I haven’t been typing as much lately because, well, life. But I’ve been asked by a few folks for an Anxiometer post on COVID-19. Since I work at two hospitals, I’m getting 20+ emails a day on the topic now. I know you’re likely saturated too, so I thought I’d put together more of an Anxiometer/Musings combo pack.
For starters, I haven’t seen a case yet and the closest I’ve come seems to have been at an EMS trade show that I attended last week where someone tested positive. I’m not an expert and really just feel like another grain of sand trying to make sense of the storm. However, what’s more remarkable to me is how much intense opinion there seems to be on the topic. It’s almost like a Rorschach test. Some folks are predicting we’re at the hockey stick inflection point, and soon our medical systems will be overwhelmed. Others are poo-pooing the whole thing with comparisons to flu mortalities and other microbial scares. And then there’s all the interwoven politics.
Personally, I’m as willing to wager here as I am on any particular religion. (Actually, on religion, the last scene from Men in Black seems compelling.) Being a poo-pooer certainly seems to be a happier way to get through life nowadays. If the rest of my life involves streaming CNN and toilet paper hoarding, I decline. Given our track record with the last few outbreaks, it’s probably reasonable to bet this will vaporize shortly after the next natural disaster, or perhaps election day. But you won’t, nor shouldn’t, win that bet with any family members of those who’ve already died.
- Direct exposure to someone who has tested positive and/or died
- Frail or elderly
- Immunocompromised (diabetic, on chemo, HIV+, on steroids…)
- Short of breath
- Fever, cough (+ other red flags)
- Recent close quarters with many people (think conference, concert, cruise ship, airplane…)
- History of asthma, COPD, lung cancer, or anything else that may limit lung capacity
- “I had a fever 5 days ago, but I feel fine now.”
- “I tested positive for flu.”
- “My wife tested positive for flu and got better with Tamiflu.”
- “It’s mainly the runny nose and congestion that’s bothering me.”
- “I really just want to get tested so I can get back to work.”
- “I’m a child and just want to play in my sandbox. But mother can’t stop reading about this pandemic, so I’m here in your waiting room to get a check up.”
To me there are three groups, as there are in pretty much all medicine: The worried well, the maybe sick, and the sick sick.
The worried well are able to have a conversation with me on the phone and dig deep with full sentences and not a single cough. They need to stick with telemedicine, avoid crowds, and find distractions. Podcasts, Netflix, pushups, situps, whatever. Don’t go to an ER or anywhere really. Just limit exposures to others and also the possibility of the double whammy (C+ something else). With telemedicine, never has the world been so ready for the worried well. Why a national telemedicine hotline to help folks stay home doesn’t exist, I’ve no clue. But if you read this and want to chat, call any time. I’m a far better doctor with digital deterrence.
The maybe sick should start with a telemedicine call and get some solid social support lined up at home. Find someone healthy who can make trips to Rite Aid for supplies like hand wipes, Ricola, Tylenol, ibuprofen and Umcka (my favorite placebo). And find someone like me who is willing to walk you through it day by day, and maybe even come visit in a pinch. ERs just don’t serve this group particularly well.
The sick sick should seek help in ERs. Actually, on planet Sammy there would be mobile isolation units that come park in your driveway. Infectious disease on my planet would be completely separate from broken hips and heart surgeries. Anyone want to start building mobile ICUs with me? I digress.
In the ER and after admission, expect what we call “supportive measures,” which include oxygen, nebulizers and possible intubation. You’ll get blood tests and antibiotics as well until your test results come back Covid+. For you medically minded readers, intubation seems preferred to Bipap to limit nebulizing the virus. Expect to be treated like hazmat, but hopefully with kindness. Expect prolonged quarantine for you and your closest contacts.
That’s really it for the medical perspective. Plus you probably know all that already. Panning back out to bigger picture musings again… what’s more interesting to me here is the possibility of “TMI” in science. I loved physics in college and still love deep dives into hard questions. But as we discover more answers, I wonder when we have to start asking how much info do we really want vs. need? This panic exists now in part because of our ability to isolate and name a particular virus. 30 or 40 years ago, we’d probably just call this a bad flu season, whether 1k, 10k, 100k or a million deaths. If particularly bad, we’d give It a name like the “Second Spanish flu” and then move on. We had warning this time also because of China being so much more open than in decades past. What would we be doing today if they were closed off like the late 50s and 60s when they lost an estimated 15 million to famine. Or was it? I’m sure a some of those deaths involved coughing too.
Scientific leaps, the internet and big data put us all at risk for chronic anxiety now. What would your life be like if you knew all the cancers you’re certain to develop in the next 5-10 years? What happens when astronomers discover we have a thousand asteroids the size of Hawaii all heading our way in a massive cloud? Most will likely fly by… or not? So much for romance watching shooting stars! What if geologists knew exactly where every 5.0+ earthquake would take place with one week’s warning, or every tsunami, or every tornado? Mass evacuations would never end. What if we had an app that showed us how many people are driving near us on meth with AR-15s at any moment? We’d never leave home. What happens when someone invents a telepathy device? Sounds cool, but I bet most of us wouldn’t last a day after the flood of unfiltered insanity.
I guess I’m done. If you’ve read this far, my apologies. Wash hands. Use COVID-19 to teach kids to wash hands. Enjoy the outdoors. Unplug from the news cycle and go live whatever life you’ve got left… or sit and type some more social media drivel like me. Whatever it’s worth, when you finally admit to being sand, it’s comforting.