I am writing to you as a concerned citizen, a mother and as a Board-Certified Internal Medicine Physician who specializes in Hospital Medicine in the state of CT.  I am writing on behalf of a large group of physicians in our state due to our concerns over inadequate enactment of social distancing in our communities during the COVID19 pandemic.  

This week, school closures were a step in the right direction, but the public continues to have gatherings, to go to movie theaters, bowling alleys, church services and other locations where large groups congregate.  

While we understand the necessity to keep some public places open such as grocery stores, pharmacies, gas stations, homeless shelters, etc., many non-essential places remain open and the attendance of members in the community is putting others at great risk for disease exposure and/or transmission.

As a result, we implore you to act within your legal obligations to cancel as much as feasibly possible.  

- Aside from closing public schools, please mandate closure of private schools and daycares.  Thus far, we have already had one reported case in a day care in Mystic, CT.  
- Encourage our hospitals and hospital administrators to cancel elective procedures so that we can limit hospital traffic, allow wings to open for COVID19 patients and to make more providers available to care for those patients, if needed.  Restrict visitors to hospitals and ensure that this is being strictly enforced, because it is not at present.
- Limit party sizes in the community to less than 10.
- Close movie theaters, gyms, recreational and sports facilities.  
- Shut down bars and businesses.  
- Restrict unnecessary travel.  
- Encourage community members to cancel play dates, sleep overs and family gatherings until this situation improves.  
- Mandate companies to allow their employees to work from home
- Cancel church services
 
For places that will remain open, I suggest limiting the number of individuals allowed in these places of businesses so that each customer can maintain 6 feet distancing; recommendations put forth by our national authorities including the CDC and WHO.  For example, there could be staggered shopping times put into place at grocery stores or pharmacies.  If restaurants are to remain open, please enforce dining room closure but allow curbside pick-up or delivery.

The first cases of COVID19 were identified in November of 2019 in China.  As their cases increased exponentially, China successfully employed containment in their community by locking down an entire province rapidly and enforcing it strictly.  While our democracy affords us more rights than an authoritarian country, we must take lessons from their successful strategy and cancel as much as possible while abiding by the rights of citizens.

This pandemic is exceptional because we have no natural immunity to this novel virus.  As a result, it will not end until we have a vaccine against it or it dies out on its own.  A vaccine is in the pipeline, but even with fast-tracking, it will not be available for 12-18 months.  If it wanes on its own, experts estimate that 60-80% of the population will be infected.  The mortality (death) rate of this virus is currently estimated to be approximately 3% based on what we’ve seen in Italy and China, but that number increases with age.  Individuals who are over 60 years of age, immunosuppressed and who have concurrent heart and lung conditions or diabetes are at a higher risk for severe illness that would require hospitalization and lead to death.

In the US, we do not have accurate numbers because we are NOT testing.  We do not have access to tests and many of the providers for whom I am speaking are unable to test patients right here in the state of CT.  Without appropriate testing, it is impossible to collect accurate data or to identify individuals who should be quarantined.  As a result, we MUST rely on social distancing to decrease the spread of disease and #flattenthecurveso that our healthcare system is not overwhelmed.  Those countries that have employed social distancing have been successful in controlling the numbers of new cases.  

While you may think that a superior healthcare system will protect us from this threat,

the reality is that other countries that have been affected are actually better prepared than the US for a surge during a pandemic.  Italy’s healthcare system is currently overwhelmed with critical care patients who require mechanical ventilation.  In the US, we are already operating at approximately 68% capacity and have only 45,000 ICU beds.  The US has 2.8 hospital beds per 1,000 people.  In contrast, Italy has 3.2 and China has 4.3.  During COVID19 in South Korea,  new hospitals were built to accommodate this surge boosting their beds to 12.3 per 1,000.  In consideration of these numbers, the Italian healthcare system is on the verge of collapse.

While our federal government fails to appreciate the gravity of this situation – and inappropriately downplays the severity – we hope that our local government and officials will not make the same mistake

I understand that these decisions are not made easily and I appreciate the role you play in our communities.  The fear that we are over-reacting often impairs us from taking appropriate action, but if we under-react, the consequences will be much greater than what we feared.  As informed healthcare professionals who continue to have a vested interest in the safety of this community, please consider our recommendations seriously. 

I will leave you with an example from history of how social distancing can make an immense impact.  During the 1918 Spanish Flu pandemic, the first cases erupted out of Philadelphia in September.  The city proceeded with its planned Liberty Loan Parade to promote government bonds despite opposition from experts.  Within 72 hours, the city’s 31 hospitals were full due to an exponential spike in illness and 2,600 people had died by the end of that week.  In the end, more than 12,000 people died in six weeks.  In contrast, St. Louis closed its schools, movie theaters and businesses and cancelled social gatherings and it had a much lower curve in disease with maximum cases reported at 1,150.  The city’s health director at the time, Pamela Walker stated, “In an epidemic, somebody has to have the authority to make those kinds of decisions that infringe on people’s rights.”

Regards,

Melissa Duarte, DO

Representing CT Physicians