This is your source for
-evidence based data on corona virus
-articles curated by me on a variety of topics affected by the pandemic, some of which is data based, and some of which is opinion, all of it in my opinion, offering something valuable.
-my frontline experience of working as a hospitalist in southern California, admitting our sickest patients
-my habits/ advice on same
Having written a novel about pandemic almost 15 years ago (Virion), I confess even my imagination and research then was not up to the reality of the current situation. The rapidity with which this virus has arrived, and the bungling of the U.S. response have, in particular, been astonishing to me, the world having become even smaller and more accessible than 2005, and the leaders more incompetent. Having said that, we are called to create the best response we can muster individually, socially and professionally, as family, friends and loved ones doing their best in an unprecedented global crisis of health, social circumstances and finance. We will persist–this is not the end of the world, but it is a time of great upheaval, and of untimely death for far too many of our most vulnerable, and unfortunately even some of our healthy.
I’ve been curating articles and writing emails to friends and family, and decided the best option for anyone interested is to place all the info on my blog. Of course you may pose questions here through blog email (email@example.com), or on my personal email for those of you that have it.
Severity of infection:
Disease is non-severe for about 80% of those who get it. The more frail one is (by age or other chronic, uncontrolled conditions or immune compromise) the higher the risk of severe disease and death. Children are readily able to acquire the virus and may have very mild cases, but are still profuse shedders of live virus and potential spreaders of disease. Children under the age of five seem to have higher risk of apparent disease than kids older than 5. Do not take them to grandma’s house!
Data regarding communicability of the virus and surface survival are limited but here’s what we have so far:
–Respiratory droplets (larger particles) from cough, sneeze, and nose, are the most laden with virus. Respiratory aerosols–smaller particles that can last in air around sick person up to 3 hours–are also infectious, though smaller size. Mask (N-95) when worn and disposed of properly, prevents infection close to 100%. Surgical masks keep out large particles and some smaller. BUT if you don’t know how to wear a mask or take it off you can actually contaminate yourself with the mask.
–Fomites–viral particles contaminating surfaces–seem to live up to 3 days on steel and plastic, however the number of viral particles decreases dramatically over that time so may not be enough to be infectious. Other surfaces have even shorter contamination times.
–Tests are still not broadly available enough to have an accurate estimate of how much disease is really here. Many locations have had to send patients home without testing if they had no known exposure and were not sick enough to be admitted to the hospital. Until we get testing ramped up enough to test large numbers of people in their cars, stay away from the ER unless you are sick enough to be admitted. Your county health department/ and /or hospital should have a hotline advising you of testing capability. Expect this to change frequently (for the better).
–COVID tests are not very reliable. In medical-ese they have unknown/ or low sensitivity. Actually we can’t even find sensitivity of U.S. tests anywhere yet as most of these tests are so new, there are no studies to verify how accurately a negative or a positive test reflects true disease. We do know that Chinese and Korean tests were/ are only 30-60% accurate, meaning 40-70 people out of 100 with known COVID disease will test negative the first time. If we do 2 tests 2 days apart the sensitivity improves to 70%–this is why people who do have the disease are being forced to remain in quarantine until 2 negative tests, 2 days apart.
The virus is here and spreading. The best we can do now is mitigate the effects by stretching out the time line–you’ve also heard it called flattening the curve–to keep the health care system from imploding from too many sick people at one time. Also hoping for effective treatment (there is none yet except supportive care–oxygen, ventilator if needed) and vaccine before everyone has contracted disease.
I”m going back to work Saturday, the 21st, having had a week off after admitting my first corona virus suspect patient last week. Like you, I have some fear of contracting the disease. Even when I think I’m fine, I’m not sleeping well at times, I suspect from sublimated anxiety. I’m over 60 with underlying mild asthma, but otherwise pretty good shape. But to put things in perspective, at this point, with modest patient census, sinks in every room, antibacterial gel hanging from the wall every 20 feet, and adequate PPE (personal protective gear), I’m more concerned about exposure at the grocery store than at the hospital. Frankly, I strip naked when I get home from the hospital, drop clothing directly into the washer, and shower immediately. Shoes that can be washed is all I’m wearing right now. News flash: I’m flashing at the condo! Cover your eyes, remember I’m over 60!
Whenever I get anxious about my own exposure, I think about all those people who support our infrastructure, who are still working to provide us with canned veggies, and apples off the tree, who deliver the mail, maintain our water supply, and fill the gas stations. They are in far higher potential exposure situations than I. Please keep them in your thoughts. I love the Calm app on my phone, and am using the breathing techniques regularly. They do have free options.
Link with graphs re: case for social distancing:
Atlantic: Now Is the Time to Overreact:
Interesting report from Morgan Stanley number crunchers–with “bear, base, and bull” pandemic scenarios for those of you into financial lingo. I have not figured out how to link it yet–it’s a PDF that I couldn’t find anywhere except in the email sent to me. If you want it, email me, and I’ll email it to you directly–or if you find a URL/ link, please send to me so I can upload.
Any produce that can be washed with soap and water is fine. I’m leaving non-perishable items in the garage until I need them. If they sit there longer than a week, I don’t wash them. 3 days or less, I wash everything before it comes into the house. In between 3-7 days, use your own judgment.
Personally, after public errands, I’m changing clothes and showering before I sit on any of my furniture. Not sure I need to do that, but as a physician I’ve been trained for years to see germs everywhere. I don’t worry about running out of toilet paper, just laundry detergent!
Finally, we are all beginning to notice the effects of social isolation. Be good to yourself and those around you. Practice kindness, patience. Find something soothing at least once daily. We can still be in touch with one another through our devices in ways we never could before. At least we have that, and it’s no small thing. Here is your link to the lovely world still going on outside–maybe even better without us gassing up the air… Birds and Bees: https://youtu.be/xHkq1edcbk4
Stay in. Stay well.