This was shared today by my smart NP friend.
By way of a physician friend in the USA who shared and I also wanted to share.
By Dr Erica Kaye...
I am hearing frequent expressions of disbelief about the seriousness of COVID19 (novel coronavirus). On social media and in real life, it seems like lots of people think that the pandemic is a “hoax” or a “political game” or “media-driven fear mongering.”
I am a physician and not an epidemiologist, and these are my own opinions informed by close review of rapidly evolving primary data sources.
I am a pragmatist. I believe data. In general, panic is rarely necessary or productive. Preparedness, on the other hand, is essential. We don’t yet know what the impact of COVID19 will be on our population. As we gather more information over the coming weeks, it’s possible that we will discover that the situation in the U.S. is well controlled. We may find that our healthcare system is more than adequate to handle acute increases in patient volumes.
I understand why people are frustrated with media reports of the pandemic. Stockpiling supplies will probably not be helpful. Misinformed anxiety can be harmful to individuals and communities. But as we collect more information over the next few weeks, it is equally unsafe for people to casually discount the gravity of this situation. At this moment, we have increasing reports from other countries suggesting that COVID19 is causing harm beyond the average flu season; we don’t have data yet to reassure us that these trends will be different in the U.S. Clear-headed assessment of the available primary data consolidated by the WHO, in conjunction with first-hand stories from our colleagues on the ground, should be sufficient to incentivize our communities to be proactive instead of reactive.
I participate in multiple private online forums of physicians who are working to share real-time information about prevention and treatment of COVID19. Over the last 48 hours, we are seeing extremely worrisome first-hand reports from physician colleagues in Italy. They do not have sufficient ventilators for all of the patients who require mechanical respiratory support. They are facing excruciating decisions about which lives to attempt to save. Many critically ill patients are older than 60; however, there also are previously healthy 30 and 40 year olds on ventilators and dying. They are unable to staff hospitals due to substantial numbers of infected healthcare personnel.
The first cases of COVID19 were reported in Italy at the beginning of February, and the sentinel cases that are believed to have triggered widespread contagion occurred around February 21. This means that regions of the country went from a handful of cases to a volume that exceeded the capacity of their healthcare infrastructure in approximately 2.5 to 5 weeks. We need to be mindful of this information, and we need to do our best to learn from the experiences of our colleagues in other countries.
I’ve also seen many people commenting that the pandemic is a political weapon. I think it is important to acknowledge that politics are involved, particularly in the context of delayed testing and censorship of information for public consumption. Last week, a mandate was passed requiring that formal messaging from epidemiology and infectious disease experts at the CDC go through the White House before being released to the public. Leadership is calling the virus a “hoax,” and misinformation is circulating. In this time of public anxiety, it is essential that we strive to elevate and center the voices of scientists, researchers, epidemiologists, and healthcare providers, all of whom are advocating for our country to consider proactive approaches to mitigate the potential impact of the virus.
Unfortunately, at the moment, it is very difficult to assess the situation in the U.S. Genomic sequencing of viral strains in Washington state suggest that COVID19 is already endemic (i.e., spreading within communities). Yet we have very few official cases of novel coronavirus documented in the U.S. – simply because we are not conducting widespread or systematic testing for it.
Weeks ago, the U.S. declined to use the COVID19 testing kits that the WHO offered. These are the same kits that have been used successfully to test hundreds of thousands of people across Europe and Asia. Instead, the U.S. opted create its own kits and then disseminated kits with faulty controls. We have still not recovered from these oversights. It remains extremely difficult for healthcare providers to obtain COVID19 tests for patients in most regions of the U.S. One week ago, the CDC removed data on “total numbers tested” from its website, so we can no longer track how far behind U.S. testing is, compared to other countries. As recently as today, I continue to hear reports that local health departments do not have capacity to provide tests for patients with classic symptoms and high-risk travel histories. Despite promises that COVID19 testing would become readily accessible by yesterday, physicians across all of my networks continue to report inability to access tests.
Why does this matter? Because identification of cases of COVID19 is a strategy for slowing the spread. It is also important to better understand the denominator in the U.S., so that we can make better predictions regarding morbidity and mortality rates for our population. Currently, we are relying on rapidly accumulating data from multiple countries 4-8 weeks ahead of the U.S., which suggest that the morbidity and mortality of COVID19 exceeds that of the worst flu season. Data on COVID19 properties (e.g., incubation rate, unchecked R0, etc) suggest that it is on track to infect 40-70% of world’s population by December, and we don’t yet know how many will die as a result. Current estimates suggest that 1 out of every 50 people infected may die (although these numbers may change as denominators increase). In comparison, the seasonal flu infects a significantly lower percentage of the world’s population, and flu generally kills 1 out of every 2000 people it infects. These numbers will likely continue to evolve; at the moment, however, expert epidemiologists are projecting a “best case scenario” of ~5x worse than flu and a “worst case scenario” of 50x worse.
At this time, infectious disease experts believe that the U.S. has missed the opportunity for containment by multiple weeks. To be fair, it may have never been possible to contain, even with excellent surveillance strategies. But there is still an opportunity to “flatten the curve.” This means that, even if we cannot decrease the number of people who get infected, we can try to slow down the rate of spread of infection. This matters profoundly, because if large numbers of sick patients show up at our local healthcare systems at the same time, it will significantly strain the system in a way that can be difficult for healthcare providers to handle. And this can have a direct impact on patient outcomes: data from China suggest a 0.5% mortality in the setting of strict quarantine and adequate resources, and a 3-5% mortality in the context of depleted resources.
It also is not just about having enough ventilators to support patients with COVID19. It is about having enough resources and staff to take care of patients with heart attacks, strokes, acute appendicitis, and other urgent medical needs. If our local hospital systems become overwhelmed, then we are likely to see patients die from treatable pathophysiology, simply because the volume of patients exceeds the hospital’s capacity.
Conversely – if we decrease the rate of infection across the community, then we have an opportunity to lessen the burden on limited hospital resources and staff. The way to do this is through social distancing. This means that, as much as possible, everyone tries his or her best to avoid large public gatherings where a single infected individual could easily spread the virus to dozens of other people.
Social distancing requires an attitude of altruism. Sure, you might think: “approximately 80% of people who get this virus basically have a mild cold. Everyone is being ridiculous, and I’m not going to disrupt my life over this.” But we have increasing crowd-shared data from other countries that up to 20% of people who present for testing may require hospitalization, 5-10% may require ICU level support, and 2-4% of people may die. Some of these critically ill patients are young and previously healthy. Extrapolating from these data, my own risk of dying as a relatively healthy woman in my late 30s appears to be approximately 1/300 or 1/400, depending on the source (although possibly higher in the setting of direct patient care exposures). I don’t know about you, but I think these odds justify proactive efforts. Even if you are not elderly, you should take it seriously. And even if you mistrust the COVID19 mortality rate – if the volume of patients seeking medical care exceeds the capacity of healthcare system, then you and your family are at risk. If you have a loved one who might need medical attention for any reason in the next 8-12 weeks, you should care deeply about flattening the curve. Skip the big party. Avoid the shopping mall. Reschedule doctor visits unless you are ill and need medical attention. Limit travel unless it is essential.
I wrote this summary in an effort to help synthesize available data. My goal is not to scare people – statistically, most people who read this will be perfectly fine. I hope that we will see a slowing of cases in the coming weeks as the weather warms. Maybe the patterns that we are seeing in Europe and more recently out of Washington state will be outliers. But I also think that our country's response thus far has been largely reactive, as opposed to proactive. Everyone is awaiting centralized instructions with regulations for social distancing – and I anticipate that government-mandated closures of large gatherings will be forthcoming in the next few weeks. But I worry that these directives may arrive several weeks too late to meaningfully flatten the curve and lessen the impact on the healthcare system.
As people gather information over the next few weeks to ascertain how this pandemic unfolds in our communities, I think it is important for each of us to be proactive in as many ways as possible. I believe that we need to start prioritizing social distancing sooner rather than later. Whenever safe and possible, please consider avoiding large celebrations. Please consider postponing social, in-person gatherings or converting to online forums in the coming days and weeks.
Please help your first responders and healthcare workers, who will likely be on the front lines soon. Encourage your friends and family to practice social distancing and to strictly follow quarantines if/when enacted. Please help your community flatten the curve.