Dr. David Katz is the founding director of the Yale-Griffin Prevention Research Center He has these letters after his name: MD, MPH, FACPM, FACP, FACLM, a physician trained in epidemiology and public health and author of 17 books and numerous articles. Also he has five kids. Also he recently volunteered his time fighting COVID-19 at a hospital emergency department in the Bronx.
Someone needs to give this doctor an award. Or many.
In March, he wrote a very important OpEd in the New York Times, “Is Our Fight Against Coronavirus Worse Than the Disease?”
I am of the opinion that most people you see in the media and government have a very limited, and often quite confused, understanding of what they are talking about. The initial argument about “let’s just slow the initial spread so the hospitals do not get overwhelmed in the short run” has now changed to “you cannot work for an indefinite period of time.”
So I am quite pleased that we get to hear from this very accomplished doctor on the April 24, 2020 show Real Time with Bill Maher.
Here are some excerpts in which he elaborates on the need for protecting the vulnerable, getting the economy open, being healthy, and helping society develop community immunity:
What flattening the curve does is keeps people away from one another – and away from the virus. So the virus doesn’t spread. But you also don’t cultivate any immunity if you do a really effective job of locking everybody in place and preventing viral transmission. There’s still some low-level potential for viral exposure out in the world but very few of us get that exposure. The minute you release those clamps, and let people back into the world, we’re all vulnerable. So most of the models suggest that flattening the curve makes sense in Phase one so you don’t overwhelm medical systems, for example.
But you’ve got to have a Phase two. If you don’t transition to a Phase two, whenever you release the clamps, the virus is out in the world waiting for you. Everybody is vulnerable, and that big peak in that case isn’t – that big peak in deaths that you were trying to avoid really just happens at a later date….
If you lock everything down, you destroy livelihoods, you destroy jobs. And, and what I was saying in – what I didn’t really think was, uh, controversial at the beginning – is there’s really more than one way for this situation to hurt people, or even kill them, and all of them are bad. And there’s more than one way to protect people and save them, and all of those are good. So one thing we want to do is keep those vulnerable to severe infection away from this nasty bug, but we don’t want to destroy people’s lives and livelihoods and means of feeding their families….
I think people have a hard time… confronting and accepting: we actually kind of want to get this, and get it over with, and be immune because that is the path to the all-clear that doesn’t require us to make or wait for a vaccine – which optimistically is 18 months away, but could be much longer….
Maybe there’s a real opportunity here for an “aha!” American moment that’s between the extremes of left and right, where we all say is, “yeah, actually we want to save as many lives as possible.” And – you know one of the interesting things, Bill, is it’s sort of the – the left side of the spectrum that – the liberal ideology, that seems to be so resistant to talking at all about unemployment and the economy. But that’s the very same camp that tends to appreciate that the single leading driver of bad health outcomes is poverty. Social determinants of health are massively important. So, you know frankly 30 million people unemployed, that falls disproportionately hard on the people who can least bear the unemployment – who are at most risk of food insecurity; who are at most risk of depression, addiction – all of that’s important too. So, maybe there’s a real opportunity here to say, “hey, there’s a middle path we’ve been neglecting. It’s the way through this thing, and it leads to total harm minimization. We want to minimize deaths and severe cases of the infection; we also want to minimize the fallout – the health fallout of societal collapse and economic ruin.”
I just want people to understand – again, I’m a physician, I do public health, I’m trained in epidemiology – it really still looks to me as it did that month ago when I wrote my piece for the New York Times. 98 to 99 percent of the cases of this infection are mild. Most people don’t even seem to know they have it and that, this is true even in the emergency department. A small portion of the cases are potentially severe, and that’s what makes your points so important Bill: the severe cases occur in people who are old and people who are sick.
Now those two things go together, but sadly in America they also splay apart: there a lot of young people with coronary disease, obesity, type 2 diabetes, hypertension, and by and large those are diseases of lifestyle. I’m a past president of the American College of Lifestyle Medicine; that’s what we advocate. Lifestyle is medicine, because it can fix all of that. Here’s the interesting bit: the stuff we can’t sell to people – eat well, exercise, don’t smoke, don’t drink excessively, get enough sleep, manage your stress – because it’s such potent medicine. We can’t sell it because the timeline for harm is too long. You know essentially heart disease stops you in slow motion; type 2 diabetes stops you in slow motion – and our DNA is wired to fight-or-flight. You know, if it’s not coming at me in minutes or days, I’m sort of blind to it. Well, COVID is coming at you in minutes and days and everybody is alarmed – and all the same things are risk factors – so essentially what this pandemic has done, has turned America’s chronic health liabilities into an acute threat.
And there is an opportunity, a crisis of interest opportunity the very things that we’re always telling people to do to promote their long-term health actually do fortify your immunity against this virus. If you start eating optimally, start fitting physical activity into your in place routes, now if you get enough sleep – that can affect how your immune system functions in hours, certainly in days, and a whole lot in a span of a few weeks.
There’s never been a better time for America to get healthy. If I were one of the grown-ups in charge of this mess I would have a national health promotion campaign as part of what we do, in an organized way. Look, we’re all social distancing, sheltering in place, let’s make lemonade from the lemons: let’s turn this into an opportunity of healthy. It will protect you in the short run, it’ll help protect your loved ones, and when this is over we’ll be a healthier nation into the bargain.