years is 0.2%, 40-49 years is 0.4%, 50-59 years is 1.3%, 60-69 years is 3.6%, 70-79 years is 8% and jumps to 14.8% in people 80 years and above. The disease affected slightly more males compared to females and pre-existing medical conditions (cardiovascular disease, diabetes, chronic respiratory disease, hypertension and cancers) increased the risk of mortality. Based on this data and assuming that the ratios remain the same in the US and the virus does not mutate, there are over 40 million Americans (~12% of the US population) above the age of 69 years who are at a very high risk for acquiring the disease and having adverse effects. Moreover, over 4 million Americans reside in nursing homes and skilled nursing facilities each year and nearly one million persons reside in assisted living facilities – this is the most vulnerable population as the disease can cause multiple mini outbreaks at these facilities if the virus breaches the current preventive measures in place.

Due to the slow and miscalculated response of the US government in regards to transparency in information sharing, screening, diagnosing, instituting timely infection control measures and providing protective gear, 330 million Americans are at risk and in panic. With not having, enough masks to initially to having defective diagnostic kits, and now difficult to ascertain diagnostic kits it is hard to judge how many Americans are infected with COVID19 and will hospitals have enough capacity to house and treat the sick. Furthermore, will there be enough intensive care unit (ICU) beds and ventilators to provide care for the critically sick.

These factors have now resulted in the government taking draconian actions including social distancing, school closures, remote work, restaurant and social gathering closures with suggestions of lockdown of the entire nation, as done by some European countries. On March 13, President Trump declared a national emergency over the coronavirus, freeing up additional resources and funding as federal, state and local governments attempt to combat the rapidly spreading disease. This move will assure freeing up Federal Emergency Management Agency (FEMA) to tap into billions of dollars and mobilize personnel rapidly to help state and local agencies. These measures initiated are to slow down the spread, so hospitals and healthcare institutions are prepared. Unfortunately, the cases and deaths in the US are rising as the virus has taken a strong hold in the community. It is critical that measures are instituted to provide screenings with a focus on the vulnerable populations. The hospitals have to institute expedited safe patient discharges, cancel all elective admissions and procedures, maximize use of remote and virtual care capabilities (telemedicine), alternative care sites for lower acuity supportive care. Moreover, ICU beds have to be secured at all costs and, staff needs to be prioritized for screenings and provided with personal protective equipment (PPE). Let us not forget the non-ICU healthcare workers and first responders as they are at high risk of acquiring the disease. In addition, the decision makers need to begin the uncomfortable discussion on the very difficult topic of ventilator triage as was done in Lombardia, Italy and not wait until ICU’s are overwhelmed.

The global and the US economic impact will be unprecedented as is being observed by how adversely the markets have reacted to the pandemic and how fragile our financial stability can be. The government standing alone cannot deal will this pandemic; it is imperative that the government gets further assistance from experts and allows private institutions to assist to mitigate this catastrophe. For standing up hospitals, the US Military needs to be engage; they already have two floating hospitals and have the experience and knowhow as well as the supplies to stand up mobile hospitals. The administration must screen and entertain every possible idea that can save lives bringing the private sector into the mix of the solution and the decision making process.

Rashid A. Chotani Rashid A. Chotani, MD, MPH, FRCPH Vice President Medical Affairs, Carelife Medical Professor Epidemiology, University of Nebraska Medical Center.

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