So, I’m not a virologist or epidemiologist. I’m not in government briefings and I don’t have any fancy title in association with this outbreak. But, I have collected a few letters behind my name. I work ‘in the trenches’ and often take a big-picture, common sense view of things.
- If you have symptoms of a cough or cold that are mild, stay at home. DO NOT go rushing into your ER or doctor’s office. There is literally nothing they will do for you besides what you see on the news and here. By using these resources when you don’t TRULY need them, you overwhelm the system and spread whatever you have to others.
- Reasons to go to the ER include: shortness of breath, high fever that doesn’t break, inability to stay hydrated (less urine than normal), or pain somewhere. The “CORONAvirus” treatment is a misnomer—you will be treated the same way that you would have been treated six months ago. You will be evaluated, given IV fluids if needed, oxygen if your sats are low, and admitted for further treatment if you meet specific criteria. This is all called SUPPORTIVE care, and it’s how we take care of people.
- We keep hearing about ‘nursing home’ patients being more effected than other populations. If you take care of patients who reside in nursing homes, you understand the reality that anything spreading through a nursing home can have devastating effects. There are restrictions on care in some cases, such as DNR (do not resuscitate) or do not intubate instructions. We have to make decisions with patients and their families what may be appropriate. If you loved one has severe dementia and can’t understand the discomfort of being intubated or having their hands tied to the bed, is it worth it to put them thru this? Intensive care–while miraculous in some instances–is not gentle care. It is mentally and physically grueling, and has long-term consequences. We must be thoughtful in how to administer this care.
- Drugs won’t ‘save’ you. Antibiotics only provide assistance to your immune system in the event your body is overwhelmed by a bacterial infection. They absolutely can be life-saving, but also have downsides and don’t work against a virus. We have an antiviral that is commonly prescribed for influenza, but it may be better for your body to fight on its own if you have mild and tolerable symptoms (like I did).
- As the news sensationalizes this situation, you may have started to hear about ICU shortages. This is nothing new. An ICU bed is a finite resource and doctors, such as me, have been making critical decisions on the best way to allocate those beds for a long time. Providing ICU care to someone is one of the heaviest burdens: it requires special units, special beds, specialized nurses and respiratory therapists. A surge in the number of patients will always stress the system, because these are extremely expensive resources, and fiscal responsibility requires these to be allocated tightly.
- Most ICU docs, such as myself, train in academic centers providing highly advanced care during our fellowship. We learn the most advanced and highest level support of care. However, when we leave these big training centers and find jobs in community hospitals, not all hospitals offer the broad reach of care. This is highly appropriate in some circumstances, such as ECMO (extra-corporeal membrane oxygenation). During times such as now, when there could be a surge in beds, we need to maximize what we can offer in community hospitals, such as mine. One of those approaches is taking a ventilated patient and rolling them onto the stomach, calling “proning”. Some hospitals “don’t offer it” (from social media ICU group I’m in) and doctors are having ethical arguments about training up and adding this to their protocol. I would strongly argue this is very appropriate to expand the capacity of our system and offload burden of the big university centers.
- There’s a reason you should prioritize your health and stay as healthy as possible: at times like this you can only rely upon yourself. If you are exposed—which is very likely—the best way to avoid serious issues is having a strong immune system to protect you. Government quaratantines, social isolation and travel restrictions may help, but are more to protect mass spread and vulnerable patients systemically.
- The stress of this situation may be more harmful to you than the virus itself. There’s a lot of fear-mongering, criticizing of government leaders, and undue hubbub right now. One way to view this is a crash-course in public health and all the things you should be doing all the time. Washing hands, staying updated on vaccines, isolating yourself when sick, and a healthy lifestyle being reiterated over and over are everyday practices that people should already implement.
- Find the silver lining. Circumstances like these are evidence that unpredictable things can happen that you would never imagine. There are always upsides; maybe you missed the major league season opener but get to spend more time with the college-aged kid who is now home for the semester. Enjoy those unexpected blessings.
- DO NOT go in for testing if you are asymptomatic! That is a waste of resources right now. The biggest issue hampering control of the virus is lack of testing, and there is a testing protocol that requires influenza rule out before you are going to have COVID testing anyway.
- Those who have underlying medical issues may feel a bit written off right now. Just remember, there is no condition that you cannot dramatically improve or reverse. There are documentations of miraculous and spontaneous remission of every known condition. Here is a link to one of my favorite articles. https://www.forksoverknives.com/plant-based-diet-got-me-off-the-lung-transplant-list-and-helped-me-regain-my-eyesight/#gs.101twj8
In the meantime, go outside and enjoy some fresh air. Keep taking your vitamins, especially vitamin A, C, D and zinc. Drink a smoothie loaded with fruits and greens. Wash your hands. And maybe get ready to invest in the stock market to ride the wave up during the recovery!