Optimism?
Despite social distancing, the threat seems to remain high. What is notable, however, if you look at the Hopkins Map of Covid-19 cases, is that major metropolitan areas such as NYC and Seattle are really suffering, whereas other areas don’t seem to be. South Carolina for instance, where I live, still only has 60 cases as of this morning, and only 1 in Spartanburg County. It appears, at least for the moment, that those of us who live in more suburban or rural environments may be spared an extremely rapid spread of this disease.
That’s not to say, however, that a few unfortunate events, such as the spread of the virus within a nursing home or similar facility wouldn’t place undue strain on a particular local health system. Overall, I am cautiously optimistic that the spread of this virus within the majority of the country will be attenuated by social distancing and by our relatively low population density and personal interactions as compared perhaps to Wuhan or Milan.
Healthcare Readiness
Much has been said over the past week about "flattening the curve" so that health care resources can meet demands. Based on discussions with colleagues, it seems as though many health systems are in an aggressive preparation stage. I believe that within the next 2-8 weeks, most health systems will likely be far better prepared than they were 1-2 weeks ago, and that in areas with less dense populations, it seems quite possible that there will be adequate resources to take care of sick patients. Many epidemiologic models predict that the nation’s # of ICU beds and # of ventilators will fall far short of critically ill patients in the coming months, but my analysis is a bit more nuanced. I may turn out to be wrong, and I am certainly not an expert in this area, but I think that rather than an even distribution of scarcity of resources, what will more likely happen is a regional resource mismatch.
What I mean is that, as mentioned above, areas like NYC may struggle to care for a huge spike in critically ill patients, whereas a more suburban or rural area may have excess ICU beds and ventilators. Perhaps these resources will be redistributed over time, or patients will be moved around by the voluntary cooperation of health systems, but my feeling is that small communities will have smaller outbreaks, which occur slower, and may be adequately cared for.
Prevention and Treatment
There is no specific medication or vaccine yet developed for prevention. The actions I am taking at this time are to avoid close contact, perform maniacal hand hygiene, avoid self-inoculation (by touching the mucous membranes of the eyes, nose, and mouth), and to obtain adequate sleep, nutrition, exercise, and stress management (see previous post below for specific suggestions).
Medications have been discussed in the news and by the president today — most notably, Chloroquine and Hydroxychloroquine. Based on the data I’ve reviewed (which can be found here), I have no reason to believe that either of these medications (or other experimental treatments that are being used in other countries) is going to make a huge difference in this disease. These data are low quality and premature, but I wouldn’t be relying on these drugs as a cure by any means. The best plan at this point remains avoiding the disease. Given a limited supply of the drug, its side effects, and that it is an unproven therapy for Covid-19, doctors, especially at first, will be unlikely to prescribe this for prophylaxis or for treatment of mild cases in "low-risk" individuals.
Silver Linings
Despite the overwhelming feeling that the world is coming to an end, there are a number of silver-linings here.
- The virus and the disease it causes are being aggressively studied and are becoming better understood. Even if we are months or years away from better treatments or a vaccine, supportive care will improve, and I believe morbidity and mortality along with it.
- Doctors and nurses have a lot of skin in the game. This virus is a threat to us all, even relatively young healthy people. Doctors and nurses always want their patients to do well, but this is even more the case on an emotional level when the disease that threatens the patient is also a threat to the doctor or nurse.
- Because this disease is a pandemic, and there is a national emergency, people are getting out of the way. The normal rules and regulations that hamper health systems, scientists, pharmacology companies, doctors, and nurses are being withdrawn so that brilliant people can fix this problem. Medical licensing regulations are being relaxed, the FDA is fast-tracking medications and vaccine trials, and CMS is making exceptions for telehealth to operate the way that it should. It’s more likely than not that geniuses will bail us all out of this mess if we let them, and we should thank them for it endlessly.
- I’ve spoken to many friends and family who report that this time period, though scary, is one of the most relaxed, still periods they’ve had in their lives.
- The next phase of this situation is likely coming as the availability of testing increases. My hope is that, once we have the ability to test people at will, including antibody testing to identify those who may have immunity to the disease, we’ll be able to identify those who need to self-quarantine and those who can resume their daily lives. This should happen quickly, and as it does, we can get back to doing what we all do best.
As always, please feel free to contact me with questions, comments, corrections, or disagreements.