Tag Archives: COVID-19

COVID-19 Isn’t A Snowstorm

Posted by Britt in Uncategorized and tagged with , , , ,

It’s been two weeks since I wrote about COVID-19, and in that time the virus has extended from a handful of countries to over one hundred, from two cases in two states to over 400 cases in 35. And though those numbers still sound low, I urge you to calculate how many degrees of separation you are, RIGHT NOW, from someone who is quarantined (or should be). Here in Boston, most of us are at one or two.

Still, there’s a whole lotta this being shared:

The FLU kills thousands and so does heart disease and the whole country isn’t losing weight and buying Pelotons and most people will be fine or don’t even know they have it so why is THE MEDIA making everyone freak out and buy toilet paper to last until Christmas?

These arguments from exasperated acquaintances on social media are troubling me. The state of Costco shelves and price gouging of Purell tells us that a LOT of people are heeding warnings and preparing to hunker down. A candid picture from Teddy’s glee club performance (which should have been canceled, but we’ll get to that) caught a kid coughing into the crook of his arm. So maybe a little bit of hysteria is a good thing? I mean, for the first time in history, men are washing their hands after peeing? But there are plenty of articles, cable news talking heads, a sizable fraction of your Facebook friends (and occasionally our own political leaders) who insist this “hype” is overblown nonsense.

They’re wrong.

First, all of us should unearth our binders from favorite college professors and revisit the definition of false equivalence. Arguments comparing COVID-19 with other diseases—diseases that have vaccines and medicines and data and more history on the planet than a handful of months—are not valid. If we shouldn’t be overly concerned with COVID-19 because the flu also kills lots of people, does it follow that we can quit reminding women to get mammograms all of October because heart disease is actually more common? That’s how false equivalence arguments fail. Further, calling fear of a probable pandemic “hypocritical” when a person’s daily life does not already include safeguards against more common ailments is just unhelpful when it isn’t unkind. Finally, insisting this virus with a “low” mortality rate is not worthy of travel bans, event cancelations, and school closures entirely ignores a really enormous and valuable and loved set of people at real risk of dying.

The CDC put together this comparison to staunch flu-is-like-COVID-19 arguments… and why I’m worried about veteran teachers, grandparents, and most people in our church pews.

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Since I wrote the last essay, my phone has been binging regularly with requests for advice. Bernie saw patients well beyond his office hours on Friday because everyone wanted his medical opinion on their travel plans and to discuss their relative risk. Should my parents come to the kids’ piano recitals? Should we go to Europe for Spring Break? Can I take the boys to the YMCA pool? Are you going to the PTA meeting? Can we go to the basketball game? Can we fly to Colorado to go skiing? The answer to all of these is no.

No no no no no.

COVID-19 isn’t a snowstorm. A rapidly spreading virus cannot be approached with the same sliced bread and bottled water hoarding preparation. We should not be trying to fit all of the activities in before it “really hits.” It’s here, people. Our churches, classrooms, stadiums, yoga studios, airplanes, and grocery stores are black ice. We’re already at risk because we failed to heed the warnings from Wuhan to be vigilant. I find this quote from Mike Leavitt, former Health and Human Services Secretary particularly poignant:

“Everything we do before a pandemic will seem alarmist. Everything we do after will seem inadequate.”

The only way to protect yourself and your family is with good hygiene, by limiting your errands to those where you can stay 6 feet away from people, or by just staying home. Is this impractical? Yes, for a lot of people. Yes, but it is also all we have. And kind of guessing that everything will be ok and this will just die out as the weather gets warmer isn’t really how viruses work. Behavior modification is the only way to prevent widespread dissemination of a disease that could kill a significant number of our cancer patients, grandparents, disabled friends, and asthmatics. If you can afford to miss things—especially if you are over 60 and/or have other health issues—please do that. Stay home. Your pets will love you even more, and you’ll stay healthy.

It should be telling that medical professionals are canceling meetings daily. Residency interviews are being held via Skype. Morbidity and mortality conferences are on hold. Faculty dinners are being rescheduled. As a division chief, every day Bernie has another cancellation to consider, and continually chooses to limit exposure. He passed on the Celtics game last night because he has cancer patients who are relying on him. We’re canceling our trip to London because those same patients will need to reschedule their operations (and caregiver and child care plans) should he get quarantined. It seems reasonable for an otherwise healthy person to risk COVID-19 exposure because for 80% of patients the course will be mild. But what if your exposure risk leaves you quarantined for two weeks? How many other people and their livelihood will be affected by your forced absence? And should you become infected, how many of your close contacts are people in the very high risk category? In that light, is the glee club choir assembly really worth it?

We should all be weighing what is “worth” the risk right now very heavily, especially if you have the luxury of opting out of things that, let’s face it, really aren’t all that critical. In lieu of any “herd immunity” to protect us (since none of us is immune), the best we can do for those of us who cannot afford to miss work or take public transportation right now is to reduce their exposure. Drive to Vermont to ski instead of flying to the Rockies. Videotape the piano recital. Watch the Celtics on TV. Not forever… just for now. We cannot discount the potential spread of COVID-19 as we would an exuberant StormWatch meteorologist tracking a Nor’Easter that could easily be just a dusting. COVID-19 is here, it’s spreading, and it only looks like a few scattered flurries now because we have yet to do any sort of adequate testing or data acquisition.

But there’s black ice out there, people. The WHO has listed its first objective to “interrupt human to human transmission…” so let’s help them do that when we can.

 

 

Go, and Do Likewise– COVID-19 and Kindness

Posted by Britt in Uncategorized and tagged with , , , , , , ,

Casual conversation, Facebook and Twitter threads, and the occasional bad joke indicate that Americans are already experiencing fatigue from media panic around the coronavirus epidemic. Citing statistics to suggest influenza is “worse” and admonishing the press for fear-mongering when only a few thousand people have died are, well, really bad takes on this. When an old friend innocently queried his Facebook buddies if we (Americans, I guess?) should be freaking out, most in the thread agreed that this is mostly media hype.

Um… no.

Let’s start with xenophobia, and then we can get into the immunology and medical stuff.

Three weeks ago, the Globe ran a story about anti-Chinese racism experienced by students since the epidemic began. I asked my boys if they were hearing any bad jokes (or let’s be honest, checking to see if Teddy was making any) when my husband piped up that it had happened to him already.

It was a crowded elevator in the hospital. Bernie was wearing his ID (and probably a freakin’ bow tie) and entered the lift with his team. “Are you… um… feeling OK?” she asked. Taken aback, he said he answered noncommittally, but everyone knew what she meant. He wasn’t flushed, feverish, or rolling luggage plastered with Wuhan stickers. The only way he looked… was Asian.

We spent a large part of the night giggling with the kids and crafting humorous, nasty, goofy, and smug responses to bank for future elevator-type inquiries. But I argued that if people are terrified enough to be casually racist toward a DOCTOR in a HOSPITAL, maybe the best response is kindness. Or, you know, just saying, “I’m not Chinese.”

Three weeks later, in spite of an alarming spread to 24 infected countries, there is an air of conspiracy about COVID-19 on this side of the Atlantic. It’s a Chinese bioweapon. It wouldn’t exist if Asians didn’t eat weird food. A quarter million people have died and China is covering it up. These theories all share the same theme: coronavirus is something that is happening to other people. And those people are a half a planet away and maybe eat bats and probably their government is lying and plus there’s, like, a billion of them. A since deleted Facebook comment said the virus was just culling “low hanging fruit.” This was meant to be funny.

Do we typically crack jokes and make silly memes when people are dying? Maybe this is who we have become. But after 20 years married into an Asian family with kids that don’t look white, as the TikTok teens would say, “this one be hittin’ different.” I jumped into my friend’s Facebook feed to share what the experts are telling us about COVID-19, but I didn’t write what I was really feeling. I didn’t admit that your, “it’s just a virus, calm down” sounds brutally insensitive to me. If COVID-19 is just virus that (so far) is killing mostly Asians… who cares? (I’m guessing its spread to Iran will garner a similar lack of sympathy.)

We may never learn the origin of this virus, or how it jumped from animals to humans, but let me tell you really loudly: IT DOESN’T MATTER. What does matter is that coronavirus is very contagious and coronavirus kills people. What does matter is that it is spreading at an alarming rate and there is no vaccine, no known drug treatment, and (over here) few kits to test for it. Most people (80%) will have a mild course of the disease and data show that until we have a system for identifying and isolating them, they won’t present for treatment for two weeks—two weeks while their viral load doubles daily and they are feeling well enough to ride subways, go to school, eat at restaurants, and infect at least 10% of their close contacts.

The scariness is not in the lethality of the virus, but its scale. Around 13% of infected individuals will endure a more severe course and 6% will be critical enough to require mechanical ventilation. If we cannot keep the sheer number of infected patients low enough, there simply won’t be enough hospital beds and ventilators to go around.

During a two hour debrief and Q&A on the WHO site, the leader of the fact-finding trip paints a picture of Chinese hospitals KICKING ASS at containing what will certainly be called a pandemic. They built a 1000 bed hospital in mere days. They shut down the entire city and created a culture of awareness that has reduced the time a contagious patient is at large in the community from 15 days to 3. Outlying cities mobilized entire medical teams and all of their equipment to go into Wuhan to treat patients and staunch the mortality rate. Bruce Aylward, the WHO expert who just returned from China, confessed that if he contracted the disease, he would want to be treated there.

China learned from the SARS epidemic ten years ago and had some preparations and plans in place. We are woefully unprepared. As I write this, COVID-19 has reached California, and this patient has no known ties to China or close contacts of infected individuals. It’s here now, and it is only a matter of time before we need to implement the transmission lessening tactics that we have not even begun to teach.

Here’s what we do know and what you can do. First, most patients suffering from COVID-19 will report a history of fatigue, malaise, and body aches; 88% will have a fever, 66% will have a dry cough, but only 4% report a runny nose. This is not an upper respiratory disease. Test kits so far have been hard to get and unstable. In China, CT scans are being used to identify a pathognomonic pattern of the pneumonia that can progress in a significant number of patients—a wildly expensive prospect if we need to scan thousands here.

Based on studies of other coronavirus strains, scientists report that it could live on surfaces up to 9 days. Forget masks for now, and Chlorox wipe your counters. Coughing etiquette (into the crook of your arm), frequent hand washing, and strict vigilance about exposing others if you have a fever (and prompt reporting) are simple things we can do now. Chinese citizens have been incredible about self-quarantining, and in public they maintain the 2 meter rule of how close you are allowed to get to others.

Some epidemiologists are estimating ultimately 40 to 70% of the population of the planet could be infected. I repeat, there is no vaccine and no treatment, therefore, no way to stop the spread of the disease aside from behavior modification. However, statistics show that 80% of those infected will be OK. Many won’t ever know they ever contracted COVID-19. For yet unknown reasons, children seem to be less affected than older patients, but co-morbidities like underlying diseases, smoking and vaping, and immunosuppression more often lead to respiratory and even multi-organ failure. If there was ever a time to convince teens to put down their vape pens, it’s now.

Should we be panicking? No. The vast majority of us will not die from this infection even if most of us ultimately contract it. But the “othering” of the disease and the refusal to recognize what it is and how it will affect all of us is unhelpful and insensitive. Replace your beer bottle memes with useful facts, recognize that “only” a small percentage of deaths are of real people with valuable lives and families that are devastated, and pray for the health care workers everywhere who will take care of us in spite of the risk to themselves.

And wash your hands.

Prayer for Healing