The title of this post came from Jabari who is my wife’s cousin. He works in an emergency room in the Bay Area. I wanted to get his perspective on how well or not he thought the Bay Area health care system did to this point and whether he thinks that they are prepared for reopening. In the course of our conversation Jabari said that we would all be much more scared of the virus if it was actually something we could see, like Murder Hornets. I liked this analogy so I’m going to stretch it a bit.

New York City Round 1 - Ran straight into a swarm of Murder Hornets.

In its first encounter with COVID-19 New York City essentially walked straight into swarm of Murder Hornets and got really badly stung all over.

I talked to a friend of my wife’s in NYC, Linus, who works in medicine. I asked how badly affected New York was and he said NYC was red-lined by orders of magnitude. Shortages within a hospital of anything such as beds, personal protective equipment (PPE), ventilators, or staff is a recipe for chaos. When there is chaos in a hospital, people die. When even your mortician and funeral home throughput is over capacity the system is broken.

Bay Area Round 1 - Grazed the swarm by one week and got stung a bit.

People in the Bay Area think that we escaped the Murder Hornets, but we didn’t entirely. Not only did the Bay Area actually get stung by the Murder Hornets, we really only escaped the massive swarm by one week.

Bay Area Hospitals and funeral homes only missed NYC level chaos by six days.

If the shelter in place order had come six days later on March 23th rather than March 17th, Santa Clara county would have run out of ICU beds. Find my analysis here. Running out of ICU beds would have put the Bay Area’s outbreak into NYC territory.

Bay Area healthcare workers got sick and died

In talking with Jabari, it is clear that the Bay Area hospitals were and are still really challenged by this virus. There are healthcare workers in the Bay Area who have caught COVID-19 and died. He knows of colleagues who have caught COVID-19. He is worried about catching it himself. It is hard to pinpoint the source of COVID-19 infection which makes it difficult to definitively say that these health care deaths and illnesses resulted from on the job exposure. However these individuals’ main exposure to COVID-19 is through their work. Until proven otherwise, one should assume that any Bay Area healthcare worker’s illness or death from COVID-19 was due to on the job exposure.

Bay Area hospitals were more chaotic than normal

Jabari described challenging conditions which make you as a healthcare worker second guess yourself. Consider a scenario in which a patient comes in with one condition, like strep throat with a fever or even a sprained ankle. They might be an asymptomatic carrier of COVID-19, or the fever might come from COVID-19. If you place them in the general population of patients, you’ve now risked infecting everyone else. Alternatively, maybe they don’t have COVID-19, but you think they might. If you put them with the COVID-19 patients and they were not positive to begin with, now you potentially have a new patient with COVID-19. During the initial outbreak, these triage challenges were made worse because of the length of time it took to get test results.

Between Rounds - Sitting underwater in a lake.

Right now both New York City and the Bay Area have escaped the Murder Hornets by jumping into a lake. We’re sitting under water breathing through a straw looking up through the surface watching to see if the Hornets have magically gone away.

Social isolation and sheltering in place is extremely hard. We haven’t getting stung recently and we’re itching to get out of the water.

Round 2 - Armed with a smoke canister and not much else.

My analogy is starting to break down. Do Murder Hornets even respond to smoke the way honey bees do?

In talking to Jabari we are better prepared for a second round with COVID-19 but not that much better prepared than we were in the first round.

Here is how we are better prepared:

Better supportive care: Nurses like Jabari have figured out more about what helps and what doesn’t help. Do you give IV fluids or not? Do you give antibiotics or not?
Faster testing: The fact that tests can be done in a matter of hours or at most a day, helps triage patients to prevent cross infections.
More equipment and resources: Hospitals have been better configured to isolate COVID-19 patients from other patients. There are more ventilators and other equipment needed to treat COVID-19 patients.

Here are the challenges we still face and things we do not know:

No Cure or treatment available: Supportive care is not a treatment or a cure. During the second wave, the battle between you and COVID-19 is still solely between your body and the virus.
PPE supplies in the hospitals are still low: The Bay Area hasn’t reached the full thirty day supply of PPE so that healthcare providers are still needing to reuse PPE.
How does the virus spread? If we don’t know how the virus spreads, it is hard to protect people from it.
What are the long term health impacts? How will COVID-19 affect the health of people that survive it?

How can you knock out an invisible enemy?

Unless you are on the frontlines with this virus, and even then, it can be easy to dismiss this threat because it is hard to see. It is much easier to build a common plan against and to fight a visible enemy like Murder Hornets. Knocking out an invisible enemy that you don’t know much about is hard.

Jabari said, sadly, that the more people die from COVID-19, the more we will know about the disease. But this is not what he wants. He wants to prioritize life. From his perspective, people should be staying at home as long as it takes to get control of COVID-19. The government should be providing the resources to make that happen. The government should be handing out masks and promoting social distancing as it is. But he would like the government to go beyond that. He would like to see food and shelter provided to everyone that needs it, so that we can keep the Murder Hornets — oops, I mean COVID-19 — at bay.

Murder Hornets vs COVID-19: the Visible vs the Invisible Threat