January 15th was the day the Peruvian health care system reported the highest number of hospitalization since the beginning of the pandemic, just a day after our efficient health minister suggested that we “may be” approaching a second wave. What do you call it when your healthcare system shows signs of collapse and your leaders are still debating whether or not there is an ongoing second wave of infections? A crisis? A meltdown? A pandemic armageddon? A Pandemageddon? I don’t know. One thing is for sure though, the pandemic doesn’t come in waves; it’s more like an avalanche, and the Peruvian health care system is about to get caught up in it, like a tiny snowflake.

In medicine, we have certain conditions that are considered “pathognomonic” for specific diseases. These are signs or symptoms that are so characteristic of particular diagnoses that regardless of the patient’s prior probability of having the disease (a healthy athlete having a stroke, for example), there’s an incredibly high likelihood of having the disease. The signs are symptoms are rare though, like a bruise around the belly button for acute pancreatitis (Cullen’s sign), or perhaps an even rarer sign such as the “sunflower cataract” in patients with Wilson’s disease.

These are useful heuristics because they provide high diagnostic specificity for certain conditions when the diagnosis is difficult, and treatment could be delayed. In the same way, if we’ve run out of ICU beds and have weeks to go before we reach the peak of infections, shouldn’t that be pathognomonic to “we are f****d?” To be honest, the analogy doesn’t actually hold. The current situation is not a difficult diagnosis. It’s more akin to seeing a patient with an exposed leg fracture and conclude that they are still breathing and, therefore, it’s not a broken neck, so it’s all good. This is not a difficult diagnosis. This is called denial.

Oh, and the new variant. So on the 8th of January of this year, we finally reported the first case of the UK SARS-CoV-2 variant B.1.1.1.7. There are still so many unknowns regarding this mutated virus. Studies have shown that it seems likely that it’s more transmissible, and if true, it would be at least 30–65% more transmissible. Numbers are funny; they can make you feel good or bad depending on what they are and what they compare to. 65% more transmissible doesn’t sound that bad. I mean, how could a 2 digit number increase be synonymous with the systematic decimation of our healthcare system? Let me tell you a story:

Once upon a time, there was a kid. He once found a magic lamp with a wish-granting genie.
“I wish I had a gazillion dollars,” the kid said.
“I cannot do that,” the genie replied. “My rules are a bit different from normal genies. I will grant any wish you want, but for every unit of whatever it is you wish for, I will create seven more every second, and for each of those units, seven more will be created per second until you tell me to stop.”
“WOW,” the kid said, “That sounds great. Let’s start with a million dollars.”
“You sure about that?”
“Abso-fucking-lutely.” “You can start now. I’ll take a quick bathroom break, 1 minute tops.”

And so 1 million dollars (1,000,000) appeared out of thin air. A second later, 7 million dollars (7,000,000) appeared out of thin air, then 49 million dollars (49,000,000). Another second passed, and 343 million dollars (343,000,000) appeared, then 2.4 billion dollars (2,400,000,000).

“uh, kid..” The genie called as 16.8 billion dollars (16,800,000,000) appeared.

“You may want to come out of the bathroom. It’s getting pretty crowded over here.” 117.6 billion dollars appeared (117,600,000,000) in another second.
“Dude, don’t they teach you genie manners in lamp school?” The kid called out as 823.5 billion dollars (823,500,000,000) came into existence, followed by 5.8 trillion dollars (5,800,000,000,000).
“oh, this motherf***r..” The genie sighed, as 40 trillion dollars (40,000,000,000,000) were created out of thin air as 10 seconds had passed since the wish was granted.

By the time the kid came out a minute later, one septillion nine hundred sextillion one hundred quintillion four hundred quadrillion three hundred trillion six hundred billion nine hundred million two hundred thousand and one dollars were created (1,900,100,400,300,600,900,200,001). The earth was crushed under its own weight, and a singularity was created, sucking the entire universe into it before the kid had the chance to zip up his pants.
The end.

So yeah, 65% more transmissible? That means that if one person previously infected 3–4 people, one person now infects at least 7. The exponential consequences of such a change are, in theory, unfathomable. So our leadership will obviously, eventually, have to close everything down. Given that elections will be this year and our government is, in general, benevolent and always does what’s best for its people, I’m sure they will comply and do it as soon as possible (/sarcasm). Did I mention our ICU beds were full to the brim and that we won’t have a vaccine for the general public ‘till later this year?

Anyway, I’m not sure if I should end this cathartic post with glhf or ggwp. Either way, if you’re a doctor, nurse, or a healthcare worker in Peru, I wish us the best of luck! If you’re not, don’t be fooled by official numbers and stay the hell away from crowded places.

Hold the fort! (Jerillo Health Centre in the deep Moyobamban jungle, where I’m currently doing rural service)