The dialogue is on-going. Do we keep everyone, except for designated critical societal functions, out of work until we can assure no one will catch the virus and maybe die, or do we, at some point during the outbreak, substantially re-populate the workforce and get America back to work? But, what if people die? Is the President then blameworthy because he chose a buck over a life? At least, that’s the crass way the media, which mostly revile President Trump, have framed the problem. He is forced to let the economy unravel or be a deliberate murderer… a callous, stone-cold-hearted businessman.

How about, in order to properly wordsmith the dilemma, we exercise some empathy? You know, put ourselves in that position of leadership and see the situation from there; feel what he feels. And, one step further, ask ourselves what we would decide to do and how we could live with it?

You keep the populace at home, binging on NETFLIX ad nauseam, doing crossword puzzles, and napping, until they can barely do it anymore. But, you stay the course. A month, two, maybe three. By that time, millions of small businesses (99% of the businesses in our country are “small”) have shuttered, never to open again. Mortgages have defaulted. Retirement savings lost. Careers side-tracked, on hold, maybe ruined. Families wondering where next week’s meals will come from. Homelessness rampant. The elderly left without support… with the broad, middle-class taxes gone (out of work), no revenues coming into the US Treasury to fund Social Security payments or Medicare. For that matter, no funds for the military budget. Oh, yeah, this is a national security situation, that our enemies are loving. And, maybe the U.S. is defaulting on its loans. Now, with so many out of work, no one has money to support (by spending) the remaining businesses. So, maybe Amazon, Google, Tesla, United Airlines and Hilton Hotels are facing default and collapse- and their thousands of workers out of jobs. Who comes to the rescue? The federal and state governments are in arrears with no money coming in.

You have societal breakdown. Then what? Social disorder. Anarchy.

Be clear the media and presidents political opponents are putting him on the spot to not be a murderer with their questions. Why? They don’t want all of this. But, they do want some of this. Just enough for a recession to kick him out of office- the only solutions for his 3 years of success and an unprecedented economic boom that would re-elect him, since all they have is a cognitively incapable candidate and a Marxist as contenders. Problem is, no one knows if you let this genie out of the bottle that it can be controlled or limited. Bill Maher, a well-known liberal TV host, mused just that in the past year. That what we need is a “good” recession. That was the only way to get the Left back in the White House. Of course, rich and entitled, he would never lose his house or retirement accounts in a downturn. So, getting the power back was worth some terrible suffering and disruption… of others’ lives.

Why is this relevant? Because it is what underlies the questions of media in the Rose Garden at the daily COVID-19 press conferences with President Trump’s Pandemic Task Force. Can he guarantee no one will die if he sends folks back to work a bit early? It is a set-up.

Does anyone realize that if he sends people back to work too late, all the above can happen, and fast? What if he sends them back to work and some people die? The answer is, either way he goes, people die. The key is it cannot be put on him. Decisions must be made and people will die. Is this any different than wartime? We decide the country’s future is at risk, we conscript young people, and we train them to fight and die. Then we ship them off, knowing a good percent will not come back. If you are not comfortable with this you cannot lead, or be in a position where your decisions can impact a person’s longevity or even result in pre-mature death- like a physician. We physicians get all of this. It is not easy. It is not for the disinclined. It hurts. But, it cannot incapacitate you and you must be able to live with it. There will be losses. There can be no losses. Your job is to get the best outcome in a bad circumstance; minimize losses. And, live to fight another day.

Current political leadership has a responsibility to every single American and to the reality of America – e pluribus unum. From many, one. Each of our ultimate responsibility is to something bigger than ourselves, to our way of life, which is America.

So, what are the steps?

• A substantial interval of total societal pandemic suppression by self-imposed quarantine– only those at work who do life and societal essential services- probably a month.
• Continue all those at home for a month or longer who can carry on at home without loss- such as students on home study.
• Absolute quarantine of all COVID-19 high-risk for death groups- over 65 yrs-old and those with medical problems.
• Somewhere around 4-6 weeks into suppression behavior, send low-risk for serious disease people back to work,
• Those industries most vital to economic resurrection
• Areas of the country not currently epidemic  “hot spots” for disease activity
• Continue mitigation behaviors across the society- masks, handwashing, social distancing.
• Accept the premise of herd immunity as a goal- that we hope to let the virus infect those unlikely to die or to end up in hospital. We want infection to immunize the general low-risk population (ultimately the students, too) so that there is much less risk of resurgent epidemic waves of disease as we restart our society. Use the SARS-CoV-2 virus as the vaccine.

This approach should “flatten the curve” to match numbers new of illness cases to available medical resources (physicians, nurses, hospital beds, ICU beds, ventilators, medications), so we avoid horrible rationing decisions and we break the 50-foot tsunami pandemic wave down to five 10-foot waves.

It is critical, though, that there is a consensus that we will have rational expectations- that some of us will die, in the name of an American way of life for the generations of our children and grandchildren that will be our legacy. No different than what many Americans before us did on beaches and battlefields, not even having kids or grandkids. Let’s join with our president and his Administration leadership to tell them we are with them to rebuild the American Dream, not to point fingers, to blame- -let’s put politics on hold. We’re better than that. We’re Americans.

Now, how do we get this rhetorical language and content to the President of the United States?

Edward R. Rensimer, MD

Infectious Diseases