A Fullness of Uncertain Significance:

Surgery, Clarity, and Grace

BRUCE CAMPBELL, MD FACS

 

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  • Bruce Campbell MD

When people say that we must reopen the country now, the following story comes to mind.

Mount Vernon, in Washington’s idyllic Skagit Valley, is nestled amidst wide expanses brimming with fruits, vegetables, and flowers. It is home to the annual Skagit Valley Tulip Festival, celebrating colorful fields that stretch for miles. I have a special connection to the region because my cousin lives in Mount Vernon and my father-in-law was born there.

A cautionary tale…

On March 10, 2020, The Skagit Valley Chorale, a volunteer community choir, gathered in a meeting room in the Mount Vernon Presbyterian Church. Even though COVID-19 was active in other parts of the state – particularly an hour south in Seattle – there had been no cases in Skagit County and the choir decided to rehearse. The members took extra precautions, though. No one at the rehearsal was ill. Everyone brought their own music. Hand sanitizer was plentiful. Contact was minimized.

The Chorale had a wonderful evening of friendship and music. The rehearsal lasted two-and-a-half hours, and everyone headed home.

Three days later, people began getting sick. Of the sixty members of the Skagit Valley Chorale who were at the March 10 rehearsal, forty-five eventually tested positive for COVID-19. The average age was 67; the youngest was 31. Three choir members were hospitalized and two died. You can read about their story here. A few days later, Washington issued a Stay-at-Home order.

Super-Spreaders

There have been several “super-spreader” events spawned by COVID-19 where a single infected person rapidly shared the virus with a large group. Typically, super-spreader events involve indoor gatherings of people from different households in close, extended contact. Contact tracing has identified events after get-togethers such as religious services, birthday parties, family gatherings, funerals or, as in Mount Vernon, choir practices.

In most cases, the person from whom the infection spread had no idea they carried the virus.

Clearly, some situations pose more risks than others. An indoor choir rehearsal is more dangerous than a socially-distanced gathering in a park. Shopping in a grocery store for one hour is probably safer than working in the same store for eight. As epidemiologists analyze data, they pass along information. No iterative process is perfect, of course, and the science continues to evolve as data are collected. We owe it to ourselves and to our fellow citizens to push for evidence-based decision making.

Guidance from George Carlin

I hope we error on the side of caution. I am reminded of a comment that George Carlin once made that applies the same logic to a controversy of his time to the controversy of ours. While reflecting on the lunacy of municipalities and people debating smoking in airplanes, bars, and restaurants, Carlin ranted, “Isn't making a smoking section in a restaurant like making a peeing section in a swimming pool?” We could say the same about shutting down one region and leaving the neighboring region open.

It is dangerous and disheartening to see our national and state leadership (on both sides) look at the same data, listen to the same public health experts, and yet be incapable of reaching consensus. With no coherent vision from our leaders, everyone feels vulnerable, lied to, and angry. It can seem as though some people are more focused on reelection than on our wellbeing.

What’s next?

Here’s what we can say for certain. The guidelines will continue to evolve – we just don’t know if the changes will be based on public health data or polling data. We know that a vaccine, extensive tracking, widespread testing, and PPE will change the course of the pandemic. We know that if we open before there is full population immunity, there will be lives lost. We know that if we reopen too soon, the flare will be more intense, more people will die, and more super-spreader events will occur.


The people in Mount Vernon likely felt safe to go to choir rehearsal because they were healthy, they were careful, and they were following the available guidelines. Many of us would have done the same. What could possibly go wrong? I hope we listen to the public health experts, do what we can to protect ourselves and others, and show that patriotism includes being patient.



 
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