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COVID19 Real Talk

Abstract: This post has nothing to do with testing, so that makes it a first on this blog, but it is time for some Covid19 real talk. However my brother, Dustin Roberts, medical doctor and former US Navy Lieutenant Commander, and I believe this is important information to share. Dustin has prepared an article with his answers to some frequently asked questions that have been swirling around the COVID-19 / Corona Virus pandemic. There’s some truth, some common sense, and some soap-boxing, all three of which seem to be needed right now. You’ll see some Christian viewpoints mixed in here, which is an important part of our family culture, and part of the unique perspective that we wanted to share. Regardless of your creed, we both highly value critical thinking skills, and believe this information will help you.

Introduction:

Regarding specific questions about how this will affect you if you have a specific pre-existing condition, or what is to come one or two months out from now in terms of the virus spreading…look – For some of this stuff, we just don’t have enough data yet to know.  This is still a VERY new disease and we’re learning at a breakneck pace, but the data just isn’t available to give specific risks at such a granular level. This link here, Worldometer – Corona Virus Death Toll breaks down some of the data we DO know. I hope the rest of this can be of help to people who are confused by the myriad information online.

Is this just another flu?  How concerned should we be?

Background: Coronaviruses have been around for millennia.  There are several which cause the common cold but don’t confer much long-lasting immunity which explains why it’s common to get a cold yearly.  However, there is a subset of these virusues that are more dangerous.  In 2002 and 2003 SARS-CoV1 caused the “SARS epidemic”, in 2012 MERS-CoV caused an outbreak (with about 30-40% of infected patients dying) but these were smaller, not quite as contagious (and other factors).  Now we have a new or “novel” coronavirus – 2019-nCoV (2019 novel Coronavirus or SARS-CoV2 which causes the Coronavirus Disease of 2019 or “COVID19” which is what I’ll call it because it’s easier than the more formal name.  https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2

Normally the overall, average death rate of influenza A is around 0.1-0.2% and just like any disease, the flu disproportionately affects the sick and elderly because they have less ability to fight off a system-wide infection.  Of course the higher numbers of elderly patients skew the average higher – the chance of death from influenza as a generally healthy 30 or 40 year old is very, very low.  We’re used to just staying home and drinking chicken soup.

Unfortunately, COVID19 is more serious.  It’s no ebola, but the overall mortality rate is probably around 3-4%.  Again, as with any viruses or other infectious diseases, the sick, elderly and immunocompromised are more likely to be disproportionately affected.  (https://www.worldometers.info/coronavirus/coronavirus-death-toll/).

The death statistics grab headlines because it’s sensational, but more worrisome is COVID’s ability to cause a pretty high rate of morBIDity (as opposed to morTALity).  This means that those lower risk patients can get sick enough to require serious medical care like hospitalization up to and including intensive care which can mean intubation (a breathing tube) and ventilation.  A very high percentage of these patients who need to be hospitalized end up developing Acute Respiratory Distress Syndrome (ARDS) which can be considered lung failure (https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome).  Serious lung infections including ARDS leave the patient with permanent lung damage – maybe requiring oxygen, but certainly just having trouble breathing well for a long time and maybe even enough to permanently alter behavior.  For example, a patient I had (years ago from another reason) who went into ARDS was a long-distance runner prior to getting sick and afterwards, even years later, he just didn’t feel the same and the residual slight difficulty breathing cause him to give up the running he used to enjoy.  All this to say, even if you don’t die, a single “flu” has a chance of causing life-long damage.  (this is the very reason, in addition to preventing death, that we vaccinate against various things – to prevent many different long-term complications)

Additionally, COVID19 is more contagious than influenza.  There is a metric called the “R-naught” value.  Generally, it describes how many people get infected after coming in contact with an infected person.  Influenza has an R-0 of about 1-1.3.  COVID19’s R-0 is about 2-2.5.  (Measles is 12!)

A quick note about how it’s spread – You contract this virus from droplets.  This means directly from a sneeze or cough from an infected (though maybe asymptomatic) person or indirectly from a surface with infected droplets (i.e. doorknob, pen, etc).  You do NOT get it via airborne means (if you’re more than about 6 feet from another person).  So…go for a walk, enjoy the outside away from people.  Picnic on your lawn.  Talk to your neighbors from a safe distance.

Takeaway: No, it’s not just flu.  It is more lethal, more morbid and more contagious.

How safe is takeout, pizza delivery, etc? Related: If I or my family haven’t been outside the house all day and haven’t had any contact with anyone, are we safe?

Yes because staying away from other people (the source of potential infection) is very, very important.  [PLEASE practice social distancing]  However, the note of caution is that this virus is a tough cookie.  It can survive on surfaces including skin, cardboard, steel, etc for hours to days!  The good news is that it can be easily cleaned off with normal household sanitizers – bleach, alcohol >70%.  The single most effective thing to kill it is hot soap and water.  https://www.livescience.com/how-long-coronavirus-last-surfaces.html

I highly recommend takeout/delivery, but once you receive it, open it, then wash your hands.  THEN transfer it from the delivery box onto your own clean plate with clean utensils. THEN wash your hands again before eating.

Disinfect all “high-touch” surfaces in your life – car door handles, steering wheels, light switches, computer components, phones.

You’ll feel like crazy person but it really makes a difference.

You need to continue washing your hands regardless of who you’ve been in contact with for 2 reasons: first – COVID19 has an incubation period of up to 14 days, meaning you could have been exposed up to two weeks ago (we think) and still develop symptoms.  So unless you’ve truly been completely isolated for that long, just keep washing.  Secondly, there are still wee beasties like Salmonella, E.coli and good ol’ influenza that can get you sick and hand washing works really well against these too.

Takeaway: Use takeaway. (see what I did there?).  Just disinfect the surfaces, then your hands afterwards.

If I HAVE to go out should I wear mask and gloves?

In an ideal world, perhaps.  We recommend this to cancer patients who need to avoid getting just the normal stuff in normal times.  However, right now those supplies are desperately needed at local hospitals to treat those who are very sick – it’s not really ethically justifiable to divert them to people who aren’t sick (and who can stay that way by just following simple social distancing guidelines).

What is the survival chance if I get it?

Pretty darn good.  The vast majority of patients have a mild cold and that’s it.  But the patients who do need hospitalization tend to get very sick and take up a lot of resources.  THIS is the single biggest reason we need everyone to help “flatten the curve”…so those of us who tend to critical patients don’t get overwhelmed all at once.

https://www.worldometers.info/coronavirus/coronavirus-symptoms/#mild

Are there any treatments?  Semi-related: Is there a treatment that’s being hidden from us?  or on the flip-side Is this a conspiracy?

Yes and No.  We treat patients with supportive care right now – oxygen, ventilators, etc.  There is NOT a vaccine yet, though trials have started (with incredible and unprecedented speed).  There are some very early and potentially promising medications – you may have heard the president talking about Hydroxychloroquine (an anti-malaria med) and yes in a small study it, in combination with a common antibiotic, shortened the how long the patient had detectable virus (13days untreated vs 6 days treated).  However, that’s about all we know right now.  Researchers, doctors, NIH, CDC and researchers around the world are working as fast as possible to find a good safe therapy.  But the important thing to remember is that we (doctors) are not going to “just try it”.  We need to see that it works well and doesn’t cause dangerous side effects.  It’s really not enough to hear it might have worked this one time from a friend who knows a guy who’s sister read it on Facebook, etc, etc.

If I may get on a soapbox for a sec: What does not kill it are essential oils, crystals or anything sold by a pyramid scheme.  And I don’t say this in jest.  There is a LOT of misinformation out there.  Social media is generally a cesspool of misinformation (I’m lookin at you Facebook) .  Please, I am begging you (friends, romans, countrymen) just quit sharing COVID-19 related “information”.  Resist the urge to share this or that – It does real damage.  There is no cure right now. None.   There is no conspiracy to unseat Trump.  The hospital around you probably looks quiet because all the elective cases, office visits and visiting hours have been cancelled and we’re all inside bracing the phalanx for the oncoming tidal wave or treating patients in the ICU.  So don’t film the outside inactivity as a sign of “no cases therefore it’s a conspiracy”.  Before you buy into one, please at least check out: https://www.snopes.com/collections/new-coronavirus-collection/ and see if MAYBE there’s another explanation. Let’s be careful what we say (James 1:26 NASB)

So, where can we get reliable information?

I’ve tried to share what appear to be reliable sources.

Unfortunately our administration and the president, so far, haven’t been the best sources.   At a national media level, Dr. Anthony S. Fauci, NIAID Director, is giving good information (if you still want to watch TV).  Info about this changes nearly daily as we learn more and gather more data so we have to take people with a grain of salt, but some sources are more reliable than others.  I refrain from watching the media coverage anymore because they seem hell bent on using sensationalizing words to stir up fear over the least little bit of data.  It’s maddening.

How long will it last?

I have no idea.  If I were a betting man, I’d say this wave might last until May or June.  It will probably come back around as restrictions are eased.  Hopefully as time progresses we’ll know better how to battle it and hopefully have a vaccine. This site from IHME gives some sobering dates: http://covid19.healthdata.org/projections

So, the last word?

It’s serious enough for the older and more vulnerable people among us that we should take more precautions than normal.  Let’s show Christ’s love by caring for the least, the last and the lost. (Matt 25 NASB) and let’s use our heads – God gave us brains for a reason and good public health people for a reason.  Don’t panic or let ourselves get lost in an online echo chamber – all too easy when you’re bored at home.

Stay apart.  Wash your hands. Don’t touch your face.  Cover your cough and sneeze.  Look out for your neighbors. 

“Which of these three do you think was a neighbor to the man who fell into the hands of robbers?” The expert in the law replied, “The one who had mercy on him.”

                                                                            Jesus told him, Go and do likewise.” – Luke 10:36,37

I’m always happy to answer questions, so post a comment below, and I’ll work with Connor to upload a response for you.

Dustin Roberts, MD