Dear Friends,
I know each of you have reached out about this, so I wanted to get my thoughts on COVID-19 to you especially on the heels of major announcements last night from President Trump and the NBA canceling the season. I have been following COVID-19 closely from NYC for the past week and wanted to share my thoughts for those who are interested. I will include several hyperlinks to additional articles where appropriate for those who would like to read further on this.
First and foremost, there is no reason to panic. It is true that ~80% of us will have mild to no symptoms when we acquire COVID. This should reassure everyone that even if you do come down with COVID, you will most likely be fine.~20% will have moderate symptoms and a portion of those (definitely less than 20%) will go on to have more severe symptoms that require hospitalization. I will not put a % on how many will need to be hospitalized because we do not have enough widespread testing data to say with certainty. Similarly, I will not put a fatality rate on this due to lack of data but unfortunately a certain percent of those hospitalized will die. We know from initial data that older folks with underlying co-morbidities and those who are immunocompromised are at higher risk, but currently there is no other way to predict who will develop more severe symptoms.
While there's no reason to panic, it is critically important that we use the next few weeks to all do our part to 'flatten the curve' of the spread. This acknowledges that many folks are likely already infected and many of us will become infected at some point. Flattening the curve means that we all take protective measures to slow the speed of spread so that not all of us catch the virus on the same day or within the same few days. While at some distant point the same number of people under both curves below will become infected, they become infected over a longer time horizon as opposed to all at once.
Why is this important?
Our healthcare system has a finite supply of hospital beds, ICU beds, and ventilators. When people do develop severe symptoms, they require hospitalization and may develop respiratory failure requiring mechanical ventilation. We can predict from other countries experience about how many days from the initial day of infection it takes to develop severe symptoms and need to do everything we can to prevent the red curve above where everyone needs the hospital, ICU, and ventilators at the same time, but instead, space out those who require intensive care so we do not overwhelm our system.
Further, we currently do not have the ability to widely test for COVID. Delaying the spread of the virus gives scientists and lab manufacturers additional time to catch up on increasing our testing capacity and learning more about what treatments may be helpful when people do get sick.
How do we do this?
Put simply, socially distance from others. Limit gatherings to very small numbers, no sharing of plates / food / buffets, and those at particularly high-risk should take additional precautions. No hugs, no handshakes, frequent hand-washing, and avoiding touching your mouth, nose, and eyes as much as possible. You can read here how the virus rapidly spread amongst a conference in Boston a few weeks ago. These are the types of 'superspread' events we're trying to avoid. It is on all of us: young, old, high-risk, low-risk to do our part to flatten the curve. Avoiding nursing homes and similar places where elderly folks live together will be of particular importance since we know those facilities are especially vulnerable to an outbreak, particularly if you do not feel well. It will require sacrifices from all of us but we have not encountered a virus such as this in our lifetime and the next few weeks still matter in terms of how well we're able to mitigate the consequences of this pandemic. Will social distancing do anything? Initial data just published last night shows that it is likely limiting spread in the State of Washington:
Evidence such as this only further strengthens how important it is to socially distance over the next month.
What should I do if I develop symptoms?
If you develop symptoms, the most important thing you can do is self-quarantine to prevent spreading to others. If symptoms are mild, I would obtain medical care via telehealth / virtual care as opposed to going to a doctor's office as they will not have the ability to test you for coronavirus given our lack of testing supplies and you'll only spend that time potentially infecting others. Tylenol, Advil, etc should help w/ mild symptoms. If you develop trouble breathing, shortness of breath, or high fevers you should go to an emergency room. Unfortunately, there is no cure or remedy to take if you do have the virus.
How long will this last?
Impossible to say, but my best guess is it will be a tough 2 months with slowing by end of summer but this is hard to predict and wouldn't trust anyone's ability to perfectly predict the next 2-6 months. A source I follow closely, Dr. Scott Gottlieb, former FDA commissioner, has a nice Q&A in the USA Today that answers this question among others.
Are we doing enough?
Last night was important in seeing the NBA suspend the season and I suspect more cancellations will be coming. It is the right thing to do to limit large gatherings for reasons described above. A sobering but accurate article would suggest that we need to continue taking aggressive measures to flatten the curve further.
We should also be thinking about how to expand our capacity for hospital beds, ICU beds, ventilators and the like, perhaps through military physicians and the Army Corps of Engineers to develop mobile ICU's in case we reach capacity in certain areas. And, of course, we need to dramatically increase our testing capacity.
What is worst case scenario?
The worst case scenario is that we fall into the red curve above and end up in a similar situation to what they're experiencing in Northern Italy where we simply run out of beds/ventilators to care for people. This is the scenario we desperately need to avoid. I will warn you this article may disturb you and my hope is that we are able to avoid falling into this situation in the US by taking aggressive measures described above.
Are we over-reacting?
No. My hope is you re-read this article in 2 months and say I over-reacted. That would be ideal. Unfortunately, I don't think that will be the case. We will not get a do-over next month if we don't like how things are playing out. By that point, social distancing and the risk mitigation window will have passed. Dr. Marty Makary, a leading health expert from Johns Hopkins, nicely summarizes why we are not over-reacting.
What else can I do to help?
This will be a particularly challenging for the elderly and those at high-risk who should ideally be socially distancing. Assuming you feel well, frequently checking in and visiting with those who you know should stay out of the public would be hugely beneficial so they do not become completely isolated and depressed. Leverage FaceTime and other tech to stay connected to folks in lieu of meeting in person. It will also be a very challenging few months for healthcare workers, hospitals, nursing homes, and the like. An article in the New York Times describes some of those difficulties being felt in Seattle at the moment. If you're young, healthy, feeling well and have additional time/bandwidth consider checking in on your friends that are work in healthcare to see what you can do to be of assistance to them or their families or consider calling any of the above facilities to see what you can do to help. Our healthcare workers and facilities will be the most important assets to support over the next few months.
Stay up-to-date especially as testing becomes available in your area.
Lastly, we're all aware of how disruptive the pandemic has been and will continue to be on the economy. Everyone will feel it, but those who work hourly jobs, have kids at home now that school is canceled, and those who can't afford to miss multiple paychecks will be particularly hard hit. Keeping an eye/ear out for those folks and the community will also be of great benefit.
How did this happen?
This was a multi-factorial failure on several levels, but now is not the time to look backwards as there will be plenty of time for that in the future. The focus for now needs to stay on what each of us can do over the next several weeks to do our part to flatten the curve.
In closing,
We still have time to modify the course of this virus in the US. Taking actions such as those described above will have meaningful impact and make a difference. Every day counts and the next few weeks will be of particular importance as we all do our part to flatten the curve.
To quote former HHS Secretary Mike Leavitt, "Everything we do before a pandemic will seem alarmist. Everything we do after will seem inadequate." Nothing will better sum up how we've felt for the past few weeks and how we'll likely feel in several months.
Feel free to share this with others and email with any questions.
Best wishes to all,
Harry