The Shutdown As Mass Casualty Event

by James A. Bacon

More than 600 physicians have signed a letter to President Trump calling for an end to the national shutdown aimed at slowing the spread of the coronavirus. The letter describes the unmeasured and overlooked health consequences of skyrocketing unemployment and income loss as a “mass casualty incident.”

The letter makes the same point I have been emphasizing over the past several weeks, but with the authority borne of first-hand interactions with patients: The policy response to the COVID-19 virus has been driven by adverse health effects that we are measuring and reporting in real time rather than adverse effects that we either cannot measure or are reported only after delays of weeks, months, or years.

“We are alarmed at what appears to be the lack of consideration for the future health of our patients,” write the doctors. “The downstream health effects … are being massively under-estimated and under-reported. This is an order of magnitude error.”

The docs are particularly concerned with the shutdown of elective procedures, a lockdown measure still in place in several states. Governor Ralph Northam rescinded the elective-procedure ban in Virginia effective last Friday. But other observations are germane to the situation in Virginia and worth quoting at some length.

During a mass casualty incident, write the docs, victims are triaged in four classifications: black, red, yellow and green. Millions of Americans are at triage level red, those with severe but survivable injuries.

These include 150,000 Americans per month who would have had a new cancer detected through routine screening that hasn’t happened, millions who have missed routine dental care to fix problems strongly linked to heart disease/death, and preventable cases of stroke, heart attack, and child abuse. Suicide hotline phone calls have increased 600%.

Tens of millions of Americans are at triage level yellow, with serious but not immediately life-threatening injuries. “Liquor sales have increased 300-600%, cigarette sales have increased, rent has gone unpaid, family relationships have become frayed, and millions of well-child check-ups have been missed.

Hundreds of millions are at triage level green. These are people who currently are solvent, but at risk should economic conditions worsen. Poverty and financial uncertainty is linked to poor health.

A continued shutdown means hundreds of millions of Americans will downgrade a level. The following are real examples from our practices.

Patient E.S. is a mother with two children whose office job was reduced to part-time and whose husband was furloughed. The father is drinking more, the mother is depressed and not managing her diabetes well, and the children are barely doing any schoolwork.

Patient A.F. has chronic but previously stable health conditions. Her elective hip replacement was delayed, which caused her to become nearly sedentary, resulting in a pulmonary embolism in April.

Patient R.T. is an elderly nursing home patient, who had a small stroke in early March but was expected to make a nearly complete recovery. Since the shutdown, he has had no physical or speech therapy, and no visitors. He has lost weight, and is deteriorating rather than making progress.

Patient S.O. is a college freshman who cannot return to normal life, school, and friendships. He risks depression, alcohol abuse, drug abuse, trauma, and future financial uncertainty.

The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise.

Northam is a physician. He should grasp this reality immediately. If he does, his shutdown decrees do not reflect it.

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21 responses to “The Shutdown As Mass Casualty Event”

  1. He doesn’t get it. If he did, he wouldn’t have done this in the first place.

  2. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    I will put this here as well as under Dick’s earlier post and commentary before Jim posted this.

    “The University of Virginia has announced seeking more CARES aid. Check out UVAToday.

    So have America’s hospitals announced great need for federal funds, including those in Virginia. They are threatened with financial ruin. While the American people are facing a huge surge in the ruination of their health, according to a growing numbers of doctors.”

  3. NorrhsideDude Avatar

    Quick…. I’ll add the snark…
    But what about…
    Testing everyone every day every where?
    Do other super professional “REAL” doctors from the WHO agree with every piece of every data set?
    What links do these “doctors” have to the GOP, Trump, or big Pharma…
    Do the Soothsayers at CNN completely agree?
    Do we know the exact death rate for evey single race, creed, religious background, birth sex, identifying sex, IQ, income rate, educational background, birth place, etc….
    Blah blah blah….

    1. Nancy_Naive Avatar

      That’s not snarky. Those are questions.

      To Trump there are winners and losers. A loser is anyone of whom he can take advantage. If he wants something from someone, he lies, and if the someone believes him and he gets what he wants, then he is a winner; the someone is a loser.

      Trump despises losers.

      Trump wants your vote. 16,000+ lies from the Offal Office. Trump despises those who would vote for him.

  4. LarrytheG Avatar

    So much for the “Virginia Blog”, eh?

    so Doctors are now “economists”? Cool!

    so if the virus is “not that bad”… then why are we
    closing meatpacking plants and FORD plants and others?

    Is the idea that we just get everyone in those plants infected at once then lay low for a few weeks and then the ones that survive come back to work?

    Oh.. and we compensate the families of the ones who didn’t make it?

    is that the idea?

  5. Nancy_Naive Avatar

    Paid professional witnesses.

    1. Steve Haner Avatar
      Steve Haner

      Need to look and see if my GP is on there. He’s been a Trump fan since day one.

      1. LarrytheG Avatar

        yup… these are more than likely existing registered GOP supporters.

        And truthfully – you’d think there would be thousands, not hundreds, no?

      2. Nancy_Naive Avatar

        Two words: second opinion

  6. Peter Galuszka Avatar
    Peter Galuszka

    And “uplifted by Fox News”

  7. LarrytheG Avatar

    Well, FOX and the GOP and those “doctors” have their view and the
    public has theirs – note than even Republicans have concerns:

    1. I’m trying to follow your logic here, Larry. Are you saying that we can ignore the arguments presented by the doctors because FOX decided their letter warranted a news story? Are you saying that FOX news is so biased and tainted that we can summarily dismiss that their sources say?

      1. LarrytheG Avatar

        Not that much to do with FOX. per se. The doctors are (willingly) being used to promote a “open up now” narrative that is disagreed with both virtually all public health officials and epidemiologists as well as most people:

        Remember how doctors were used when cigarettes were being said to be bad for your health? They trotted out Doctors who “smoked”. Even had TV ads with doctors smoking.

        So – let’s get back to FOX… let’s go check WSJ and see how they cover this…. is WSJ “biased”?

  8. LarrytheG Avatar

    re: ” Northam is a physician. He should grasp this reality immediately. If he does, his shutdown decrees do not reflect it.”

    what more would you have Northam do? Hasn’t he pretty much
    opened up the state outside of NoVa/Richmond?

  9. Nancy_Naive Avatar

    How many died in the last two weeks?

    Well, that’s what the military calls “acceptable losses”. The rate of infection has leveled. We’re open. That level won’t go down with more activity, but it MAY stay constant.

    Like Trump, I’m optimistic. It may just go away. Why not? SARS-Cov-1 did. It took 3 years, but it just “went away.” The fastest vaccine developed was for measles and it only took 4 years.

    When I was just a little girl,
    I asked my mother, “What will I be?”

    C’mon everybody! Sing it with me! Que sera, sera!

  10. Jim Loving Avatar
    Jim Loving

    Unfortunately, our political discourse, polarization and inability to work on substantive issues, have affected every issue, even a global/national pandemic and emergency.

    All decisions become politicized, polarized into binary either/or choices, with one party and media faction lining up on one side, and the other lining up on the other side.

    Developing a national response and approach to the combined health and economic issues posed by this severe of an event as the Covid-19 pandemic, requires extreme political, corporate, faith-based, civic and media and journalistic leadership to devise appropriate responses that can weigh the pros and cons and interests of the myriad of stakeholders involved.

    Where has any of that been in evidence in VA or the US in the last… 20 years? And, how exacerbated has the problem become in the last 4?

    So, let’s just get back to choosing up sides with either/or choices – like open or close, and get it on. It is so much easier and so much more entertaining.

  11. djrippert Avatar

    My challenges with Northam were around his inability to launch an effective testing program (as was successfully done in most other states), his unwillingness to be open and transparent and Virginia’s bungling of the COVID19 data. As I’ve said before, he now seems to be following Larry Hogan’s lead with reopening. Hogan made beach opening a local decision and Northam (eventually) did too. Following a leader makes a lot more sense than blazing your own path to nowhere so I give Northam credit for starting to see the light.

  12. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    People are going hungry in New York City. A free food for poor operation opened up early this morning to find thousands of people waiting in line.

    “Thousands Line Up Outside Queens Food Pantry Hours Before Opening” says CBS.


  13. Practicing physicians interests have nothing in common with interests of public health official or epidemiologists. And public health official and epidemiologists have nothing in common with interests of physicians.

    Perhaps they were in 10th grade biology together, but that’s it.

  14. Trump cannot open up or close the states; the governors do. Northam has said that his decision is data driven. Have you seen the data on which he is basing his decision? If not, how can any of you judge his decision?

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Image this Virginia regime Northam has got, going into the business of contact tracing, forcing people into lock-downs.

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