Italy has a modern, westernized medical system similar in quality to the United States. The country is quite a bit smaller and less populated than the US, but it’s easy to look there and imagine it could be an example of what may befall us here if we are unable to stave off a massive outbreak of the virus. In my opinion, due to the lack of control over our border and ports of entry, we will be unable to stop the spread. We have already had one case of the virus land in my own county, treated by the hospital that cuts my paycheck. That patient, who was elderly and had multiple serious comorbidities, died, and we are basically in a holding pattern waiting to see if any medical staff were infected. According to trends worldwide, we will have some that are infected, and they will spread it. If not, we will be one of the only, or maybe the only, location in the US with a case of COVID-19 that didn’t result in a larger outbreak. We will see. In a few weeks.

Back to Italy. Tourist sites are closed, schools are closed, stores are closed, streets are empty. More serious than that, is the fact that one region, Lombardy, has been hit so hard that Italian officials have been pulling retired doctors back into the field, and graduating nursing students early in order to get them into the workforce. Italy has extended emergency protocols to the entire nation, effectively putting the entire country into “lockdown”, and a quarter of the Italian population has been quarantined, including tens of millions in Lombardy who require special permission to travel anywhere.

One woman in St. Louis has tested positive for the virus after traveling to Italy.

Imagine in your state that every single school, K-12 and colleges, are closed without a reopen date. Now add to that every major big box store, like Walmart or Target, and at least half of the smaller ones like Dollar General. Add to that most of your local government buildings, like tag offices. And on top of all that, every single bed in every hospital is full, and every ER, and patients are waiting in the halls, lobbies and parking lots. Maybe 15-20% of your police forces and Fire/EMS workers are either sick or quarantined, and 10% of the nurses and doctors as well.

That is what is happening in Lombardy, Italy right now, and it’s probably going to be happening in the rest of the country within a few weeks. On March 8th, Lombardy went from around 5,900 infections to over 7,300 in a single day. In that same day, the number of deaths went from 133 to 336. A modern, westernized society that has at least twice as much control over their borders and ports of entry as we do, is on the brink of having a collapse of their medical system, and this virus really just started it’s worldwide warpath in January.

It is not time to panic, because panicking, by nature, is an irrational response to any stimuli. But while it’s not time to panic, it IS time to take this seriously. No, it does not matter that the flu has killed more people, because this is much more contagious than the flu, and by all accounts it does have a significantly higher mortality rate (3.4% of all cases, but they also include unresolved cases as survivors, despite those cases still being unresolved, which means the death rate is always inaccurately low). No, this is not just the next hysteria like SARS or MERS, which will probably always be a nothing-burger. This is not Ebola, where even a mediocre second world medical system can control the spread (mainly because, mercifully, Ebola kills extremely quickly and burns itself out). This is different. Is this the big “Disease X”, a term the WHO coined a while back? I don’t know, probably not, but only because that is very unlikely. But it’s the closest we’ve come since the Spanish Flu.

In my ER, and I suspect most or all of the others in the country, we have rolled out policies and protocols for treating suspected COVID-19 patients, protocols that are based in preventing spread of the virus. So far, nothing I’ve seen or heard seems likely to work well. We in the US simply do not have the system in place to handle this, and conjuring one up from scratch isn’t really a thing that happens. As Aesop at RR has stated, every ICU in the country is already at 90% capacity on an average day with zero COVID-19 cases. I would add to that most of the hospitals in the US are at 90% capacity on an average day, not just the ICUs.

It’s past time to stock up on things you don’t want to be without. Once you’ve stocked up, take a trip to the woods. Like I said before, they aren’t going to find the virus in your local creek or state forest. As for us, we will be in the mountains next week. Might be the last vacation any of us will be able to take for a while.

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