More than six out of 10 Americans are hopeful about what 2021 has in store for the world, according to a new Axios/SurveyMonkey poll.
The big picture:After a year dominated by the pandemic and a seemingly endless presidential election, Americans are overwhelmingly hopeful that things will get better with the pandemic — and more narrowly hopeful about Joe Biden’s presidency.
By the numbers:63% of poll respondents said they’re more hopeful than fearful about what 2021 holds in store for the world, while 36% said they’re more fearful.
That’s a jump in optimism compared to the same poll heading into 2019, when just 51% said they were hopeful and 48% said they were fearful.
The only group that wasn’t optimistic about 2021 was Republicans: 41% said they were more hopeful, while 58% said they were more fearful.
Between the lines:Americans were even more optimistic about the year ahead for them personally — mostly driven by the hopes of young adults, people of color and Democrats.
The coronavirus was the one issue that united most people in optimism. Overall, 76% were more hopeful than fearful about the pandemic next year — a view that held across most age groups, racial and ethnic groups, and parties.
82% of Democrats, 72% of Republicans, and 73% of independents said they were more hopeful than fearful.
The Biden presidency was more divisive. Overall, 56% were more hopeful about his presidency, while 42% were more fearful.
Not surprisingly, Republicans are the most pessimistic: 82% said they’re more fearful than hopeful about his presidency.
By contrast, 59% of independents said they’re more hopeful about it — and 92% of Democrats said the same.
And while Republicans are ready for President Trump to take on a big leadership role in the Republican Party after his presidency ends, that’s not true of everyone else.
75% of Republicans said they’re more concerned that Trump will play too small a role in the future of the GOP rather than too big a role — while 51% of all respondents said they’re more concerned that he’ll play too big a role.
And more than half of Republicans (52%) said they believe Trump will have a major role in the Republican Party, while 30% said they think he’ll have a minor role.
By contrast, just 34% of all respondents expect him to play a major role, while 32% think he’ll have a minor role and 31% think he’ll have no role at all.
As people across the country refuse mask mandates, public health officials are fighting an uphill battle with little government support.
DR. MEGAN SRINIVAS was attending a virtual American Medical Association discussion around the “Mask Up” initiative one evening in July when she began to receive frantic messages from her parents begging her to confirm to them that she was all right.
“Somebody obtained my father’s unlisted cell phone number and spoofed him, making it look like it was a phone call coming from my phone,” she told Des Moines’s Business Record for a November profile. “Essentially they insinuated that they had harmed me and were on the way to their house to harm them.”
This malicious hoax, made possible by doxxing Srinivas’s private information, was only the most severe instance of abuse and harassment she had endured since she became a more visible proponent of mask-wearing and other mitigation measures at the beginning of Covid-19 pandemic. A Harvard-educated infectious disease physician and public health researcher on the faculty of the University of North Carolina, Srinivas currently lives and works in Fort Dodge, her hometown of 24,000 situated in the agricultural heart of northwest Iowa.
Srinivas is not just a national delegate for the AMA, but a prominent face of Covid-19 spread prevention locally, appearing on panels and local news segments. Fort Dodge itself is situated deep within Iowa’s 4th Congressional District, a staunchly conservative area that simply replaced white supremacist Rep. Steve King with a more palatable Republican.Join Our NewsletterOriginal reporting. Fearless journalism. Delivered to you.I’m in
Basic health measures promoted by Srinivas in Iowa since the beginning of the pandemic have been politicized along the same fault lines as they have across the rest of the country. Some remain in the middle ground, indifferent to health guidelines out deep attachment to “normal” pre-pandemic life. Others have either embraced spread-prevention strategies like mask-wearing or refused to acknowledge the existence of the virus at all. In a red state like Iowa, an eager audience for President Donald Trump’s misinformation about the dangers of the coronavirus has made the latter far more common, which has made Srinivas’s job more difficult and more dangerous.
“It was startling at first, the volume at which [these threats were] happening,” Srinivas told The Intercept. “I know people get very heated about politics and the issues that people advocate for in general, but especially on something like this where it’s merely trying to provide a public service, a way people can protect themselves and their loved ones and community based on medical objective facts. That’s surprising that this is the reaction people have.”
“I have trolls like other people, I’ve been doxxed, I’ve gotten death threats,” she said. “When you say anything people don’t want to hear, there will be trolls and there will be people who will try to argue against you. The death threats were something I wish I could say were new, but when I’ve done things like this in the past, I’ve had people say not-so-nice things in the past when I’ve had advocacy issues.”An untenable pressure has been placed on public health workers thrust in a politicized health crisis — and that pressure only appears to be worsening.
At the same time, as an Iowa native, Srinivas has been able to gain some trust through tapping into local networks like Facebook. Though she has encountered a great deal of anger, she’s also seen success in the form of a son who’s managed to convince his diabetic father, a priest, to hold off on reopening his church thanks to her advice, and through someone who’s been allowed to work from home based on recommendations Srinivas made on a panel.
“At this point, almost everyone knows at least one person that’s been infected. Unfortunately, it leads to a higher proportion of the population who knows someone who’s not just been infected, but who’s had serious ramification driven by the disease,” Srinivas said. “So it’s come to the point where, as people are experiencing the impact of the disease closer to home, they’re starting to understand the true impact and starting to be willing to listen to recommendations.”
Without cooperation and support at the state level, however, what Srinivas can accomplish on her own is limited. Even as the number of Covid-19 cases grew and put an increasing strain on Iowa’s hospitals over the past few months, it took until after the November election for Iowa’s Republican Gov. Kim Reynolds to tighten Iowa’s mask guidance. And board members in Webster County, where Srinivas lives, only admitted in November that she had been right to advocate for a mask mandate all along. Though Trump lost the election nationally, he won Iowa by a considerable margin, which Reynolds has claimed as a vindication of her “open for business” attitude and has continued downplaying the pandemic’s severity.
“The issue with her messaging is it creates a leader in the state that should be trusted who’s giving out misinformation,” Srinivas said. “Naturally, people who don’t necessarily realize that this is misinformation because it’s not their area of expertise want to follow what their leader is saying. That’s a huge issue under the entire public health world right now, where we have a governor that is spreading falsehood like this.”
The embattled situation in which Srinivas has found herself is the new normal for public health officials attempting to stem the tide of a deadly viral outbreak, particularly in the middle of country where the pandemic winter is already deepening. Advocating for simple, potentially lifesaving measures has become a politically significant act, working to inform the public means navigating conflicting regulatory bodies, and doing your job means making yourself publicly vulnerable to an endless stream of vitriol and even death threats. The result across the board is that an untenable pressure has been placed on public health workers thrust in a politicized health crisis — and that pressure only appears to be worsening.
DESPITE THE FACT that Wisconsin’s stay-at-home order was nullified by the state’s Supreme Court in May, the Dane County Health Department has used its ability to exercise local control in an attempt to install mitigation measures that go beyond those statewide. By issuing a mask mandate ahead of a statewide rule and advocating for education and compliance efforts, the department currently considers itself in a good place regarding health guideline compliance.
These actions have drawn a lot of ire from those unhappy with the regulations, however. According to a communications representative for the department, anti-maskers have held a protest on a health officer’s front lawn, a staff member was “verbally assaulted” in a gas station parking lot (an incident that prompted the department to advise its employees to only wear official clothing to testing sites), and employees performing compliance checks on businesses have been told to never perform these checks alone after “instances of business owners get a little too close for comfort.” They’ve also received a number of emails accusing health workers of being “Nazis,” “liars,” “political pawns,” and purely “evil.”
In Kansas’s Sedgwick County, Wichita — the largest city in the state — has been considering new lockdown measures after a November surge in coronavirus cases has threatened to overwhelm its hospitals. Though Democratic Gov. Laura Kelly attempted to instate a mask mandate in July, 90 of the state’s 105 counties rejected it, including Sedgwick, though the health board issued its own directive and Wichita had installed its own at the city level.
Now, with cases surging again, just as Srinivas saw the number of believers rising as more got sick, counties in Kansas that previously resisted mask mandates are changing their tune after Kelly announced a new mandate. But Sedgwick County health officials see an intractable line in the sand when it comes to who’s on board with mitigation measures and are focused more on what those who are already on board need to be told.
“It seems like a lot of the naysayers are naysayers and the supporters are supporters,” Adrienne Byrne, director of Sedgwick County Health Department, said. “There’s some people that are just kind of whatever about it. We just remind people to wear masks, it does make a difference. As we’ve gone on, studies have shown that it works.”
“I think it’s important to acknowledge to people that it is tiring, to acknowledge and validate their experience that people want to be over this stuff, but it’s important to reinforce that we are in a marathon,” she said. “In the beginning, we all wanted to hear that we would reach a magical date and we would be done with this stuff.”
Sedgwick has managed the streams of angry messages but has seen her colleagues in rural counties endure far worse, including death threats. She knows of one public health worker in Kansas who quit after being threatened, and others who have cited the strain of the politicized pandemic as their reason for leaving the public health profession.
“We’re certainly losing some health officials, there’s no question about that,” said Georges Benjamin, president of the American Public Health Association. “In the long arc of history, public health officials are pretty resilient. And while it absolutely will dissuade people from entering the field, we all need to do a better job of equipping them for these issues in the future.”
Benjamin would like to see institutional and public support for public health workers resemble that given to police or firefighters, government professionals who are well-funded, believed to be essential to the functioning of society, and wielding a certain level of authority.
“For elected officials who are charged with protecting the officials and their public officials, our message to officials then is that they should protect their employees,” Benjamin said.
IN RURAL NEBRASKA, the situation has presented even more complex challenges to public health workers. Outside of Omaha, the rural expanse is ruled by a deeply entrenched conservatism and, like Iowa’s governor Reynolds, Nebraska’s Republican Gov. Pete Ricketts has resisted a mask mandate. The Two Rivers Public Health Department, which oversees a wide swath of central Nebraska and its biggest population center, Kearney (population 33,000), is a popular pit stop along the Interstate 80 travel corridor and home to a University of Nebraska outpost.
Prior to the pandemic, Nebraska’s decentralized public health system had seen significant atrophy, according to Two Rivers Health Director Jeremy Eschliman, and was wholly unprepared for this level of public health event. There were few epidemiologists to be found outside of Omaha, though the department was able to hire one earlier this year. It also became clear early on that, despite the department’s traditionally strong ties with local media, messaging around the pandemic would be an uphill battle to get people to adapt new habits, especially when the president was telling them otherwise.
“There was one clear instance I remember when I caught a bit of heckling when I said, ‘Hey, this is serious. We’re going to see significant death is what the models show at this point in time,’” Eschliman said. “[The station said], ‘Are you serious? That seems way out in left field’ or something to that effect. That station had a very conservative following and that was the information they received.”
Eschliman has taken a realistic stance to promoting mask-wearing, thinking of it as akin to smoking. (“You could walk up to 10 people and try to tell them to quit smoking and you’re not going to get all 10 to quit,” he said. “Fun fact: You’re not going to get more than maybe one to even quit for a small period of time.”) Over the summer, he traveled just over Nebraska’s southern border into Colorado, where he was struck by the night-and-day difference between his neighbor state’s adoption of mask-wearing and Nebraskan indifference to it, each following the directives of their state leaders.“It’s become very difficult to do the right thing when you don’t have the political support to do so.”
Home rule is the law of the land in Nebraska, and there’s been strong rural opposition to mask mandates, despite more liberal population centers like Lincoln and Omaha installing their own. It’s taken Kearney until November 30 to finally install its own after outbreaks at the college and in nursing homes. Public health care workers have also been left on their own to make controversial decisions that have caused political friction. In May, the local health board voted not to share public health information with cities and first responders due to what they decided were issues of information confidentiality.
“Mayors, county board members, and police chiefs ran a sort of a smear campaign against me and the organization,” Eschliman said. “So when we talk about resiliency, that’s what we’re dealing with. It’s become very difficult to do the right thing when you don’t have the political support to do so.”
Even having a Democratic governor doesn’t necessarily ensure that support. In Hill County, a sparsely populated region of Montana’s “Hi-Line” country along the Canadian border, Sanitarian Clay Vincent supports Gov. Steve Bullock’s mask mandate, but doesn’t understand why it exists if it’s not enforceable. The way he sees it, if laws are made, they should create consequences for those who refuse to follow them.
But Vincent and the Hill County Health Board also saw what happened elsewhere in the state, in Flathead County, where lawsuits were brought against five businesses who refused to follow Bullock’s mask mandate. After a judge threw the lawsuit out, those businesses launched a countersuit against the state, alleging damages. In order to bring businesses in Hill County into compliance with the mask mandate, the health board is considering slapping them with signs identifying them as health risks or, barring that, simply asking them to explain their refusal to comply.
“These are community members. Everybody knows everybody and [the board isn’t] trying to make more of a division between those who are and those who are not, but I come back to the fact that public laws are put there for the main reason to protect the public from infectious diseases,” Vincent said. “You have to support the laws, or people sooner or later don’t give any credence to the public health in general.”
Regardless of whether they can push the Hill County businesses into compliance, the political winds are already changing in Montana. Republican Gov.-elect Greg Gianforte will take power in January and likely bring the party’s aversion to mask mandates with him. President-elect Joe Biden will take power at the same time, and even if he attempts to install a nationwide mask mandate, it will likely be difficult to enforce and may end up meaning little out in Montana. It will also likely exacerbate ongoing tensions in communities throughout the state. The building that houses Hill County Health Department in the town of Havre was already closed this summer out of fear that a local group opposed to the mask mandate and nurses doing contract tracing are routinely threatened in the course doing their jobs.
Regardless, Vincent is determined to encourage and enforce public health guidelines as much as it’s in his power to do so, no matter the backlash. He sees protecting the public as no different than preventing any other kind of disease. “I don’t care if it’s hepatitis or HIV or tuberculosis or any of these things,” he said. “You’re expected to deal with those and make sure it’s not affecting the public. Otherwise you have a disaster.”
Dr. Anthony Fauci, the nation’s top infectious disease expert, said he and his family are getting death threats because people don’t like what he says about COVID-19.
“Getting death threats for me, and my family, and harassing my daughters, to the point where I have to get security is just — I mean, it’s amazing,” Fauci said during an interview with CNN’s Sanjay Gupta on Wednesday.
“I wouldn’t have imagined in my wildest dreams that people who object to things that are pure public health principles, are so set against it and don’t like what you and I say, namely in the world of science, that they actually threaten you.”
He noted that crises like COVID-19 has brought out the best of people but also the worst of people.
Fauci’s notoriety has been elevated by COVID-19, as he is often on TV offering a blunt portrayal of the state of the pandemic in the U.S.
Fauci, 79, is one of the world’s most respected infectious disease experts, having advised six presidents on HIV/AIDS, Ebola, Zika and other health crises. He has earned a reputation for being blunt and willing to correct the president.
Fauci also reflected on what he says is a degree of “anti-science” sentiment in the U.S. that is making it difficult to get people to do things to slow the spread of COVID-19 like wearing masks.
“There is a degree of anti-science feeling in this country, and I think it is not just related to science. It’s almost related to authority and a mistrust in authority that spills over,” he told Gupta.
“Because in some respects, scientists, because they’re trying to present data, may be looked upon as being an authoritative figure, and the pushing back on authority, the pushing back on government is the same as pushing back on science.”
He said the scientific community should be more transparent and reach out to people to underscore the importance of science and evidence-based policy.
“I know when I say that if we follow these five or six principles, we can open up we don’t have to stay shut…There are some people that just don’t believe me or don’t pay attention to that. And that’s unfortunate because that is the way out of this,” he said.
President Trump has repeatedly undermined Fauci, questioning the White House coronavirus task force member on Twitter and in interviews with the media.
Over the weekend, Trump tweeted out a video of a portion of Fauci’s testimony explaining why the U.S. has recorded more cases than European cases and called it “wrong.” Trump has falsely claimed several times that the U.S. has more cases because it is doing more testing.
Trump has also retweeted multiple messages that question Fauci’s expertise, including one last week that said he had “misled the American public.”
Cancel the MLB year, maybe by the end of this week.
Forget about the NFL season; it’s never going to happen.
The idea of attempting a college football season — putting amateur athletes at risk — is obscenely unthinkable.
Within days or a couple of weeks, we also may find out just how feasible it is for the NBA, in its Florida bubble, or the NHL, playing in two hub cities in Canada, to finish truncated seasons and crown champions.
Sure, none of that is certain, but Monday morning’s news that at least 14 members of the Miami Marlins and their staff have tested positive for the novel coronavirus in recent days was a Category 5 covid-19 hurricane alert. You couldn’t have a worse MLB start or a grimmer predictor for other games.
With lots of inherent social distancing, baseball was supposed to be the easiest major American team sport to resume, just as leagues in Japan and South Korea have functioned smoothly for months. But MLB couldn’t go even a week without the serious prospect that its 60-game season should be canceled.
“Hey, I’m going to be honest with you: I’m scared. I really am,” said Washington Nationals Manager Dave Martinez, 55, who has a heart condition.
Why is MLB creating a situation where Dusty Baker, 71, the survivor of multiple life-threatening conditions in the past 15 years, manages Houston every day while Texas is a national coronavirus hot spot?
Martinez added that before long his team may see more players “opt out,” as Ryan Zimmerman and Joe Ross already have. Once the defections start, the cascade won’t stop until the sport must call a halt.
“Now we REALLY get to see if MLB is going to put players health first,” tweeted Los Angeles Dodgers left-hander David Price, who passed on $11.8 million by opting out of this partial season. “Remember when [Commissioner Rob] Manfred said players health was PARAMOUNT?! Part of the reason I’m at home right now is because players health wasn’t being put first. I can see that hasn’t changed.”
Underneath all the discussions and elaborate plans to reopen various sports — MLB, the NBA and NHL now, and the NFL and college football by the end of next month — has been one naive assumption: If the virus hit a team, it would infect one or two players. Maybe three. But the sense was things still would be manageable. You could still field a team.
When did this become the highest of all human goals?
The danger and the damage would not be “too bad.” In this, we see Americans’ national tendency toward willful pandemic ignorance being played out on a small, crystal-clear stage so everyone can get the message.
For months, we have watched healthy people, mostly young, swarm into bars or hit the beaches with an apparent sense that community spread was a fiction or not something that applied to them. Maybe, the fantasy went, one person in the wrong bar would get the virus.
The wider effect: Back to normal, or even semi-normal, in sports was shattered just days after being reintroduced.
What does this mean?
Some events have ambiguous consequences. We won’t know their impact for some time. But in rare cases, one event may have enormous impact, just as the positive virus test for the NBA’s Rudy Gobert in mid-March resulted in the shutdown of every major sport within 48 hours.
This is such a moment — but perhaps bigger.
Why are we here? The answer is simple yet inexplicably unacknowledged in wide swaths of this country: The pandemic is not under control until you stop it, suppress it, dominate it and crush the curve.
Though many other countries have done it, America has not come within a million miles of that outcome.
As I pointed out in a column last week, when a league says, Given what we are seeing with covid-19 hitting our teams, maybe we should cancel the season, the correct response is “get rid of the word ‘maybe.’ ”
The entire American experience of this pandemic has been: Don’t embolden the virus by acknowledging its threat. Try to outrun it, hide from it, say it’s not so bad and will go away.
That just breeds a disaster, and now that disaster has hit MLB just days into its season. The Cincinnati Reds also have multiple positive tests. The Atlanta Braves have been without two catchers who have symptoms, though no positive tests. Nationals star Juan Soto is inactive after a positive test.
Do we need a longer list?
You can’t be much healthier, as a group, than a pro baseball team. You can’t be much better protected or tested more often than an MLB team. The Marlins are close to the safest possible case. And now, less than a week into their season, at least half of the team has the coronavirus!
That is what is meant by “community spread.” That is what is meant by an “outbreak” in an epidemic. All of us have worried that one or two players — or people in the MLB community — would have bad outcomes from the virus if a 60-game season was played. Time to blow up that assumption. If half of the Marlins team can test positive within a few days, then the scale of danger to health — the number of people who may get sick and the severity of the damage they may suffer, including prime-of-life pro athletes — just shot through the ceiling.
Our assumptions, while well-intentioned, have been blown to pieces. And in short order, so will the season of one, or perhaps several, of our sports.
The Marlins are just the latest — but one of the most vivid — illustrations of what America is facing. And how little we are willing to take seriously the true measure of our fearsome enemy.
Valid concerns have been raised about mail voting. In New York, the local election boards have taken weeks to count primary ballots received in the mail as a result of the coronavirus, leaving several races for Congress still unresolved. The problems have been blamed on the late decision to send out the absentee ballot applications, outdated ballot counting machines, and the sheer number of mail ballots. The New York case raises a serious alarm with the 2020 election approaching and many states considering more reliance on mail voting in the midst of the pandemic.
Adding to this sense of urgency, President Trump has declared, without evidence, that mail voting is an open invitation to fraud and will be used unfairly against him this fall. He has tweeted that mail voting would make this the “most rigged” election in history. Setting aside the fact that states have relied on absentee and mail voting to hold secure elections for many years, the stumbles in New York and the irresponsible fear mongering by Trump raise the potential of a very real crisis come this fall.
Consider the national disruption surrounding the 2000 election, which was decided for George Bush after a recount in Florida, a month of legal battles, and a controversial split Supreme Court decision. After you add the factor of a second wave of coronavirus cases in the fall and a sitting president shouting “rigged!” to the rafters, and you can understand why some analysts worry that the period following the 2020 election may be one of the most disruptive contests in our modern history.
A crisis foretold, however, can be a crisis averted. Instead of wringing our hands over the recent problems with mail voting in New York, we have to learn from them and from the multiple states that have implemented mail voting systems without problems or fraud. Then states can make common sense preparations to ensure the process goes as quickly and smoothly as possible to prevent a potential election crisis in November.
The fact that election boards were overwhelmed by an influx of absentee ballots in New York must be the rallying cry for dedicating more resources to efficiently implement mail voting systems. Reducing funds available for mail voting initiatives, as some Trump supporters have advocated, in this era when many people have to rely on these ballots or literally risk death, will only serve to suppress voting, which may be the point.
Consider the case of Ohio for a glimpse of what a proactive mail voting initiative looks like. At the urging of Governor Mike DeWine, Republican and Democratic lawmakers unanimously approved their all mail voting primary that was successfully concluded in April. Governors and state legislatures across the country have to learn from Ohio, and additional federal funds have to be made available to assist the efforts.
All those claims that mail ballots are subject to rampant tampering is not evidence that they are, and it suggests the need to educate voters on the issue. Members of the Armed Forces have relied on absentee voting with mail ballots since the Civil War. Trump himself has voted absentee by mail. Meanwhile, three states allow ounties to conduct elections completely by mail if they choose, five other states conduct elections almost entirely by mail, and more than two dozen other states permit their residents to cast absentee ballots by mail without having to provide a reason.
Over 250 million votes have been cast using mailed ballots since 2000, according to the Vote at Home Institute, and yet exhaustive analysis has identified only a tiny fraction of cases of fraud. None of those states that hold their elections almost entirely by mail has seen voter fraud scandals. The bipartisan group Vote Safe, chaired by former Governor Tom Ridge of Pennsylvania and former Governor Jennifer Granholm of Michigan, notes that several studies have consistently proven that mail ballots are secure and do not advantage one political party over the other. The team rightly emphasizes that the goal of ensuring the safety of voters as they exercise their rights during a raging pandemic is not a partisan issue.
Whether we improve our voting systems or defund them, the use of mail ballots will inevitably be much greater in the 2020 election than in years past. We can prepare for this eventuality and find innovative ways to deal with the challenges that arise, or we can shift our gaze from another crisis foretold and suffer the major consequences come November.
Winston Churchill noted that democracy is the worst form of government, except for all other forms that have been tried. In the midst of a pandemic across the country that has already claimed the lives of tens of thousands of Americans, exercising our right to vote by mail instead of in person may also seem like the worst solution, except for all other options.
Seriously ill people avoided hospitals and doctors’ offices. Patients need to return. It’s safe now.
More than 100,000 Americans have died from Covid-19. Beyond those deaths are other casualties of the pandemic — Americans seriously ill with other ailments who avoided care because they feared contracting the coronavirus at hospitals and clinics.
The toll from their deaths may be close to the toll from Covid-19. The trends are clear and concerning. Government orders to shelter in place and health care leaders’ decisions to defer nonessential care successfully prevented the spread of the virus. But these policies — complicated by the loss of employer-provided health insurance as people lost their jobs — have had the unintended effect of delaying care for some of our sickest patients.
To prevent further harm, people with serious, complex and acute illnesses must now return to the doctor for care.
Across the country, we have seen sizable decreases in new cancer diagnoses (45 percent) and reports of heart attacks (38 percent) and strokes (30 percent). Visits to hospital emergency departments are down by as much as 40 percent, but measures of how sick emergency department patients are have risen by 20 percent, according to a Mayo Clinic study, suggesting how harmful the delay can be. Meanwhile, non-Covid-19 out-of-hospital deaths have increased, while in-hospital mortality has declined.
These statistics demonstrate that people with cancer are missing necessary screenings, and those with heart attack or stroke symptoms are staying home during the precious window of time when the damage is reversible. In fact, a recent poll by the American College of Emergency Physicians and Morning Consult found that 80 percent of Americans say they are concerned about contracting the coronavirus from visiting the emergency room.
Unfortunately, we’ve witnessed grievous outcomes as a result of these delays. Recently, a middle-aged patient with abdominal pain waited five days to come to a Mayo Clinic emergency department for help, before dying of a bowel obstruction. Similarly, a young woman delayed care for weeks out of a fear of Covid-19 before she was transferred to a Cleveland Clinic intensive care unit with undiagnosed leukemia. She died within weeks of her symptoms appearing. Both deaths were preventable.
The true cost of this epidemic will not be measured in dollars; it will be measured in human lives and human suffering. In the case of cancer alone, our calculations show we can expect a quarter of a million additional preventable deaths annually if normal care does not resume. Outcomes will be similar for those who forgo treatment for heart attacks and strokes.
Over the past 12 weeks, hospitals deferred nonessential care to prevent viral spread, conserve much-needed personal protective equipment and create capacity for an expected surge of Covid-19 patients. During that time, we also have adopted methods to care for all patients safely, including standard daily screenings for the staff and masking protocols for patients and the staff in the hospital and clinic. At this point, we are gradually returning to normal activities while also mitigating risk for both patients and staff members.
The Covid-19 crisis has changed the practice of medicine in fundamental ways in just a matter of months. Telemedicine, for instance, allowed us to pivot quickly from in-person care to virtual care. We have continued to provide necessary care to our patients while promoting social distancing, reducing the risk of viral spread and recognizing patients’ fears.
Both Cleveland Clinic and Mayo Clinic have gone from providing thousands of virtual visits per month before the pandemic to hundreds of thousands now across a broad range of demographics and conditions. At Cleveland Clinic, 94 percent of diabetes patients were cared for virtually in April.
While virtual visits are here to stay, there are obvious limitations. There is no substitute for in-person care for those who are severely ill or require early interventions for life-threatening conditions. Those are the ones who — even in the midst of this pandemic — must seek the care they need.
Patients who need care at a clinic or hospital or doctor’s office should know they have reduced the risk of Covid-19 through proven infection-control precautions under guidelines from the Centers for Disease Control and Prevention. We’re taking unprecedented actions, such as restricting visiting hours, screening patient and caregiver temperatures at entrances, encouraging employees to work from home whenever possible, providing spaces that allow for social distancing, and requiring proper hand hygiene, cough etiquette and masking.
All of these strategies are intended to significantly reduce risk while allowing for vital, high-quality care for our patients.
The novel coronavirus will not go away soon, but its systemic side effects of fear and deferred care must.
We will continue to give vigilant attention to Covid-19 while urgently addressing the other deadly diseases that haven’t taken a pause during the pandemic. For patients with medical conditions that require in-person care, please allow us to safely care for you — do not delay. Lives depend on it.
