CVH--Mark Ackerman, PA

Mark Ackerman

By Mark Ackerman, PA-C

As a former college basketball coach I sometimes like to approach issues from a sports strategy perspective. On one team that I coached we had a saying that we repeated before every game; “Respect everyone, fear no one.” The concept is simple. It basically reminds us that if we don’t give our opponent enough respect, that if we look past them, they can beat us. At the same time, if we give them too much respect and don’t believe in ourselves, we can also get beat. 

When it comes to Covid-19, I think the same mantra holds true. We have to respect the virus and what it can do, but at the same time, we can’t afford to cower in fear of it. Approaching this thing from either extreme position could get us into trouble. And before we define those troubles, I think it is a good thing to remind us all of an important difference between sports and viruses. That difference is that our opponent here is a virus and not a person. Remembering that our enemy is the virus and not each other is important when we form our strategy and our approach to defeating it.

It is good to remember that this virus consists of billions of tiny particles that we can’t see, taste or smell. So part of the problem here is that we are fighting a ubiquitous entity that attacks us when we don’t even know it. That means a lot when it comes to forming our strategy. What it means is that we have to, for the most part, take a defensive stance. It means we have to mitigate our risk of being attacked.  

So how do we do that? Well this sounds a little counterintuitive but I think the first thing we have to do is to refrain from immediately putting on all of our protective gear. The first thing we have to do is form a team. Why? Because the first risk you have to mitigate is the risk of beating yourself. It is this very lack of a team concept that gets us confused between defending ourselves from a virus and looking at other people to blame as if they are the virus.  And while I understand that this analogy breaks down a little if you consider yourself an individual sport competitor, it should also be stated that even individual athletes have teams- every NASCAR driver has a pit crew etc.

So please excuse my philosophical ranting here but I do want to mention the four cornerstones of becoming a team in the truest sense of the word. I think it is important for our community to act like a team in this truest sense. So, here are the four basic principles of being a team: 

The first principle is that we treat each other, each team member, with a certain respect. How much more important is it for us to respect our own teammates before we respect our opponent?  

Secondly, great teams approach situations recognizing that we need to be working for the common good, not looking to push individual agendas like being the high scorer. Since we are living in a community, we need to be on the same team and that means working for the same goals.  

Thirdly, knowing that if we are all working towards the good of each other and towards a common goal, we need to have a sense of responsibility to each other. We have to have each other’s back! Even if your role on the team seems minimal, take pride in playing that role well. 

Finally, we need to have shared decision making.  Great teams do not have one leader who is calling all the shots. Great teams have what we call, in the sports world, collectivity. That is we have collective leadership, collective toughness, collective discipline. If you only have one person on a team who has toughness, one person who is a leader, one person who has discipline, then you really don’t have a team at all. You only have individuals who are trying to do the right thing in the midst of chaos.

So putting all the analogies aside, let’s get to the point. These are the risks we must mitigate. 

The harms of disrespecting the virus (not taking it seriously): 

People die- especially the older and more frail people in the community.

Even if you don’t die, there is a chance you can have long term troubles and symptoms from the virus. Persistent shortness of breath for example can keep you from your favorite activities like hiking and hunting in the mountains for a long time. In addition, there can be cardiac and neurological problems that can complicate your health.

Further lock-downs. It is estimated that sheltering in place prevented an estimated 10 times the number of cases that we initially had in the first three months of the virus. With all measures taken, we may have avoided 35 times the number of cases. So while it may work, let’s not go back to that!

Cancelation of many of our activities through closures. The more the virus spreads and infects people, the less opportunity there is to travel, go to (and participate in) sports, theatres, restaurants, concerts etc.

The harms of fearing the virus (locking ourselves away in hiding):  

For every 1% increase in unemployment, there is a 1-1.6% increase in suicide rate and a 3.3% increase in drug overdose deaths. Physical and social isolation each have an increase in mortality of over 30% compared to age and gender matched controls who are not isolated and lonely. So reaching for a lock-down to solve our problems may help control the virus, it won’t protect us from other problems.

For every 1% increase in unemployment, there is a 35% increase in heart attacks. When less people go see their doctors for fear of catching Covid-19, many other diseases can cause problems as well.

Economic instability. It is far better to keep the community working and supporting our local business so we don’t fall into further problems related to unemployment. 

Lack of supplies. There is already a major shortage of important items like lumber and car parts. In some places there is a major food shortage.

Increase in domestic violence. This happened during the initial lockdowns and is sure to increase with more lockdowns.

So what should be our strategy? While mandated lockdowns and closures can control the spread of the virus, they have unintended consequences that in some cases may be worse than the disease. This includes dividing communities and seeing each other as the enemy rather than seeing the virus as the enemy. On the other hand, if we open everything up and don’t respect the virus, it will simply spread more and larger lockdowns/closures will become necessary. 

My suggestion is this. Mitigate the risk as a community. If we take the team approach then we can combat this virus on our terms. But to do that we need to respect each other, strive for the common good, be responsible for protecting each other and have a collective mindset in all these things. The mitigating actions then become:

1. Respecting the virus by donning our protective gear; wearing a mask when around others, washing your hands before and after touching each other (or common objects), and staying home when you are sick.

2. Not fearing the virus by going to the grocery store and the restaurant, going to school and work, to church and to social events.

The bottom line: Respect the virus, don’t fear the virus, become a great team, and don’t beat ourselves!

(1) comment

Mveine

Dear Coach,

I 100% agree with the need to respect and care for each other always. This pandemic is trying everyone and is revealing the areas we shine and also, sadly, where we fall short.

In clarification to your fine article I would like to post this article from the Washington Post the takes exception with 'The Lancet' study that supplies the statistics you cite regarding unemployment and health risks/ deaths.

The Lancet's data points were only recorded up to 2010 and since then there have been no real world correlation with their conclusions. Please see the excerpt below from 'The Washington Post' June 1, 2020 article : 'Theory about the fatal dangers of quarantine is very wrong'.

"We would not go so far as to predict that this will be the case in the recession we are entering. One study that Azar cited, published by the Lancet in 2012, examined the period 1999 through 2010 and found an association between U.S. unemployment rates during the Great Recession and suicides — but the finding has not held up in subsequent years. Unemployment rose from 4.7 percent in the fall of 2007 to 10 percent in the fall of 2009. In one calculation, the authors found that suicide rates rose by about 1 percent for every additional percentage point of unemployment, translating into 1,330 additional deaths from 2007 to 2010. In another calculation, they found about four times that number of “excess” suicide deaths during the period.

If that pattern holds, and if we are now heading toward an unemployment rate upward of 25 percent — despite the modest improvement reported this week — starting from 3.5 percent in February, we would expect from 10,000 to 40,000 additional suicides.

We already know, however, that the pattern does not hold.

The Lancet study used data only up to 2010, and since then the short-lived coincidence between trends in unemployment and suicide has broken — spectacularly so. From 2010 to February of this year, the unemployment rate fell from above 9 percent to 3.5 percent. Suicides therefore should have declined (or at least risen less rapidly than before the Great Recession). What happened was just the opposite. Suicides increased unabated as the recession unwound, with deaths rising from 38,672 in 2010 to 48,631 in 2018, the last year for which data is available. If the American economy was being made great again, the news didn’t reach those who were destroying themselves. We obviously should not conclude that the recovery led to thousands of additional suicides.

What about opioid overdoses? Or deaths resulting from alcoholic liver disease and cirrhosis? In our recent book, “Deaths of Despair and the Future of Capitalism,” we track these collectively. They rose rapidly from the mid-1990s to 2018: before, during and after the Great Recession. There were 24.6 deaths of despair per 100,000 people in 1999, 30.5 in 2007, 31.9 in 2010 and 44.4 in 2018. A key finding of our book is that short-term fluctuations in the economy are simply not related to fluctuations in deaths of despair.

Another study cited by Azar found that between 1999 and 2014, drug overdoses increased faster in counties where unemployment grew more rapidly. But geographical differences in opioid deaths do not speak to whether the total number of these deaths tracks over time with national unemployment; in fact, the authors’ own data shows that total deaths and unemployment moved quite differently during the Great Recession.

Despair takes many years to take hold and build, and it is typically preceded by community destruction — erosion of the institutions that hold life together, including marriage, two-parent child-rearing, and church and union affiliation. What’s more, many pockets of declining employment and rising hopelessness have been disproportionately targeted by pharma companies pushing their drugs. The link between unemployment and opioids or suicide in such communities cannot be used to gauge what will happen as unemployment rises there or elsewhere over just a few years. In short, we can safely dismiss confident predictions that the forthcoming recession will cause 75,000 or more new deaths of despair, or more, over the next decade — a number recently publicized by the Well Being Trust, relying on sources similar to Azar’s.

There is already some fragmentary and incomplete evidence about the non-coronavirus health effects of the pandemic. The Centers for Disease Control and Prevention estimates “excess deaths” for each state by comparing weekly deaths reported since February with deaths reported in the corresponding weeks over the past three years. There are several states with few covid-19 deaths; West Virginia had 78 and Montana 17 as of Wednesday, for example. Yet like states with more coronavirus cases and deaths, those states have also experienced government-imposed shutdowns. If shutdowns are themselves deadly, we should see excess deaths in those states — yet there are none. Indeed, total deaths in these states are running below expected levels.

Of course, excess deaths unrelated to covid-19 may show up as the recession continues, but we do not see them now. In fact, data for several states shows a drop in fatalities from traffic accidents — deaths in New Jersey and Nebraska are down by 5 percent (197 deaths vs. 208) and 18 percent (71 deaths vs. 87), respectively, compared with the first months of last year. The shutdown has also reduced accidents on job sites and cut pollution, another source of sickness and death.

Although many scholars have argued that recessions lead to improved health outcomes, because of fewer accidents and other changes, we would not make that claim for the unusual recession we are entering. And yes, a prolonged slump may bring some additional suicides: These effects are often found, though not consistently across different periods nor across studies. And nonessential health care has been put on hold — not as a consequence of the shutdowns but of the commandeering of facilities for covid-19 treatment and patients’ fear of infection; still, the failure to vaccinate children (for example) bodes ill, as does the likelihood that treatable conditions are going undiagnosed.

But a wave of deaths of despair is highly unlikely. Recessions are immensely costly because they disrupt people’s lives, deprive them of work and income, and inhibit many of the activities that make life worth living. We need to find safe ways of getting back to work. But we should not scare ourselves with nightmares about tens of thousands of additional suicides or drug overdoses."

accase@princeton.edu

Thanks for considering this and know that your words and concern for the community are commendable and exemplary.

Best Regards,

M Veine

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