The 80/20 rule of Coronavirus, Kindness, and antidotes to fear

As everyone but a dedicated hermit must know by now, 80% of people infected with Sars-CoV-2 aka the coronavirus that causes COVID-19, our pandemic respiratory infection, will have mild infections. It's the 20% who get the disease in older decades (like, gulp, ours) or who have chronic debilitating health issues, who get very sick.


I learned from my Kenyan colleagues, who are used to massive numbers of patients in the public health system, that as a doctor we need to find the 20% who are most sick and give them 80% of our attention. That is no less true now. MOST of our concern, effort, preparation, needs to go to our most vulnerable. In this year of pandemic, that means that 80% of us have to alter our behaviour to protect and love the 20% who are at risk. People are changing their lives, overnight. Giving up freedom. Travel. Habits. Churches and schools, closing. It's a massive effort by the relatively well to protect those most vulnerable should they become sick.

And some people are doing so in a very inspiring way. I love the videos of Italians, and Spanish people, on their balconies singing and clapping. They are social distancing physically, but not emotionally. Zion Williamson, the Duke basketball phenom who went to New Orleans, decided to pay the salaries of the arena workers whose jobs would be impacted by the shutdown of the basketball season. He's a 19 year old; his trajectory to wealth was so rapid he hasn't forgotten. Julia's church farm is providing food for people, and started a program to cook up large batches of nutritious broth. Luke and Abby had to give up their long-delayed honeymoon planned for April; Luke is back on straight night shifts next week for emergencies after having already put in his two-months of that in January and February, because that's what's needed as the health system narrows down its focus. Abby is working extra shifts, and both of them already have COVID-19 patients in their hospitals. Our moms are in isolation hoping as 80+ people to avoid the virus altogether. Friends are lamenting the loss of time with children or grandchildren, the honing down of wedding lists, the inability to celebrate milestones. Yet I see people posting ideas on how to help your neighbour, how to be grateful and generous which is an antidote to fear.

There is another 80/20 rule at play.  On a global scale, the poorest countries are those 20% vulnerable. It is not just age and pre-existing health conditions. It's other pre-existing conditions. Like poverty. Like a health system that doesn't even have ICU care or much in the way of oxygen. 155 countries are now reporting cases. Amongst the handful which are not? Uganda, and Burundi, two of the places we work. Yes, they are remote to get to and perhaps slow to receive travellers, but more likely they just don't have enough testing to really know what is happening. Interestingly there is only one state left in the USA without reported cases, West Virginia. On the WV:USA scale; or the Bundibugyo and Burundi : Africa scale, there are similarities. A study found that WV had the adult population with the worst health in the USA, so when COVID-19 hits, they will be severely affected with minimal resources. We anticipate the same here. No one knows the impact of HIV prevalence mixed with this pandemic. Or malaria, or malnutrition.

So here we are for a couple of days in the capital. (We were called to the State House's office on Land Matters because of the 6-year law suit trying to steal back land bought 20 years ago. That turned out to be an unpleasant morning of being told by a young lawyer that, and I quote loosely but sadly pretty accurately, we might lose our lives over this but hey everyone dies whether it's a bullet or old age, so just trust the courts. . . . the meeting was miserable but seeing the support of the community who sent multiple witnesses to explain how the mission's work was of value to them, and how they all feared the injustice being perpetrated, was pretty heartening.) Our couple of days here consist of scouring pharmacies and calling contacts who know the market from 25 years ago (no lie, the same guy who used to help us procure flour and rope and fuel when those were rare items today came up with some N-95 facemasks and hand sanitizer, no easy task when some enterprising person sold all of Uganda's supplies to China a month or two ago) for medical supplies. We're shopping but not for massive amounts of toilet paper (we LIVE NORMALLY in increments of months between access to groceries, so we generally stock up on peanut butter and beans and popcorn and cheese . . and one or two packs of TP). In between life-maintenance and medical-supply searching, we answer emails and talk to our people. We supervise dozens of adults and dozens more kids in four countries. Some are older than others, some are pregnant. Some are anxious. Many are health care workers. All of us have always had the sense that worse comes to worst, we can probably evacuate. We don't have that anymore. We are coming to new normals of facing an impending pandemic with inadequate supplies, of looking for weeks or months of being isolated from our origins. And the peculiar experience of being visibly indistinguishable from whomever brought the virus to our countries. We're in the guilty minority this time.

One more day and we'll head back. None of us know what the next weeks and months will hold.

But God does. We don't have ventilators or chest CT scans, labs or blood gases, high flow oxygen or access to tests. But we do have communities that would come to Kampala to testify for the good God is doing in our homes. We do have a genuine team of people in East and Central Africa sharing information and praying for each other. We do have some simple energy to care for the sick, to comfort, to support. We do have a few facemasks and bottles of sanitizer to stem the onslaught of virae. And we do have a promise, that nothing can separate us from LOVE.

This is today's paper. If our schools close tomorrow, please remember these kids will return to homes with no books. No computers. No online alternatives. They will not be fed at public lunch programs. They will be severely impacted.

All entrances in Uganda in the city look like this--hand sanitizer and warning posters.

The group that came from Bundibugyo to support us.

Kenya announced cases and a closing border but by the mercies of God this family was able to get from Eastern DRC where the Ebola epidemic is waning, to Kenya where they can more safely deliver a baby in May. Praying for them!!