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From a Physician on the Frontlines

March 16, 2020
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I am a family physician who spent 12+ hours in the past two days reading reports of COVID-19 from other doctors all over the world. I know for years and years the media has tended to sensationalize every little thing, which is making it very hard to hear the voices that are sounding a REAL alarm. We doctors don’t tend to be alarmist. I don’t tend to be alarmist. But, alas, this is alarm-worthy.

 

We in America are used to doing whatever we want, whenever we want (“Live Free Or Die” was our motto in 1776), so it is hard to understand why “social distancing” is necessary when what I want to do is to socialize.

 

So this post has two parts: One, the reason for social isolation. And two, what to do if you get respiratory symptoms and wonder if it’s COVID-19.

 

ONE: We are isolating ourselves because of math, essentially. That is, if you do the math, you realize there aren’t enough resources to take care of the anticipated medical need. So the only way to slow down the process is to keep people separated from each other so they stop passing it on. Why is it spreading so rapidly? Because it is new, and nobody has immunity to it. We are all vulnerable.

 

Once you “catch it,” there is a several day lag (as few as two and as many as 14, though generally four or five) when you are infected but you feel normal. Then the symptoms begin. They start out mild—usually cough, fatigue and a fever—and for five to eight days people tend to worsen.

 

Occasionally, perhaps rarely, people have a sore throat, runny nose, headache, muscle aches, diarrhea—but again, they tend to start out mild and then get worse. So it is not really like the influenza virus (“the flu”), which tends to hit you like a ton of bricks, right away. People with the flu are miserable—and often in bed. But having COVID-19, with its milder initial symptoms, means you could be up and interacting with other people—and spreading it.

 

This tricky little virus is infectious not only when you develop symptoms, but before you have your first cough. And some people aren’t going to have any symptoms at all (lucky them!) and yet they are infected and could infect others.

 

The problem comes after those five to eight days of relatively mild symptoms. One out of seven people get worse. Much, much worse. They get so short of breath they need extra oxygen and specialized care and they need to be hospitalized.

 

And a few of those people (two, or so, out of 100 people with the infection) will get even worse and need to be intubated because they can’t get enough oxygen into their lungs otherwise. They need a bed in the intensive care unit (ICU), generally for around two weeks, sometimes up to four.

 

So what does this have to do with math? Let’s focus only on the people who need to be hospitalized. The U.S. population is 331 million. Without any “social distancing,” 40 to 70 percent of the population will catch it in the next several months. So let’s be optimistic and say 40 percent. That is 132 million people sick, of which 15 percent need hospitalization: 20 million people. And 2 percent, or so, need ventilators: 2.6 million people.

 

The U.S. has 925,000 hospital beds, and 98,000 ICU beds. There are 160,000 ventilators that can be pressed into service. And remember, people will be needing to be hospitalized, in the ICU, or on a ventilator for other reasons, also. May of those beds are already occupied. Do you see the math problem?

 

Medical people earnestly want to take care of all sick people, but if everyone is sick at the same time, then the people who need ventilators, or even to be admitted to the hospital, cannot be cared for. And if everyone is sick, then some medical people are sick also, and won’t be able to work for a time.

 

It is vital to “flatten the curve” so that fewer people are mildly ill, moderately ill and critically ill at the same time. If you or your family members haven’t been exposed to it already, it is important it stays that way.

 

Families need to stay home. That means no playdates. No group gatherings. Only necessary trips to the store.

 

TWO: So what if you are one of the many, many people who have been unknowingly exposed, and you are either about to get sick or are already having symptoms?

 

If you have mild symptoms of cough, fever and fatigue, at this point you should assume it is COVID-19 (until proven otherwise). Stay home and isolate yourself as much as possible from other family members. If you have a primary care provider, call and report your symptoms, and get further instructions about testing and care.

 

Many people don’t have primary care providers, though. And, alas, testing for COVID-19 is unavailable in much of the U.S. for people with mild symptoms. That may change soon. Many places have “drive through” testing sites, where you stay in your car and get tested. Then it takes anywhere from half-a-day to three days to get the results. Unless you are seriously short of breath, you will probably spend those days at home.

 

If you are seriously short of breath, then you may need to be hospitalized. This is what hospitals are for—to treat people with serious illnesses.

 

If you have COVID-19, or if you or your doctor are highly suspicious you have it (with or without testing), then stay at home, isolated, for two weeks at least. Add extra days to those two weeks if you still have fever. Be sure you are fever-free for three full days before you consider yourself not able to spread it.

 

The official recommendation for “recovery” is two negative tests for COVID-19, 24 hours apart. With how scarce the tests are, that doesn’t seem feasible to me. But if you can get those tests, then do it.

 

Feel free to pass this on to anyone you think would benefit from it.

“Beloved, I pray that all may go well with you and that you may be in good health, as it goes well with your soul” (3 John 2, ESV).

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About Amy Givler, MD

Amy Givler is a family physician in Monroe, Louisiana. She and her husband Don met in 1980 at a CMDA student event her first year of medical school, and they have both been active members of CMDA ever since. Amy graduated from Wellesley College and Georgetown University School of Medicine, and she then completed her family medicine residency at the same indigent-care hospital where she now works part time. She also works at an urgent-care clinic and is the medical director for a Shots for Tots clinic. Amy loves to write and has written many articles and one book, Hope in the Face of Cancer: A Survival Guide for the Journey You Did Not Choose. She and Don have a heart for missions, and hope to do more short-term trips now that their three children have launched from the nest.

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