“I’m going to have to make a decision, and I only hope to God that it’s the right decision,” President Trump said on Friday during his daily news briefing on the fight against the coronavirus pandemic that has killed more than 18,000 Americans so far. “But I would say without question it’s the biggest decision I’ve ever had to make.”
Whether one is a supporter of the President or a fierce opponent, it is evident by these words that any guidance provided for an incremental retreat from a battle against a silent enemy that is ravaging our nation weighs heavily on the shoulders of our President and his team of advisors.
A comment made by George W. Bush to Barack Obama prior to inauguration captures a fundamental truth. “Ultimately, regardless of the day-to-day news cycles and the noise, the American people need their president to succeed,” Bush told him. Americans still need their president to succeed.
In my latest essay, I wrote that the Covid-19 pandemic has caused suffering in two patients: the individual patient and the “nation’s economy as a patient.” Two weeks ago, we were anticipating a spike in patient deaths which materialized in many hot spots across the country. However, the aggregate number of deaths that had been modeled dropped significantly and was attributed to the social distancing imposed and followed by Americans.
It’s now time to turn our attention toward a mortality trajectory relating to our other patient, our nation’s economy. More than 16 million are out of work. It is an unfathomable responsibility to begin weaning the nation off of the economic ventilator packaged as an initial $2.2trillion dollar infusion that supports our critically ill national patient. Add to this the steps necessary to relieve some of the strict social distancing requirements. No one would want to see a reverse trajectory for the nation, an economy that is incapable of being weaned and no chance of revival.
In ICU, a patient who is placed on a ventilator is intentionally put into a medically induced coma. Otherwise, the patient would fight the 10” tube threaded through their throat into the airway exchange system. However, the longer a patient remains on the ventilator, the poorer the long term outcome for an individual’s quality of life if he survives the episode.
There are similarities when looking at the nation’s economy. The nation was thrust into a medically induced coma in mid-March when a $21trillion economy was shut down, put on a ventilator by passing the largest debt financing in US history along with initiating mandatory social distancing. The longer the nation is not breathing on its own, the worse the quality of life outcome the nation faces, assuming it survives the Covid-19 episode.
Another parallel can be drawn between the ventilator-dependent individual who has been treating underlying conditions and the nation. A patient with co-morbidities faces greater challenges and may not survive the Covid-19 assault on the body or the weaning process as an otherwise healthy patient would on the same life-support.
We are a nation of 328 million autonomous individuals, most harboring unique underlying conditions. We also live in urban areas versus rural, we are wealthy versus middle class or poor, young versus old and we belong to myriad cultures.
The geographic expansiveness of the US, our enormous diversity, daunting disparities, and our federalist society of state-governance add complexity to incremental decision making that might work more smoothly if we were monolithic.
Patients are weaned off of ventilators through an incremental process of slow adjustments and a re-evaluation based upon results. These results determine the need for additional weaning, a return to the more aggressive ventilation, or a decision that continued life support is probably futile.
Physicians face a delicate balance when weaning a patient from a ventilator. The same is true when weaning our nation from the social distancing and the debt financing ventilator providing current life support. Is ventilator support ideal for an individual or a nation? Absolutely not. Does ventilator support followed by withdrawing support for an individual typically require mid-course corrections? Certainly. Is there a one-size-fits-all approach to ventilator support for a patient? Is weaning and removing life support easier than initiating ventilator support? Both, an unequivocal “no.”
The same dynamic and considerations are true when our nation’s leaders begin the delicate process of weaning and ultimately removing the nation from its current ventilator support.
The cure cannot be worse than the problem. We have already witnessed the impact of the cure on so many of our most vulnerable. Long term life support causes irreparable damage not only to an individual but also to a country. Attempting to determine the best outcome for the most people in a nation of individuals is formidable.
The weaning process will not be perfect. It will probably require mid-course corrections. The nation could see a resurgence in cases, just as a patient could experience a resurgence in respiratory distress. Is there an absolutely perfect time to remove 328 million people from life support without any negative outcomes?
Is there anyone who truly knows the right answer?
If so, please step up. If not, the President deserves our support to act to protect both the sanctity of individual life and that of the nation. It is “without question…the biggest decision [he’s] ever had to make.”