COVID-19 break

COVID-19 on my mind, hopefully not in my lungs ::::


It’s been awhile since my last post about our Peru trip. I haven’t been able to finish the posts about our amazing trip.

Distractions away from a measly blog abound, serious ones that keep my mind from writing about Machu Picchu.

The month of March in the United States, and for my consciousness of the world’s goings on, turned to a place I never thought I’d see in my lifetime as someone with a public health degree and a medical degree. A pandemic. Not an outbreak confined to a country or region (like Ebola), but a globally reaching infectious disease that as of today has 1,506,936 confirmed cases and 90,057 total (known) deaths in 184 countries/regions (see the Johns Hopkins Coronavirus Resource Center frequently-updated link).

Days after I last posted in early March, the COVID-19 pandemic hummed louder and louder in our country, first ignored by our government as a problem despite the panic and lockdowns in China, South Korea, and Italy. “A hoax” we were told. (For what it’s worth, South Korea and the U.S. had their first confirmed case on the same day. Look how different our responses and numbers are today.)

No hoax. Science is real. COVID-19 quickly reached our community. My kids’ schools closed on March 14, indefinitely. My clinic has drastically cut clinic hours and patient contact to help avoid potential virus exposure. We converted to telemedicine appointments, though challenging to cover many of the people I treat. Some do not have the technology to do a video appointment, some do not have the help to prepare for the appointment, and some have complicated medical issues that need addressing in person, risking COVID-19 exposure when in public. In the end, people will fall through the cracks. This makes me so, so sad and angry.

I’ve pored over graphs and read well-written articles from science writers, epidemiologists, and physicians (you are all amazing!) showing exponential confirmed cases and deaths. Hospitals are running out of personal protective equipment (PPE) or they don’t even have the PPE necessary for staff. We, the healthcare workers all over the world and our allies, are trying to rectify this. Donations. Seamstresses. So much kindness from some people.

But kindness doesn’t always save. Many physicians are still forced to work with less pay or without pay or sufficient PPE; this will worsen our physician shortage. We will die or leave medicine: who will take care of you then? Why is it that some healthcare staff working the frontlines get hazard pay and (most) physicians don’t? Someone said to me “Isn’t this what you signed up for?” Hell, no. I didn’t sign up to go to war like this. Even soldiers get paid. And they go to war with proper equipment.

Nationwide, many hospitals’ needed capacity for sick people will be well beyond what is manageable. State to state, this varies. This link shows us the projected data well: “Chris Murray model“. Remember, hospitals don’t only care for COVID-19 infected patients. The usual cadre of strokes, car accidents, and cardiac issues will roll in there too. Some hospitals have set up beds in parking lots. Doctors are coming out of retirement to help. Some of us expect to be redeployed to other departments. I’m board-certified in PM&R–you don’t want me intubating you. Some states are calling veterinarians to be back up if things become dire.

Testing has been fraught with error. Some idiots believe that China refused to share viral samples in January with the U.S. to help in testing development, thus delaying the CDC’s ability to develop. This is BS. The CDC had sufficient viral substrate to work on PCR assays at the end of January. There was an error in the test’s basic chemistry and difficulty getting reagents needed. That has nothing to do with China. Next, there is a lack of testing with not enough tests to do wide rollout, even people who have been sick but may not meet all criteria. There are so many uncounted deaths because of lack of testing. The scope of the disease may look dire now; if we had more testing, more people would recognize the full dire extent of COVID-19.

And 2018 portended failure on the government’s side. Public health officials expressed worry about the U.S. Health and Human Services taking control of the Strategic National Stockpile (basically, the government’s storage of critical medical supplies) and NIOSH out of the CDC. Budget cuts set up public health for failure during this crisis.

Our government failed us. Again. Again. Again.

Socially distancing (physically distancing is a better term) is critical to decrease exposure. In that picture above, I’d add add even farther away than 6 feet. It’s frustrating to see people STILL not physically distancing themselves (some people down the street tried to have a group birthday party last week?!)–this is not rocket science, people. Introverted me never thought I’d miss standing close to a familiar face at the gym. Or clustering in conversation with my neighbors. Or letting my kids run around the neighborhood with friends. Or touching a patient’s arm at work. But being safe, you and me, outweighs my urge to hug or stand close.

The state of Georgia is also waiting for our “peak.” It’s not really a peak. A peak hits a high point then goes down quickly.

That’s not how this virus works.

We’ll hit a high point then a plateau. That’s great because there will be no more rising cases but a plateau could last for weeks, months — and this is partially dependent on how we are physically distancing ourselves. Our medical resources will be used (some people on ventilators for extended periods) and there will be no let up for awhile. Lots of people will die and healthcare workers will be stretched thinner. It will be an intense time after our so-called “peak.” #notapeak

Ed Yong for The Atlantic wrote an excellent article published 3/25/20 called “How the Pandemic Will End.” The section The Endgame summarizes this:

  1. Every country in the world must synchronously control the spread. This is unlikely.
  2. The pandemic will leave behind millions of corpses and immune survivors. This will also devastate many health systems. That’s dire.
  3. There must be global efforts to stamp out outbreaks until a vaccine is ready. THIS IS THE BEST OPTION. But, it’s the most complicated and longest of the three. We will continue to have more physical distancing periods for the next 12-18 months.

Yong also writes that our preparedness mentality will now encompass more for the future. It’s not just about PPE. It’s also about fair labor policies and an equal healthcare system. Our healthcare and public health systems shouldn’t be suppressed. And this, I love: “Public health becomes the centerpiece of foreign policy.” YES. (Ed Yong, if you ever read this, your piece was one of the best I’ve read on COVID-19’s scope and future. Thank you for writing it.)

I wake up every morning knowing this is not permanent. But in many ways, it is. The waiting for the other side moves slowly though, like some allegory for depression, swimming through a lake tangled with roots.

Stay home. Wash your hands. 

Now I’ll dream about Peru for my next rambling post.

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