I’ve skipped a few days of writing. Too much going on with the office and trying to make everything as safe as possible. Incredible thanks to my partner Kevin Mock who literally spent Saturday cleaning all of the office with Clorox. I didn’t ask him to…It’s how he copes. Me on the other hand… I think and worry and try to implement strategies and try to educate you guys. This is going to be long but important blog. So read on.
FIRSTLY: This is so real. If you are allowed to work from home, absolutely do so.
This virus, officially known as SARS-CoV-2 , has an “infectivity” quotient known as R0 of 3. That is INCREDIBLY high. It’s estimated that the Spanish Flu had an R0 of approximately 1.8. This means that the if you have the virus and just go out there, and just talk to whomever, kiss whomever, not take precautions, you will infect three people. Let’s say you don’t infect anyone else, those three people will infect three people and so on…here is how many people will get infected without social distancing….
DAY 1 1 Day 2 3 Day 3 9 Day 4 27 Day 5 81 Day 6 243 Day 7 729 Day 10 2,187 Day 11 6,561 Day 12 19,683 Day 13 59,049 Day 14 177,147 Day 15 531,441 Day 16 1,594,323 ETC….
You get the picture.
SECONDLY. This is not like Seasonal FLU… this is NOTHING LIKE SEASONAL FLU. This is a new virus to humans. Our body has no, none, zero defenses against. You don’t have immunity against it. Which is why being so cavalier about not caring is so infuriating. Because those of you that don’t want to take precautions are putting ALL of us at risk. Not just older people. EVERYONE. Here is really good explanation of this that I swiped from someone else:
“Feeling confused as to why Coronavirus is a bigger deal than Seasonal flu? Here it is in a nutshell. I hope this helps. Feel free to share this to others who don’t understand… It has to do with RNA sequencing…. I.e. genetics. Seasonal flu is an “all human virus”. The DNA/RNA chains that make up the virus are recognized by the human immune system. This means that your body has some immunity to it before it comes around each year… you get immunity two ways…through exposure to a virus, or by getting a flu shot. Novel viruses, come from animals…. the WHO tracks novel viruses in animals, (sometimes for years watching for mutations). Usually these viruses only transfer from animal to animal (pigs in the case of H1N1) (birds in the case of the Spanish flu). But once, one of these animal viruses mutates, and starts to transfer from animals to humans… then it’s a problem, Why? Because we have no natural or acquired immunity.. the RNA sequencing of the genes inside the virus isn’t human, and the human immune system doesn’t recognize it so, we can’t fight it off. Now…. sometimes, the mutation only allows transfer from animal to human, for years it’s only transmission is from an infected animal to a human before it finally mutates so that it can now transfer human to human… once that happens..we have a new contagion phase. And depending on the fashion of this new mutation, thats what decides how contagious, or how deadly it’s gonna be.. H1N1 was deadly….but it did not mutate in a way that was as deadly as the Spanish flu. It’s RNA was slower to mutate and it attacked its host differently, too. Fast forward. Now, here comes this Coronavirus… it existed in animals only, for nobody knows how long…but one day, at an animal market, in Wuhan China, in December 2019, it mutated and made the jump from animal to people. At first, only animals could give it to a person… But here is the scary part…. in just TWO WEEKS it mutated again and gained the ability to jump from human to human. Scientists call this quick ability, “slippery” This Coronavirus, not being in any form a “human” virus (whereas we would all have some natural or acquired immunity). Took off like a rocket. And this was because, Humans have no known immunity…doctors have no known medicines for it. And it just so happens that this particular mutated animal virus, changed itself in such a way the way that it causes great damage to human lungs.. That’s why Coronavirus is different from seasonal flu, or H1N1 or any other type of influenza…. this one is slippery AF. And it’s a lung eater…And, it’s already mutated AGAIN, so that we now have two strains to deal with, strain s, and strain L….which makes it twice as hard to develop a vaccine. We really have no tools in our shed, with this. History has shown that fast and immediate closings of public places has helped in the past pandemics. Philadelphia and Baltimore were reluctant to close events in 1918 and they were the hardest hit in the US during the Spanish Flu. Factoid: Henry VIII stayed in his room and allowed no one near him, till the Black Plague passed…(honestly…I understand him so much better now). Just like us, he had no tools in his shed, except social isolation… And let me end by saying….right now it’s hitting older folks harder… but this genome is so slippery…if it mutates again (and it will). Who is to say, what it will do next. Be smart folks… acting like you’re unafraid is so not sexy right now.” #flattenthecurve. Stay home folks… and share this to those that just are not catching on.”
That about says it all. Yes. Different medications are being tried and some show promise. Yes. Vaccines are in development, this takes a LONG time. Yes, the summer may see a natural decrease. But until then, a lot of damage can occur if we don’t follow social distancing. So, until then….Stay calm. Stay healthy. Stay vigilant. (Stop with the toilet paper already!)
Today has been a very depressing day. Maybe it was the rain. I warn you… you’re not going to get the funny until the end of the blog. It must feel the same for most of you.
I lived through the worst of the HIV epidemic, where in total 25 million people died. A million Americans died in that plague and are dying still. But this feels different. Maybe because during the AIDS epidemic it was just “us” . The rest of the world kept marching along because it didn’t really care. But at least there was a sense of stability outside of “our” disaster. Now it is all of us. It is “quicker”, if that makes any sense. The social impact is more abrupt. The financial impact is hugely obvious COVID19 needs to be taken seriously. Yet people who have never even heard of Pythagoras’ Theorem, let alone solved a problem using it, are leading this country. The divides that are ripping our county apart are making this epidemic even worse. There are no teams here people. There are no walls. We are in this together . Anyway. I am rambling. So here are my pearls of wisdom for today.
If you have a cough, fever, sore throat or shortness of breath, call your health care professional FIRST. They will advise you. DO NOT COME into any office. You will be triaged via telehealth or advised to come into an office or an ER.
Slowly test kits are arriving. For now, symptomatic people are the ones being tested. But we need almost everyone tested. We need information about what is really happening. It is not sufficient to tell people to just stay home. Don’t get me wrong… it is crucial at this time to not spread this virus. But when new studies show that people who are not symptomatic can spread the virus, it is crucial that we know patterns of spread. Along with risks for acquisition and severity. If nothing else, by doing so we can get real data and probably reassure people that the death rate is less than we thought. Therefore, less panic. We can hopefully predict sooner when this epidemic is ending.
In the meantime, take social isolation seriously. Tempting fate and laughing at fate doesn’t make you cool. It makes you stupid.
Hang in there. I will get over today’s funk and so will you.
So here is the bright, funny part. I had a really sweet patient of mine come in to the office last week. He is one of my favorites. He said the he had been having a cough, but that he did not have a fever. I congratulated him for taking his temperature. At least he had a thermometer. He hesitated and said that he didn’t have a real thermometer. When I asked how he took his temperature he said sheepishly: “with a meat thermometer”. I didn’t ask. People, buy a real thermometer.
O.K. People! Calm DOWN! Yesterday, the President of the United States spoke on national T.V. and the pandemic became real. The same pandemic that we have been talking about for months. Except it was finally called such. And perhaps because a huge travel plan was put in place without anyone’s notice and because it was clear that perhaps there was no other clear plan in place people have become anxious today. CALM DOWN. Unless this virus was created in some lab (which is doubtful) there is no one to blame for its existence. Unless you want to have a long talk with mother nature. Viruses happen. But guess what? Humans happen too. And our gift is intelligence. So, let’s start using it.
The key now is to decrease the spread of this virus. Flattening the curve, if you will. The postponement of major events is vital. The washing of hands. The covering when you cough. The cleaning surfaces. All of them are vital. The rest is theatre. Don’t become part of the drama. The drama is currently a big problem. This is exactly why doctors sometimes do not tell people the whole story. Because panic sets in. It is not time to panic. It is time to be careful.
We need more test kits and they should be free. We should test as many people as possible to get some FACTS. It is the lack of facts that make us all nervous. We will all make sacrifices in one way or another. It will not last forever. Hopefully for weeks or months only. Let’s not CREATE the apocalypse. So, you want to do something useful? Call your representative in D.C. and tell them that if they don’t work toward providing testing, you will never vote for them again.
Stop hoarding. It only goes toward creating an atmosphere of panic. It is reasonable to buy groceries for a couple of weeks. But that is all. Toilet paper? Really? If you don’t have toilet paper, then you can always shower after a BM.. Come on people, where is the common sense?
Next. The really important thing. Buy a thermometer. Be aware of your body. If you have fever or a new cough that does not go away or shortness of breath. Call your local hospital or doctor. Do not go to the health care office immediately. Tell them your symptoms and they will guide you. Remember. It is estimated that 80% of all infections will be mild. Another 15% will have more intense symptoms. Only a small percent will require hospitalization. Do not overuse the healthcare system like it was toilet paper.
There is a saying in medicine: “in an emergency, always take your pulse first”. That means that the last thing you need, when you need to think clearly, is to panic. So, take your pulse first. Don’t panic. We will get through this. And I predict better than expected.
What a day. The World Health Organization declared this a “pandemic”. Before you freak out let me clarify what that means. It means that this infections have crossed geographic boundaries and is affecting an exceptionally large number of people. It does not mean that it is necessarily deadly. The truth is that those of us in the health profession, especially those have been in my field have known that this is what was probably going to be happening. The physician assigned to Congress and the Supreme court supposedly stated that there will be approximately 75-150 million Americans affected. That may true. Or it may not. The difference starts NOW. It should have started two months ago. This is what is called #FlatteningTheCurve. Which means that the greater the number of people that get infected, the more other people will get infected. Some people I have spoken to have thought it is no big deal because 80% of the people get only mild symptoms (see yesterday’s post). Well, it is a big deal, because the more people get infected the more there will be of really sick people. Which will possibly put a huge drain on our health care system. That being said. DO NOT GO TO YOUR DOCTOR JUST TO GET TESTED. (Hopefully in the near future that will be the case) Firstly there are not nearly enough tests. If you feel sick CALL YOUR DOCTOR’S OFFICE FIRST or CALL YOUR HOSPITAL. They will guide you to testing if appropriate and to treatment. But when in doubt call your physician. (Make sure to buy a thermometer! Most places with telemedicine are going want to physically see you take your temperature!). All is NOT bad news. Many will be putting pressure on government to increase testing production. Research on potential treatment is proceeding at a speed that I have never seen before. Research on a vaccine is also proceeding in lightning speed, with the first human tests possibly starting in a few months. But right now, YOU can make the biggest difference. In conclusion, the time to make a difference is NOW. Hygiene is crucial. WASH those hands. Use towels to close and open doors. Avoiding places that are too crowded is also helpful. If you feel sick, stay home and CALL your health care professional. And remember, this is NOT a foreign virus. This is a virus. Period. It does not discriminate. So, chin up. Let’s stay healthy.
As parts of the world take extreme measures to prevent the spread of COVID19, I wonder. Is it better to limit coming into contact with the virus or is it better to be healthy in case we do contract it? It’s probably a bit of both. I am reminded of a medical school professor of mine, who would put us in our place when we tried to impress him with the latest journal article we had read. He would dismissively tell us: “all you’re saying is that the sicker you are the worse you do”. Case closed. And in deed he was and is correct. The vast majority of the people who have died from COVID19 have either been very elderly or had an underlying disease. My point is this, whether there is COVID19 lurking or not, we should all be as healthy as possible. I need to remind myself every time a donut calls my name. But seriously; if you are diabetic, get that sugar under control now. If you have high blood pressure, see your doctor, take your medication and modify your lifestyle. STOP smoking. For God’s sake stop smoking! Take care of your asthma. If you are battling a malignancy; make sure that all your other labs and organs are where they should be. In other words: YOU are the best armor. Forget the toilet paper and get as healthy as you can. It’s never too late. #COVID19 #ITALY #QUARANTINE #CORONA #COVID