What Next COVID-19

Hugh Moore, MSN, RN-BC

UNNC Area Rep, Harvard Heights & West Adams Heights

As a psychiatric nurse not dealing with COVID-19 positive patients, I am going to attempt to make sense of what is happening to our collective lives. While there is very little the UNNC Governing Board can do to assist the larger government bodies dealing with the response to the COVID-19 pandemic, educating our constituency about why the state government is making the decisions they are is something we can help with.

The most important point that needs to be emphasized is that our collective actions are saving lives. This concept is difficult to see since the lives we are saving are not ones at risk today but those that will be at risk in the coming weeks and months. The County of Los Angeles Public Health Department this past week has shown the first decrease in total amount of visits to local emergency rooms with patients complaining of flu-like symptoms. This is evidence that social isolation is beginning to work and will make it possible for our health system to handle the amount of COVID-19 hospital admissions to come. The COVID-19 virus will continue to spread even as we abide by the isolation orders, but the decreased rate of spread will allow the health system to better care for those who become ill,  since the total who will get very ill will be spread out over a span of weeks and months rather than days.

It is great news that our current efforts are effective but how long will the current social distancing orders have to be in effect? The answer to that question is unknown at this time and the “correct” answer to the question will be based on health science evidence, politics, communal ethics and hopefully some amount of community involvement.

As for the science, the decision to end isolation will be based on several factors which, unfortunately, are unknown at this time.

1. How many people have COVID-19 (which can only be determined by widespread testing that at this time has not been available to enough people)?
2. When will herd immunity become effective (herd immunity: a point in time when enough individuals are immune so as to significantly reduce the possibility of susceptible individuals being exposed)?
3. Are health system resources greater than the expected demand (i.e. Are there more ICU beds available than expected admissions?)? Is there a vaccine or effective treatment to cure the virus (neither which are available at this time)?

As for politics, our government’s leaders are under pressure to decide what is the best course of action to take in controlling the pandemic as well as dealing with the economic consequences that stay in place orders cause. Actions have already been taken to offer businesses financial relief, as well as rent assistance for individuals, and the federal government’s attempt to put money directly into the hands of people by sending out checks. As we are all aware, these are very short-term answers that will need to be followed up with longer term solutions if stay in place orders are to be continued for many months. Those longer-term solutions are added to the list of unknowns that our community is dealing with while we are choosing to abide by current isolation orders.

Our community involvement in the decision-making process of how long isolation orders will need to be maintained has been limited to the voluntary compliance to the orders given. Our community’s strongest signal that we trust the actions being taken by the government is our willingness to continue to follow those orders. The longer the isolation orders stay in place, community involvement in the decision-making process will need to increase or the community may no longer voluntarily agree to follow the mandate.

With so many unknowns, it may be difficult for community members to choose to continue to support actions that present so many restrictions on our liberties for an undetermined length of time. As the community continues to deal with these restrictions, academics are busy attempting to give guidance to our leaders and community members. A recent article, “When Can We Go Out? Evaluating Policy Paradigms for Responding to the COVID-19 Threat” indicates support for the government’s current efforts to address the pandemic:

As we see it, the appropriate frame for analyzing the Covid-19 situation draws from the broader literature in political philosophy on the purposes of government and political legitimacy. These purposes include ensuring basic rights to physical security, emergency healthcare, protection from predation and the safety of personal property, as well as the social capacity to feed ourselves and educate our children, or what the Declaration of Independence once called the “pursuit of happiness.” Any government that intentionally ceases efforts to protect such basic rights for any one of us has abandoned the basis of its legitimacy. As in the norms of just war theory, the goal is to secure our society as a whole, accepting only such loss of life as is necessary as a part of seeking to protect the underpinnings of well-being for all.

This article points out many failures our leaders have made up to this point in addressing the pandemic, but it also indicates the restrictions on our liberties have been justified. How much longer we will need to agree to the current restrictions on our liberties is unknown, but it is a hopeful sign that, so far, our community has decided to abide by the stay at home orders to place the needs of the weakest members of our society ahead of our individual desires.