To all of my patients:
Many people have contacted me with concerns surrounding the coronavirus pandemic. In an effort to update you on the latest information, I am sending this letter to answer some of the most commonly asked questions. I would also like to try to put this crisis in perspective. This is going to be a long haul, so what I am saying now is merely a snapshot in time.
The first thing we need to do is identify our priorities and act from those priorities. As individuals, we all want to stay well. We want to try to avoid getting the COVID-19 infection ourselves and we want to protect our loved ones. Second, as members of the community, we need to prevent our already overburdened hospital systems from complete collapse. This is not hyperbole.
It is important to realize that our emergency rooms are not just trying to cope with a large number of patients who may or may not have COVID-19. They must simultaneously continue to provide emergency medical care to people who are suffering from heart attacks, strokes, trauma, influenza and all of the other life-threatening conditions that show up in the ER every day. The actions we take, or fail to take, to reduce the spread of this virus will quite literally make or break our already weakened hospitals here in Tucson.
And finally, before I answer the most common questions about this infection, you should remember that you have easy access to me for any and all questions you may have about COVID-19. If you have a routine question, send me an email. If you want to see me, or if you would prefer to have a phone visit, we can arrange this. If you have an emergency, call me through the answering service at 570-6015 and I will promptly call you back.
Now to the questions:
What is the scope of the problem?
Right now, there are pockets of COVID-19 infections in the country where the incidence is high. In these cities, it has not taken very many cases of COVID-19 to cripple the system. In places like Seattle, which has world-class hospitals, systems are already overwhelmed. Supplies of masks and protective gear are limited. Medical staff are overworked, and some have become infected themselves. Two ER physicians in the U.S. have already developed severe disease and are in intensive care units. In other places, like Pima County, the epidemic is just getting started. We have only 2 confirmed cases as of today. There are certainly more than 2 cases of COVID-19 in Tucson, but as of Friday night, only 18 people had been tested. Coronavirus test kits are still not widely available. When people call the coronavirus hotline in Tucson, they are being told to stay away from the ER unless they have severe symptoms, because there are no tests available and they may just spread or contract the virus. I expect the number of confirmed cases to rise over the next two weeks. Local hospital ERs have made plans to try to deal with this coming storm. But for those of you who have had any experience with Tucson hospitals over the past few years, you know that they are not centers of excellence. So we are adding a huge burden to an already weak system, which means that we should not expect a very high level of care.
How important is “social distancing?”
In terms of your own protection, and preserving the ability of local hospitals to function, distancing is everything. This virus is transmitted by touching an infected person or contaminated surface, or sharing the air with an infected person. If you stay in your own home, or walk outside in the fresh air without close contact to other people, you will not get the virus. However, if you don’t restrict contact with others, you will be taking some risk of contracting the virus. Based upon research that has been done in Seattle, experts believe that we can reduce the risk of new cases by over 90% during the next 6 weeks if the public reduces their contact with others by 75%. https://www.seattletimes.com/seattle-news/how-big-will-the-coronavirus-outbreak-get-this-bellevue-scientist-is-figuring-that-out/ Alternatively, if people reduce their exposure to other people by 50%, the spread of infection would be reduced by about 60%. So, if you want the ERs and hospitals to be there for you when you or your loved ones need them – and if you want to reduce your own risk of getting COVID-19 – dramatically reduce your contact with other people. For older individuals with chronic medical problems, I would advise that you have as little contact with other people as possible. The article above shows the critical importance of social distancing and it is well-written. If you understand the graph in this article, you will understand all you need to know to keep yourself and your loved ones healthier.
What should I do if I feel sick or have a fever?
Call me first. I will give you the best advice in the moment, given what will be a changing medical landscape. Medical authorities are advising patients to call their doctor if they feel sick or have a fever, but not to show up in medical offices. Experts manning the hotline in Tucson are advising patients not to go to the ER unless they are having shortness of breath or other severe symptoms that might require hospitalization. Going to an ER if you have a mild COVID-19 infection will not only run the risk of infecting others, you could infect doctors and staff, limiting the supply of professionals to care for you. The fewer medical professionals who are out of commission due to quarantine, the more people we will have to take care of all sick people. Johns Hopkins and other institutions are working on novel treatments for healthcare workers, such as antibody therapy to protect them until we have a vaccine, more definitive therapy, or until the epidemic recedes.
What are the most common symptoms of Coronavirus?
99% of people with this infection have fever, generally a high fever of 102-103°. Cough is also common. Symptoms run the gamut, from mild cold-like symptoms to severe flu-like symptoms, with bad muscle aches and pains. Shortness of breath may be a sign of pneumonia and severe infection, so this is a reason to call me immediately. It is important to realize that we are still in the middle of the flu season, so it is impossible to differentiate clinically between flu, pneumonia and coronavirus without additional testing. And even if you’ve had the flu shot, you can still get influenza. As an example, my 13-year-old daughter has had both influenza A and B this year, despite getting the flu shot. The flu vaccine match was not good this season. The match for influenza B/Victoria viruses, which represents 98% of circulating influenza B, is just 58%.
Should I fly or travel?
Most people should avoid flying if at all possible. Older patients, and those with underlying conditions should fly only if it is absolutely necessary. I have a couple of patients who need to fly out-of-state for critical surgical procedures that cannot be delayed. In circumstances like these, or if you must fly due to a family emergency, wear a mask if you can find one, distance yourself from others and bring hand sanitizer with you.
How long will this last?
We don’t know for sure, but we are only at the beginning of this epidemic in the United States. I suspect we will be in some kind of social distancing mode for at least 3-4 months.
What about testing?
The CDC got caught with their pants around their ankles on this one. Tests are supposed to become more readily available over the next 2 weeks. Until then, we are left with managing patients based upon their symptoms, and doing triage by phone to determine whether or not people should go to an emergency room.
What can I do to keep my sanity?
Keep things in perspective. This is not bubonic plague and we will not lose a third of our population. Allow yourself to slow down and spend more time with those in your household. Exercise outside or in a home gym. You are at no risk of contracting COVID-19 by going for a long walk, swimming in your pool or going for a bike ride. If this epidemic provides a little additional time for you to work on a personal goal that you’ve never had time for, take advantage of this. Focus on your personal goals and don’t get caught up in the panic. And if you are losing tons of money in the stock market, stop looking at your portfolio. There isn’t anything you can do about it! The cost of reducing the risk of death and pain on a mass scale is accepting that this pandemic will likely cause a global recession. You can only take measures to be alive to enjoy a recession, which is not a terminal illness.
Steven D. Knope, M.D.