Chinese Coronavirus, You, and Me

It has been a fairly busy year so far, with assorted projects at home and work, so I haven’t posted a lot to the BLOG. For some readers, that’s good news (so why are they bothering reading?).

However, the coronavirus that arose in Wuhan, China, and is igniting a worldwide and U.S. pandemic, has taken over the news, and the minds of everyone who isn’t utterly isolated from modern communications. This is the worse worldwide disease outbreak in 102 years, since the Spanish flu, because of its easy spread and higher-than-flu death rate of roughly 3-4% (so far).

Two days ago (as of this writing), my friend Dr. Jason Persoff, physician at a major Denver hospital and all-around great guy, sent out the following update from the front lines of medicine. I’m posting it unedited, exactly as he wrote it.

This is not some clickbait quack online, nor your buddy Bubba who heard something on the news, nor Aunt Bea with her worthless herbal remedies. Jason understands the science behind this disease. Pay close attention to his words. If you read anything about the coronavirus epidemic, start here. Serious stuff, but also, reasons for hope…

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COVID Update 3/8–Long, but Important–yes you can share

Well, it’s been an interesting week. For those who don’t know me, I’m a hospital medicine physician and the Assistant Director of Emergency Preparedness for the University of Colorado Hospital. We are still very much in containment mode (isolating patients w/ COVID, quarantining persons of interest), but there are hallmarks that this will likely be in a different phase in the next week or two. For now, the increase numbers continue to be correlated in part with increased testing and in part due to real time increase in disease burden. I think the key message here is that containment will be unlikely and we’ll enter mitigation: treating the most sick with most people quarantining at home. I do think it is reasonable to assume that COVID will be a global pandemic. Now the question becomes: how do we deal with that?

That brings us to the term social distancing. This is a pretty serious issue that is a stage above mandatory quarantine. Social distancing means, essentially, no unnecessary public gathering. We’re seeing ideas of this begin to pop up with the NBA and Olympics. I think others are coming. We’re already seeing self-selection in this direction with canceled conferences, canceled airline flights, and self-imposed canceled vacations.

What makes me the saddest at this time is how truly financially and socially devastating this could become and is becoming. Some of this is driven by hype, but truly I believe all the extreme measures–be it canceling SxSW or closing University of Washington–may help in spreading out the disease. Why would that be a good thing? A trickle of cases over a longer period of time means a better opportunity for us in healthcare not to be overwhelmed.

As an insider in our hospital’s emergency response, I can tell you that this past week has proven to be really draining. Long days and lots of meetings with multiple successes and failures at dealing with this disease. We’re getting on top of it, but this disease is just beginning. We’re still ramping up.

The most startling information to come out of China from the WHO is the abysmal rate of oxygen needs for patients. Five percent of patients end up on ventilators whereas 15 percent require oxygen for the 3-6 weeks it takes to recover. That’s an unprecedented burden on the healthcare system. We are simply not able to take a head-on hit if these numbers remain accurate–but over time, we could handle a sustained surge better.

Think about being out of work for 3-6 weeks on oxygen and you get a better perspective why I have concerns about the wherewithal of the financial system. I feel very sad for people whose lives depend on working day-to-day–this is going to hurt for a while and so that brings us to not panicking.

Okay, so what if we are facing a pandemic. First off, and I beg you to heed this, if you fall ill with fevers and a cough DO NOT GO OUT until the fevers have been gone at least 24-48 hours. I don’t want you to get me sick and you don’t want to sicken anyone else. Sorry, no going to work or socializing–self-quarantine. Oh, not because you have COVID, but because I don’t want any of the other types of illnesses out there either. What has been staggering to me is how many cases are tied to people who were ill not being mindful of others and going to their events anyway.

Second, if you have persistent fevers and are worried about COVID, contact your local health department for guidance. Do NOT go to the hospital unless you are gravely ill or can’t breathe. We’re not going to test you just because you want reassurance you are COVID-free. The most common types of respiratory illnesses remain far more prevalent right now, so you probably have them rather than COVID: flu, RSV, human metapneumovirus, etc.

Third, STOP PANIC BUYING. Hand sanitizer is a good idea, but you don’t need a 36 month supply. Don’t be an asshole–stock up, but leave some for others. I can’t even imagine why people need 14 months worth of toilet paper, btw. Again, be reasonable. If you don’t panic buy, the manufacturers should be able to keep up.

Fourth, start contingency planning. It turns out most travel insurance policies don’t cover epidemics. Anticipate that most businesses may be running at 85% capacity at their worst, so be courteous and patient with everyone. Be flexible with your job–you may need to help keep operations running meaning changes in your schedule–and you may need that time yourself, so be generous. Hold off on purchasing trips for a month or so to see how we’re doing then.

Fifth, masks aren’t going to protect you. Your biggest enemy is your own face. We touch it on average >40 times an hour. Learn to be mindful of this. We believe, other than getting sneezed or coughed on, hand-to-face contact is a main mode of transmission. So, begin to learn when you do this. Do you know that most people unconsciously sniff their hands within two minutes of shaking hands with someone? Crazy but true: therefore, stop shaking hands and bump elbows or feet. Wearing a face mask will not prevent you from your own habits.

Sixth, don’t visit with ill friends. Hospitals, including ours, are severely restricting ALL visitors at this time, and even more stringently for patients who may have COVID. Facetime and video messaging is the way to go.

Seventh, keep reminding yourself that this is going to last a while. Don’t sprint, slow down. Make haste slowly. Don’t spread panic, deal with the numbers as they become available. The current numbers on the Johns Hopkins site show that China appears to be reaching a sustained plateau of cases, but it’s not dropping off yet. Were that to apply elsewhere, we have months to go.

Eighth–have hope. I do. And I’m in the thick of things. We’re all in this together and we’ll muddle through. Things may not look like we want them to look for a while, but this will pass. The virus will mutate, the vaccine will come out, a medicine may work, whatever happens this will change. This isn’t forever even if it feels like it. We’ve made it through 9/11–we made it through 2007. Be at peace that this is happening. Be practical but caring. Believe in the future…

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Jason is well aware of what’s happening in prepared places like South Korea and Taiwan, which are holding their own, and Italy, which is overwhelmed despite a modern health-care system. They are short of both staffing and needed medical supplies, and having to let people die among those most seriously affected with the viral pneumonia that is destroying their lungs fast.

Most folks who get this (apparently about 80%) will experience only minor to moderate symptoms and move on with some immunity. Others, particularly the old, hypertensive, diabetic, cancerous, immuno-compromised, and those with heart or lung disease, have a much higher death rate. The brutally honest truth is that each of us — you, me, each of your friends and co-workers — ultimately will know someone who dies from this, and maybe multiple someones. Perhaps you or I will lose a parent grandparent, mentor, old friend, esteemed colleague, or role model. Even a few otherwise healthy and/or young people will be lost…who knows why?

We have to get obsessive as can be about prevention and hand cleanliness — to delay the onset of this crap in ourselves at least long enough for the medical system to not be overwhelmed everywhere. I’m trying to change habits quickly and use lots of soap and wipes. For the sake of the most vulnerable among us, I hope you are too.