What we’ve done.  And what lays ahead. COVID in 2022, Part 4 – Michael Fine

© Michael Fine 2021 

Introduction

This is the last of four essays about Covid, our culture, our time, and the moral responsibility we share for what we have, where we are, and what we’ve done.

Thanks, as always for reading.  And thanks as always to Nick, Deborah and Kendra for their help, wisdom and support.

Part 4

The numbers woke me from sleep last night.  I had reported them in a previous essay but had not really processed them yet.

Again:  In December of 2021, a year after the vaccine became available, and about eight months after it became widely available, Rhode Island had 152 deaths, 59 of which were in vaccinated people.  In January of 2022, Rhode Island had 252 deaths, 113 of which were in vaccinated people.  

That means that in December of 2021, 93 unvaccinated Rhode Islanders died, and in January of 2022, 139 unvaccinated Rhode Islanders died.  

404 Rhode Islanders died in December and January alone.
Big numbers.
But picture these numbers another way.

Almost all of the breakthrough cases died because we failed to mask and stay home. That’s 172 people. Because the rest of us went to the Dunk to see a URI-PC basketball game, went out to eat or kept shopping. Because politicians failed to lead, and the rest of us just went about our business as if nothing was wrong.

And almost 232 people died because they were unvaccinated.  Human beings.  In little Rhode Island.  In two months.  Because our politics got so crazy they those people couldn’t trust government and the rest of us.

Although, truth be told, if we had all masked and stayed home, and kept community transmission low, very few of the unvaccinated 232 people would have died.

The experience of other countries is clear. Controlling community transmission saves lives.  If we had done our duty, all of us, and stayed home, we would have had a mortality rate like Australia, which is one tenth of ours, or like Japan’s, South Korea’s, or Singapore’s, which was one twentieth of ours, and then we’d be mourning 40 or 20 Rhode Islanders in those two months, instead of 404 Rhode Islanders.

In the early weeks in December, I had occasion to warn a group of very good people who were planning an event for 1200-1500 people that if they went ahead with the event, they would very likely contribute to the deaths of at least 1 to 3 human beings. The numbers were pretty simple. The statewide infection rate at the time was about 1 percent – about 1 percent of the population was infected with the virus at any one time. That meant 12-15 people would likely attend infected.  The R0 of Omicron was 8.  Which means the 12-15 people would each likely infect 8 others, so that the event would likely infect 96 to 120 people. The incubation period of Omicron was three days.  If you walked out  generations of spread, that means 800 people infected in 3 days, 6400 people infected in 6 days, and 51,200 people infected 9 days out and so forth.  he case fatality rate in Rhode Island in October and November (number of deaths divided by number of cases) was 0.0045.  But the number of deaths associated with just 800 infections, one generation of spread, is 3.6.  But I wanted to be conservative (maybe only 500 people would come to the event, which reduces the numbers considerably), and cut all those projections in half or more, so I said at least 1 to 3 deaths.  

And my colleagues said, thank you very much. The Governor hasn’t ordered us to stand down.  We depend on this event for fellowship and for sales.  So we are going to go ahead.  Objections noted.
I didn’t go, of course.  But the event happened.  Good people who were forewarned couldn’t see it.  They didn’t understand.  I’ll bet now they are saying, that Dr. Fine, always saying the sky is falling.  No one who came to the event died.  What the hell was he talking about?  

And guess what?  In March, that organization, made of good people, is going back to having monthly meetings in person.

My guess is that a substantial number of infections resulted from that event, but perhaps no one who attended died. Perhaps. Or not. Just people who got the virus from someone who got it from someone else who attended the event died.  Out of sight, out of mind.

The problem is that none of us see the consequences of our choices.  And so we can tell ourselves that, oh well, 404 Rhode Islanders died in December and January.  Too bad.  The virus is endemic.  939 Rhode Islanders died in December of 2020 and January of 2021, the direct consequence of the previous governor’s choices and actions, because ninety percent of those deaths resulted from our failure to control community spread.  Out of sight.  Out of mind.  939 Rhode Islanders. See how much better we did?

I have been thinking about the Nazi era and what Hannah Arendt (who was the teacher of one of my teachers, turn-about being fair play) wrote about the banality of evil, about a time when too many good people turned their heads away, and didn’t object, when millions were being murdered.  Who followed orders.  Who didn’t see, because the camps were far away.  Out of sight.  Out of mind.
The Governors say we can stop masking now.

These are the numbers.  This is what we’ve done.

Thanks for reading.
Michael

Many thanks again to Nick Landekic, who provided me with tons of data and publications over the last twenty months, and whose knowledge of Covid-19 is encyclopedic; to Deborah Faith, MPH, for her unending editorial support and great editorial suggestions, and to Kendra Tanquay, for her support of my writing over many months.  Thanks as well to the many readers who respond to these emails and help keep me honest.  Part one of these emails was written in response to a very good question.  Thanks for that question, Matt.

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Michael Fine, MD was the Director of the Rhode Island Department of Health from February of 2011 until March of 2015. His career has been devoted to healthcare reform and the care of under-served populations. He served as Medical Program Director at the Rhode Island Department of Corrections; and founder and Managing Director of HealthAccessRI, the nation’s first statewide organization making prepaid, reduced fee-for-service primary care available to people without employer-provided health insurance.

Dr. Fine practiced for 16 years in urban Pawtucket, and rural Scituate, RI. He is the former Physician Operating Officer of Hillside Avenue Family and Community Medicine, the former Physician-in-Chief of the Rhode Island and Miriam Hospitals’ Departments of Family and Community Medicine. He was co-chair of the Allied Advocacy Group for Integrated Primary Care.

He currently serves on the Boards of Crossroads Rhode Island, the state’s largest service organization for the homeless, the Lown Institute, the George Wiley Center, and RICARES. Dr. Fine founded the Scituate Health Alliance.

Dr. Fine is past President of the Rhode Island Academy of Family Physicians, has served on a number of legislative committees for the RI General Assembly, chaired the Primary Care Advisory Committee for the RIDOH, and sat on both the Urban Family Medicine Task Force of the American Academy of Family Physicians and the National Advisory Council to the National Health Services Corps.