Monthly Archives: March 2020

Scared As Hell

I’m not gonna lie. It’s scary as hell to be a doctor right now. In Italy, which is our projected immediate future, up to 10 percent of infected people are health care workers. Health care workers are also more likely to experience severe and critical diseases. There’s not a great explanation for why this is, other than just higher risk from repeated exposure over and over to infected persons. When we go to evaluate a patient, we can’t even be sure when we enter a room of who is infected, due to 5 percent of cases being asymptomatic carriers and the failure of our testing systems in the U.S. to actually diagnose people with the infection. So every time we see a patient, it is basically Russian Roulette as to getting exposed to the virus.

I’m not as scared for myself individually, more for all of us health care workers as a whole. So many of us have given our entire lives to medicine; trust us, we have the loans and emotional scars to prove it. It feels scary to know that just doing our jobs during this pandemic could ultimately lead to our demise. Yes, we run that risk every day, as common infections like the flu can still kill you, but those risks are so much greater when facing a novel virus as we have never seen before in our lifetimes.

The biggest challenge facing your health care workers is the lack of PPE, personal protective equipment. The hard truth is that we still don’t understand how much of this virus is transmitted in the air versus in droplet form. Droplet spread infections, like influenza A and B, can be successfully contained with just regular surgical masks, while airborne infections like H1N1 (swine flu) require specialized masks or hoods.

We do know that reports show that workers in other countries such as China and Italy are more likely to become ill as access to protective equipment dwindles, and supplies are exhausted. The bottom line is: Until we have a full understanding of how the virus is transmitted, it is safer for all health care workers who will have close contact with patients to wear N95 masks.

Well, here’s the problem, there is a critical shortage of this and other equipment which we need to protect us. Many communities are even soliciting donations of N95 masks from private companies, as they are often used in construction work.

We need all the help we can get. Without the support and cooperation of the general public, we will not be successful in mitigating the spread of this virus and the ensuing deaths. So please, don’t stockpile masks. If your doctor or nurse becomes sick, who will be left to take care of you when you need it? In countries further along into this infection, anyone with a medical license is being pulled to the frontlines to help combat the shortfall of physicians. That means your psychiatrist, who is extremely well educated and trained in psychiatry, may end up being your general hospital doctor if enough of our current staff become sick and unable to work.

So help us help you. Leave the masks and medical supplies to the professionals that need them. If you own or know of a construction company or other business with access to N95 masks, please reach out to your local hospital to see if you can donate them. This pandemic is not a sprint, it’s a marathon, and we need to be prepared now and for the future. Please share this message in your local communities to encourage the donation of N95 masks.

Covid 19: We Are So Unprepared

I’ll admit that in February, I thought COVID-19 was going to be another overblown SARS or MERS or even H1N1. I talked about it with my friends in the medical field, and we had a bit of a “been there, done that” attitude. But I was wrong, and in the time since, I’ve educated myself as much as possible. This strain of coronavirus is more contagious than the flu, with a R0 value estimated up to 4. It’s more lethal, and though the mortality numbers are currently inflated due to lack of widespread testing, low-end estimates are a mortality rate of 1 percent. The seasonal flu has a mortality rate of only 0.1 percent. COVID-19 has the potential to quickly use all our resources and overwhelm our healthcare system. We have a gory, vivid example of this playing out right in front of our eyes, in Italy. Many people are disparaging the spread of information about this virus, calling it a government hoax or “fake news.” They call the national news outlets “fearmongers” for distributing information about this infection, and about what we can do to protect ourselves. It is up to those of us who have dedicated our life to medicine and science, to help educate and inform our patients and the general public.

The response to this virus in the U.S. has been varied and haphazard. Starting from the very beginning, with our government’s decision not to utilize existing WHO testing kits and to come up with our own testing. Well, the CDC botched coming up with their own test. Instead, individual states have been left to go it alone, all trying to formulate new processes out of thin air. Each state is seemingly reinventing the wheel and starting from scratch. Testing has taken weeks to get online, as it took that long to verify each lab and it’s testing methods. When tests become available, they are hindered by very limited capacity and very strict testing criteria. For weeks, we saw evidence of community spread, but testing criteria was directed only at high-risk travelers. Now, many states still have little to no testing available.

Why does this matter? It matters because we missed many early cases. It matters because we are still missing them. Those cases spread to others, which spread to others.  Many people are asymptomatic or nearly so, and are just carrying it along and propagating it without knowing they are doing so. In Korea, where the outbreak was contained, and deaths were minimized in relation to other countries, they tested early and often. They quarantined all those affected and were able to curb the spread. Less than a hundred people have died in Korea. Contrast that with Italy, similar to the U.S., which tested much fewer people, much later into the outbreak, and was much slower to impose quarantines and lockdowns. Italy currently had 368 deaths from the virus in the last 24 hours alone. Rapid, frequent testing, which we are lacking, has been shown to save lives.

This leads us to social distancing and self quarantining. Why is this so important? Because any of us could have it.  Until we can test everyone, widely, we cannot know. As it stands right now, you may not be able to get tested, as our resources are so very limited and extremely varied from state to state. Therefore, the only way to curb the spread is to assume you may have it, and do your utmost best to limit your exposure to anyone else. Or, like myself, to wait in isolation until you can get tested and cleared. Is this practical? No. Is it fair? No. To borrow a sentiment from our colleagues in Italy: we are at war. At war with this novel virus. We may be forced into unthinkable situations where, like them, we do the best we can to save those that have the best chance of making it. That same dire situation may be coming to a city near you in less than two weeks. It’s already been happening at the overtaxed Evergreen Hospital in Kirkwood, WA.

So what can we do? How can we prepare but prevent mass, hysterical panic? Well, let us rely on science to guide us now. Let us look to the other countries that have been in this pandemic for longer, and take away all the lessons we can for how to handle it here. What can the average person do? First, stay home. Stay away from other people. Cancel your plans. Cancel your travel. Tell your neighbors to cancel that big party they have planned. Wash your hands, don’t touch your face. Do not go visit anyone in the hospital or the nursing home. Do not go to the ER unless your condition is potentially life-threatening. Save the masks for those of us working in healthcare, who are going to need them to ensure we don’t get the infection, so we can keep taking care of patients. Maybe most importantly: Self-isolate for and symptoms: sore throat, fatigue, chills, stuffy nose, poor appetite, muscle aches, vomiting and diarrhea, and most of all, fever and cough. Get tested is it’s available to you in your area, and if not, stay home and self-quarantine for 14 days. Let your state representatives know that widespread, easily accessible testing is needed. Listen to the new restrictions as they come from the government, and follow them.

When all is said and done, the chances are high that you’ll be completely fine. 80 percent of people will have little to no symptoms. You may feel crappy for a few days, but then you’ll move on with your life. Your grandma with COPD, your friend with a heart transplant, and your nephew with juvenile rheumatoid arthritis may not be so lucky. While you go on with your life, they may be in a coma on a ventilator machine, or they may be one of the one percent who dies. So do it for them. We can’t survive this pandemic unless we do it together. For the common good, for all of us.

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