I’ve been hearing and seeing a lot of misinformation and simply missing information, so I wanted to take a moment and put together what I’m seeing on this thing for both my patients and any providers that may want it as well.
We are in unprecedented times, medically-speaking as well as economically-speaking. There is a lot of thought that the press is driving this and creating hysteria or overblown reactions. I’ll admit that in the early days of this, I thought that was a real possibility – now I know that is not the case.
This virus is the real deal. It is NOT “just like every other flu” or some approximation thereof. It is both more contagious and deadlier. The biggest complicating factor is that you could have the virus and be spreading it to everyone you know for up to 2 weeks without a single symptom. It has exponential spread, meaning that if we don’t take drastic measures to stop the spread now a lot of people are going to be very sick all at once. This article has a dramatic title, but a lot of great data: Coronavirus: Why You Must Act Now.
Practiced Social Distancing vs Non-Practicing
Because of exponential growth, what seems like nothing today (it’s only 15 cases!) is a crisis of unfathomable proportions in just a few weeks’ time. Italy is our greatest teacher in this. This is a great graph comparing the provinces that practiced social distancing and those that didn’t:
See here for another easy visual on why/how social distancing works: What is Social Distancing?
I’ve also heard people calculating that the “death rate isn’t that bad, similar to the flu”. They’re calculating that by dividing the total number of cases by the number of deaths – but it isn’t quite that simple. Once the pandemic is over, yes that math works. But in the early stages, it’s inaccurate because of the exponential growth and long incubation time.
Oxford did a study of the Honk Kong SARS virus from a few years ago, showing how inaccurate the “simple math” can be. This article has a lot of math and statistics but if you want to see some better methods for calculating mortality rates, here you go: https://academic.oup.com/aje/article/162/5/479/82647.
Please don’t fool yourselves or let your loved ones fool themselves into thinking this is as simple as deaths/cases right now. The governments of the world are telling us this is a big deal for a very good reason.
I’ve heard in many smaller communities in Arizona people still think “we’re isolated enough here that it isn’t an issue”. Unfortunately that simply isn’t true. In a very short time, we have had confirmed cases in all 50 states (including Alaska and Hawaii).
In those hardest hit regions around the world, there are not enough ICU beds or respirators to care for the ill. Doctors and nurses are being infected and quarantined so there aren’t enough caretakers. There aren’t enough supplies – simply because everyone got sick all at once. Italy is on the verge of issuing an order that no one over the age of 80 is allowed to have critical care, something that no one wants to see happen (that order has not been issued yet).
This is an opinion piece from a physician in Europe, on the front lines, a good 3 weeks ahead of us: https://www.newsweek.com/young-unafraid-coronavirus-pandemic-good-you-now-stop-killing-people-opinion-1491797
What I Am Seeing
This is without a doubt, a rapidly evolving situation and more information comes out daily, so we all need to stay informed to the best of our ability. As a practicing physician, here is what I am experiencing:
- We cannot get testing. They are advertising drive-through testing on the news, but it isn’t “live” yet. As of Wednesday, there is one location up in Scottsdale, but somehow it is only for Mayo patients (that is unconscionable to me). Sonora Quest and Lab Corp have the capability to test, but I cannot send my patients to a draw station to be tested. It’s been mandated that patients be drawn by their doctors to reduce the spread. This is understandable, except that the test requires special supplies and equipment that we can’t get our hands on. Urgent Care isn’t testing either. If you go into a facility they will test you for the flu and then send you home to “see what happens”. If you get worse, then you go to the ER, and then they may test you. This is problematic for any number of reasons, not the least of which being that there are several people I’m quite sure would have tested positive just from my little world that we couldn’t even get a test for. So when you see some small number of confirmed cases, know that it’s a far cry higher from that. We’ve been told tests are coming – let’s hope it’s sooner rather than later.
- Because of panic buying and stockpiling, we can’t get needed supplies. This includes everything from masks and PPE (personal protective equipment), to simple anti-viral and immune support supplements. This (like the unexplainable rush on toilet paper) takes from the people who actually need it
,and loads precious supplies into already well-stocked cabinets. Think of your neighbors.
- This virus lives on hard surfaces for DAYS. Sally comes in and doesn’t have any symptoms, has no idea she has the virus. She touches lots of things in an office/your home. If those things haven’t been wiped down, 2 days later, 75-year-old Art (who also has asthma) comes in and now he’s infected. This is easy enough to account for in a home or a single office. Now imagine Sally shedding virus everywhere she goes – school pickup, the grocery store, church, the gym, a restaurant.
- People think that only the very aged and infirm are at risk, which is false. They are at the MOST risk to be sure, but we are still seeing severe cases in even 40-year-olds. The category with the highest risk is men, over the age of 60, with other health conditions (especially cardiovascular and respiratory). So, your 59-year-old co-worker with high blood pressure and pre-diabetes? Yep, he’s high-risk. This is not the time to visit friends/family with medical conditions in person, this is the time for Skype or FaceTime.
What can you do to protect yourself? The biggest (and most important) things are social distancing and canceling your travel plans. Apart from that, we have the following:
- Use great handwashing technique (20+ seconds) and do it often
- Use hand sanitizer with at least 60% alcohol
- Sneeze and cough into your elbow rather than hands
- Avoid touching your face unless hands are washed
- Avoid touching eyes, nose, mouth
- Avoid shaking hands or elbow bumps
- Avoid large gatherings
- Stay home if sick and contact your healthcare provider
While we don’t have treatments specific to coronavirus yet, we do know how to improve immune function and overall health:
- Drinking plenty of water
- Avoiding sugar, alcohol, and processed foods
- Eating more veggies and fruit
- Getting plenty of good sleep at night
- Carrying peace and gratitude in your heart (really, it improves immunity!)
- Spending time in the fresh air and sunshine
- Having a sense of community/family. We should be distant, but not estranged.
My Personal Actions
One question I get frequently is what am I doing, personally, to fight this thing?
Well, I work in healthcare, so I will be going to the office, but if I had the chance to stay home, I absolutely would. Even at the office, we have transitioned every visit possible to a phone consult and we’re delaying all unnecessary procedures. We are wiping and cleaning like maniacs, and now we’ve started asking patients to stay in their cars until it’s time to come inside to be shown to an examining room to avoid a full waiting room. I wash my hands and use hand sanitizer – a lot.
My family is being very careful about social distancing. I am uncompromising in getting enough sleep and I take vitamins daily. The core of my vitamin regimen is a good multi, probiotics, vitamin D, and (right now) zinc – there are others that may be good immune support for you. Ask your doctor.
Those of you who know me well know that I am not a “germ-a-phobe” by any means. I firmly believe that the biggest difference in who gets sick and who doesn’t is the terrain that greets the virus – i.e., get healthy before the virus hits and you’ll come through things much better. That having been said, the actions we take right now are not necessarily for ourselves, but for our neighbors and friends, for the weaker or more susceptible among us.
We take these actions for the sick and aged, for the people who have no choice but to go to work and pray that they aren’t exposed, for the families who would be crippled without their primary income source. If we all band together, stay home, and help each other out we can drop this pandemic from millions of cases to thousands.
I’ve tried to keep the above links from being too “dry”, but if you want more hard data and clinical findings, see below: