Healthcare News first published this article, “On the Origin of Pandemic” on May 5, 2020.
The Battle for Planet Earth
Civilization remains under heavy attack, and for the first time in modern history almost all nations around the globe unify in battle. The common enemy, Planet Earth, has waged war against homo sapiens since the species first ventured away from Africa to populate the rest of Earth. The planet remains undefeated in conflict and well rested since it ended all but the birds during its last global extinction campaign some 66 million years earlier.
Science speculates that Planet Earth defeated its last enemy with the help of an extra-terrestrial ally (an asteroid/meteor). To date the planet has proven a formidable opponent, relying upon its own, antiquated but effective arsenal, employing documented textbook military strategies for over 5,000 years, including a prehistoric village in China to Athens in antiquity to Eurasia in the fourteenth century to Mexico and Central America in the sixteenth century. Recently, Planet Earth upped its game by striking the global population in the 1918 Spanish Flu, HIV/AIDS (while still a pandemic, the virus peaked between 2005 and 2012), and most recently the 2019 novel coronavirus (COVID-19).
A Predictable Attack
First discovered in the 1930s, coronaviruses are a group of related viruses that cause diseases in mammals and birds. A novel coronavirus is a new coronavirus that has not been previously identified. On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 coronavirus outbreak, or COVID-19.
The virus, a submicroscopic infectious agent that replicates only inside living cells and of an organism, historically has been Planet Earth’s “go to” weapon against humans. While the role that viruses may play in the natural selection of the genus Homo (which includes Homo erectus, Homo antecessor and today’s Homo sapiens) remains largely unknown, the ways in which humanity responds to the virus affords far greater insight, and perhaps even a better glimpse into an evolutionary transition as it occurs in real time.
We Are The Choices We Make
The United States remains in conflict over the appropriate response to COVID-19, with one side championing domestic financial stability and the other favoring the preservation of human life. The plan to save lives necessitated abandonment of non-essential businesses and an informal 24/7 curfew, which in turn caused the nation’s economy to topple like a stack of dominos. In California, the nation’s largest and most populous state, these restrictions may have “flattened” the proverbial curve for its nearly 40 million residents as some states start to reopen and others choose to riot. An opinionated United States of America can speculate all it wants on the better response to COVID-19, but only Planet Earth and the element of time will ultimately confirm if such measures saved lives or simply decimated the economy.
If nothing else, the COVID-19 pandemic has inspired individual conduct in just as many ways as the number of viral mutations. While some shelter-in-place, wear a mask and maintain suggested social distances, others flock to the beach, socialize with reckless abandon, and cling to the notion that COVID-19 is little more than ordinary influenza. Yet again, only time will tell the true impact COVID-19 may have on natural selection, as well as the influence, if any, individual actions may have in the context of Darwinism.
The Hospital in the Age of the Pandemic
Prior to entering the eleventh year since President Obama signed the Affordable Care Act into law, health care’s spotlight held steady on the Constitutionality of the Individual Mandate, and the U.S. Supreme Court agreed to revisit its propriety. When COVID-19 replaced coffee and the morning commute in the United States, the hospital institution resurfaced again, only now as the epicenter for COVID-19 patients with the highest acuity. While hospitals have cornered the market on COVID-19 patients, for almost two months COVID-19 has been the only market in which hospitals conduct business.
Hospitals already receive an abundance of criticism from both sides of the party line. If blame must be assessed for the forthcoming recession and/or depression, neither the elderly nor the immunocompromised are at fault. Instead, preservation of the hospital institution is the cause behind the curve, or at least the need to flatten it. Without governmental edicts on social distancing, we may never know if the final tally from COVID-19 would be any different.
After watching the speed with which today’s pandemic ripped through Italy, the United Kingdom and New York, other states in the Union, including California, decided to slow the virus down, even if that meant more Netflix and family bonding inside of homes decreasing in value and owned by the newly unemployed. The decision was made to protect the hospital institution above all other causes because a society with functional hospitals is far better than a society without, even if the newly uninsured, unemployed homeowners cannot afford the cost. To protect the hospital and all of the men and women working therein, federal and state leaders issued emergency proclamations to ensure the rest of the country sheltered in place.
Beyond social distancing and sheltering-in-place requirements, federal and state governments have eliminated practically every barrier as it redefined “regulatory flexibility” to assist hospitals contain the spread of COVID-19. Pursuant to the emergency declaration by President Trump under the Robert T. Stafford Disaster Relief and Emergency Assistance Act to declare a national health emergency, the Centers for Medicare & Medicaid Services (“CMS”) waived, in part: (1) enforcement of key provisions within the Emergency Medical Treatment and Labor Act (“EMTALA”); (2) requirements for sterile compounding to ensure an adequate supply of face masks; (3) regulations governing the medical staff, including credentialing, privileging, and the effect of expirations; (4) certain requirements for the physical environment as conditions of participation, affording hospitals flexibility in using non-hospital buildings/space for patient care and quarantine sites, including ambulatory surgery centers, hotels and dormitories; (5) provisions related to telemedicine, making it easier for hospitals to deploy telemedicine services; (6) requirements that secluded acute care psychiatric patients from acute care patients; (7) requirements that out-of-state practitioners be licensed in the state where they are providing services; (8) sanctions under the physician self-referral law (Stark Laws); and (9) most requirements under the 1996 Health Insurance Portability and Accountability Act (“HIPAA”).
As a result, the number of hospital beds available in the United States increased, and in California at least, so did the hospital capacity for very sick patients. As for the curve, in many areas it became so flat that the newly configured hospital, stripped of visitors, elective surgeries and non-essential workers, struggles to find financial stability within the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), code U07.1, also known as the 2019-nCoV acute respiratory disease. Filled or in most cases just partially filled with confirmed COVID patients or patients suspected of the latest coronavirus, the already struggling hospital institution now must contend with a flat and unsustainable revenue model that could last until a vaccine eradicates COVID-19 from the planet.
Society After the Age of Pandemic
For the nation’s estimated 6,000 hospitals, any proclaimed victory of COVID-19 is pyrrhic at best, especially if rejected by the nation’s non-COVID-challenged population. Over the last 100 years, the American hospital rose from the ashes of its nineteenth century stigma, not just through advances in medicine, but also due to a better understanding of infection control and the importance of the physical environment within its four walls. In just a few months the invisible threat from COVID-19 stands ready to reverse a century of improvements and effectively neutralize the nation’s primary beacon of light for practically anyone with a serious and sometimes not-so-serious health concern.
The United States and other nations will eventually defeat COVID-19, although the number of casualties along the way hardly quantifies the pandemic’s full impact. Social interaction and scores of industries may never be the same as the nation goes about its day six-feet apart and wearing a mask, ready to watch the World Series live from Studio X, or the next world-wide Billie Eilish concert through virtual reality glasses. For those still keeping score, Planet Earth continues to have the advantage.