The COVID-19 Dilemma: “Safety vs Freedom”

The most frequent question we seem to get is: “Doctor, What’s your opinion of what it will take to return to some semblance of normalcy?” Here is the best answer we can give.

In order for our communities to “re-open” we must be able to figure out how to accomplish significant risk stratification and allow a greater degree of freedom and social re-integration among those at least risk. We must also continue to enforce more protective measures for those who are at highest risk. For that to be successful, frequent and widespread surveillance/testing would need to be readily available for ongoing identification of those who are newly infected but not aware of it because they are not symptomatic. Discovery of those who are newly infected would allow these folks to be wisely isolated from the “herd”. A more detailed analysis of re-opening the economy and risk analysis can be viewed here.

So the pieces that would need to be in place for ideal success would be:  

1) Effective, integrated leadership at the top of local state and federal government who could galvanize everyone to agree to be part of the solution and who would then act accordingly. 

2) Widespread and affordable testing with high levels of both sensitivity and specificity to measure active infection (virus) and recovery (antibodies). More on testing in a minute.

3) Scientists/researchers/clinicians all working together to develop a clearer understanding about the nature of this virus and the pathology caused by it – eventually leading to reliable methods of treatment and prevention (vaccination + significant lifestyle measures).

4) Epidemiologists, business leaders and social scientists working together to collectively analyze all the complex pieces of the business and societal health proposition to determine an algorithm based on economic, psychological and medical facts that would direct the most important steps necessary to expeditiously and safely reintegrate us back to some semblance of normalcy and recovery.  

5) A system of checks and balances so that as we move forward, we continue to evaluate key indicators of success and improve upon the model (and minimize the collateral damage), making appropriate changes in real time.

6) A social movement to reunite our country as One Nation under God – where we’re all on the same team, respecting differences – actually celebrating our differences – without being disagreeable.  Moving toward a position of love and away from a fear-based mentality.  

After hearing the answer to question one, the next obvious question is: “When can I get tested for antibodies so I know if I’m safe?”

As questions continue regarding the use of antibody testing for gauging COVID-19 immunity, our community healthcare systems including SDSM continue to work toward making serologic testing available in the coming weeks. Antibody testing presently being performed is used to evaluate the degree of previous exposure among the most vulnerable front-line medical professionals in the ICU and Emergency Department of our local hospitals as well as in support of evaluating potential convalescent donors (previously infected people who donate plasma for the purpose of producing injectable medication full of anti-COVID antibodies for those hospitalized patients desperately needing life-saving treatment) and in evaluation of hospitalized patients with persistent concern for COVID-19 despite negative PCR (nasal swab test for active virus) studies. As you can see the utility of antibody testing in the near-term is for epidemiological efforts only, not for individual patient management decisions. As the science of serological testing becomes more reliable we anticipate the availability of accurate serologic testing to help us with individual patient management decisions. Then we can answer the question: “When will I know if I’m safe?”.

Drs. Lee Rice and Rick Parker

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