**March 16, 2020 Update - With Pictures
Apologies for technical issues on initial send. Now with pictures
Dear All,
Here is today's update:
What has changed?
We are starting to see increasing numbers of people requiring ICU admission for COVID including our first two healthcare workers who are in critical condition. Both are Emergency Room physicians, one in their 40's and one in their 70's, from Washington State and New Jersey. They will not be the last. Our healthcare workers across the board (physicians, nurses, social workers, technicians, housekeeping, kitchen staff, etc) will be at great risk of contracting COVID being on the front lines. Please do your part by staying home and practicing social distancing as much as possible.
Why is this novel coronavirus causing so much disruption?
The key word is novel. The human race has never seen this virus prior to December of 2019. This means several things:
We have no built up immunity to this virus. Thus, it can spread quickly and cause severe symptoms in all of us
We don't know much about it. In fact, we know very little about it because we as a scientific community have not had time to study it like other infectious pathogens.
We have no proven treatments. While scientists across the world are working on solving this every day, we currently have no way of explaining why certain people are developing more severe symptoms and what we can do to treat them. At this point, everything remains experimental.
This is important to realize as you start wanting to answer questions such as:
- What is the appropriate amount of time to stay quarantined if I have symptoms or test positive?
- How long can the virus live on hard surfaces?
- Will it go away or abate when the temperatures warm up in the summer?
We have ideas around all these questions but the honest truth is we don't know enough to answer any of these confidently. The CDC has an extensive list of FAQs related to pets, kids, pregnancy, and a host of other questions that you may find useful recognizing we just don't know as much as we'd like to about this pathogen.
This is also even more reason to stay at home over the next few weeks to buy the scientific community more time to learn more about the virus and what can be done to mitigate it.
Does Ibuprofen (Advil / Motrin) make COVID worse?
See above that we don't know very much about this virus. The French Minister of Health released a statement stating that ibuprofen could worsen COVID symptoms which has been rebuffed by many in the scientific community including in a New York Times article today.
Bottom line - We don't know very much about this. I have seen no conclusive science to date to support ibuprofen argument but that does not mean we won't come to learn more as we go forward.
If you're concerned about it, stay away from ibuprofen and use tylenol (acetaminophen) instead.
Could I have no symptoms and still have COVID?
Yes. We know from South Korea that many of their carriers were asymptomatic because they had mass testing in place very early on in their response. Because COVID is at community spread and our testing capabilities remain limited, you can move towards the assumption that everyone around you is infectious. This is not to scare you but to say that we have no way of knowing who is and isn't carrying the virus until more testing is available. Therefore, the best advice is to treat everyone around you as infectious and practice all the precautionary steps we've mentioned in prior posts. The easiest way to do this is to stay home except for essential reasons to leave the house.
Dr. Harlan Krumholz, a leading cardiologist at Yale, published a great article on this yesterday in Forbes. Selected paragraphs highlighted below:
“The fact that many people without symptoms are walking around has important implications not because of their contact with others, but because of indirect spread. Indirect spread occurs, in part by contamination of common objects. The CDC reported about indirect COVID-19 transmission in a shopping mall in Wenzhou, China. Experts from the US, again in medRxiv, reported that the virus causing COVID-19, can survive on many common surfaces for many hours or even days.
So what does this mean? We should all consider ourselves infectious. We may carry the virus and can be a threat to others even if we feel well.
This is the strong justification for the social distancing. We should particularly not be visiting elderly people. We should be avoiding crowds. We should be washing our hands and wiping surfaces with disinfectants.
We should also know that we cannot be sure who might infect us – or what surfaces might transmit the virus. COVID-19 spreads quickly through a population – and this asymptomatic spread is likely a reason. And with scarce testing in this country, we have no real idea where it is and who has it.
This information is not meant to scare you or cause anxiety. It is intended to convey why the social distancing is so important. It is also to make clear why we cannot just focus on how people feel as a barometer of whether they might be infected. We are not containing the virus by just sequestering the people with symptoms. We all need to practice good habits in keeping a distance. We need to test more. And we need to all act as if we could be infectious… of those around us could be.”
I am a grandparent and am wondering if it's safe to babysit or visit my grandkids?
There is no easy answer because I recognize that many grandparents are being asked to watch kids so that folks can go to work and that staying away from your grandkids for extended periods of time is not easy. Having said that, we know that older adults are at higher risk of developing severe symptoms and that kids can carry/spread the virus. Therefore, the more that we keep grandparents away from direct contact with grandkids, the lower chances of acquiring the virus.
If your goal is to minimize your chances of acquiring COVID, the safest way to do that is to avoid direct contact with everyone whether that be your grandkids, adult children, or friends. It would not be unreasonable for those over the age of 60 to simply use FaceTime and video chat with everyone (kids, grandkids, friends, etc) if you’re looking to maximally reduce your odds of infection. That is the safest strategy. But, I recognize that may not be feasible for everyone, in which case, be extra vigilant when around your grandkids or others to keep distance, no hugs/kisses, and frequent hand washing.
As a follow-up to Italy statement yesterday:
You'll recall we discussed yesterday how the US is tracking similar to Italy in terms of disease spread. Below is a chart that puts numbers to this comparison. You can look at Italy and see what we can expect over the next 10 days if we were to do nothing. Remember, Italy went into full lock-down on 3/10 and is still seeing a rise in cases. It takes time for social distancing and lock-downs to work. Hence why it is so important everyone take action now to stay at home unless absolutely essential to leave the house. It is our best chance to avoid following the same trajectory of Italy.
This is depressing. Is there any chance social distancing and staying at home will even help at this point?
Yes. See the below graphic showing how social distancing / staying at home changed the trajectory of cases in the province of Lodi, Italy as compared to Bergamo, Italy. Every day we wait will only make things worse. Social distancing and staying at home will be delayed gratification. Do not expect to see your communities’ numbers change tomorrow or the next day, but trust that in 2-3 weeks your actions will have paid off.
And finally, I know we're all understandably concerned about the economy and the negative consequences of staying home / social distancing on worsening the economic situation in our country. We discussed “paying the bill” yesterday but this tweet from New York Times Columnist Thomas Friedman probably does a better job than I did explaining why acting now is still in our economic best interest:
Act Now. Stay home.
Personal Update:
-Back to 100%
-No further fever or cough.
-Will find out this week if I had COVID as testing becomes more available. Even if negative planning to stay home as much as possible as all of us should.
-Thanks much for all the well wishes
Next post likely to come on Wednesday. Until then, be safe and reach out with additional questions,
Harry