As COVID-19 continues to spread, comparisons are often made to previous health events.

For many people, they remember the swine flu pandemic as being remarkably overstated. Many times the extent of the impact is not known for years as testing reveals more people who got it and survived, but were not factored into the original count. The swine flu of 2009 had upwards of 60 million people infected worldwide with up to 284,000 deaths resulting. Many deaths do not have lab results as confirmation, so you have an estimate of infected and an estimate of deaths. How can the conclusion be anything but an estimate? During the 2019/2020 seasonal flu period there have been 39 million infected individuals, 400,000 hospitalizations and 24,000 deaths. In N.C. there have been 11,961 cases and 149 deaths, which is a rate of .12% compared to coronavirus, which is 10 to 30 times more deadly.

Public health’s function is to make recommendations without taking into account economic factors. Taking in those other factors is part of the political process. While I certainly will follow the governor’s lead, my personal belief is that we could have done some fine tuning. Most of North Carolina is not Raleigh, Durham or Charlotte, but the same restrictions are in place for all. Some of those places allowed concerts and theater productions long after many rural areas had eliminated them. While there are long-term care facilities that can skew the numbers in rural areas, the problem areas are largely determined by the amount of population per square mile.

First, lets look at Italy and Spain, which have been especially hard hit. Italy has the second oldest population in the world — people 65 and older make up 50% more of their population than the U.S. Looking at Milan, there are 18,600 people per square mile, more than any large US city except New York. In Spain, Madrid has been hit hard and has 13,500 people per square mile, again higher than any U.S. city not named New York, which has 27,00 people per square mile.

New York has seen the bulk of the cases lately. Detroit, Philadelphia and New Orleans are pacing behind — all have high-density populations. In our state Raleigh, Charlotte and Durham all have higher levels of density than New Orleans, which is just under 2,000.

Let us look in our little corner of the world. Bladen has 37 people per square mile, Columbus 58, Sampson 67, Richmond 98, Scotland 113 and Robeson 130. Combined, they are about 1/5 of Charlotte’s density. So should the same spacing strategy be applied to all? I would like to have seen us try something short of a complete shutdown of businesses and maintained social distancing — restaurants could run at 33% capacity, department stores similar and so on. This would allow businesses to continue to operate. The people utilizing them would fill the off hours because that’s the only time space is available. It is extremely unlikely that the rural areas are going to be racking up huge morbidity and mortality numbers compared to cities where people are packed in.

The beauty of this line of thinking is that if it worked it could be brought back out when COVID-19 is no longer novel but seasonal. While we are at it, do away with golf courses being excluded from stay-at-home orders. Most are private entities and are a slap to many people who cannot even go to public parks because they have been shut down.

Is that truly sharing the pain?

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Bill Smith

Contributing columnist

Bill Smith is the director of the Robeson County Health Department.