COVID-19 Update from Dr. Smith: 4/26/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

The census figures for NYP and CUIMC continue to show steady declines in numbers of inpatients, admissions, and deaths, and discharges continue to exceed admissions.  Scanning innumerable sources reported across a broad array of media reveals general agreement that our region is past the peak.  Unfortunately, CUIMC ICU census has only fluctuated up and down by ~3% over the past 10 days.  As I’ve said several times, that is an enormous obstacle to our restart plans.  A bit like asking Balto to turn around and sledge a few tons of ice back to Anchorage.

That aspect of our restart dilemma made me pay attention to an article in the Wall Street Journal on the challenges facing the beer industry (Saabira Chaudry, 3/26).  During March alone, cancellation of events like March Madness and St. Patrick’s Day have left 10 million gallons of beer stranded in bars and restaurants.  Beer spoils in 2-6 months, and can’t simply be poured down the drain.  That volume of beer will upset pH balance and reduce oxygen content if dumped into any body of water.  One company hopes to defoam and pH-balance their stock, then seek permission for dumping.  Sam Adams is exploring ways to extract the ethanol for use as a gasoline additive.  Another is trying to convert the ethanol to hand sanitizer.  There is debate over whether and how the losses should be shared between producers, distributors, and bars.  Does that sound familiar?  Each keg represents $100-$120 of sunk cost, and companies will want to show possession of those assets on their balance sheets if they enter bankruptcy.  A final twist—since they want them back, how do producers reverse-ship full kegs?  The industry has well established routines for shipping back empty kegs, but not full ones—it takes three times as many trucks to ship full kegs.  Ice to Anchorage.  Poor Balto; who deserves a metaphoric rest when this pandemic is over.

If we’re honest with ourselves, we will admit that much of what we’ve learned in the past few months simply recapitulates lessons of plague and contagion that are thousands of years old.  Lo and behold, the coronavirus pandemic is generating bell-shaped curves of incidence and mortality that differ only in slope and absolute numbers.  Not that we don’t deserve some sense of achievement.  1000 years ago, when Leif Erikson and his crew landed in Newfoundland, they deserved to feel pride in their nautical skills, and gratitude for the success of dead-reckoning navigation.  I’ll bet they also fell to their knees, reached their arms to the sky, and wailed abject relief for being alive on dry land.  Like Leif, there is still a great deal we don’t know, much of which revolves around testing.  Understanding mortality rates and herd immunity awaits accurate denominators.  We don’t know if antibody formation confers immunity, and if it does, how long it lasts.  How little do I know thee?  Let me count the ways.  Topics for another day.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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