When the most recent series of containment measures were issued by the governor last week it was undoubtedly a shock to many and anxiety producing to most (myself included). While we’ve all been watching the wave of this global pandemic loom closer and closer I think that the events of last week marked the moment when we collectively realized that it is actually here!
We are at a point now where the predictive models and experiences of other countries show that we are very likely going to see a huge surge in active cases of COVID-19 in our area in the near future, probably within the next month. While it is natural to experience some fear in a situation such as this, it is also important to also know that there are things we can do now to achieve the best possible outcome for ourselves, our families and our community. In this post I am going to focus on what I believe are three key areas that need our attention now.
Follow State and Local directives to minimize spread
Recent directives issued by the governor, including “shelter in place”, “social distancing” and the closure of “non-essential” businesses, have dramatically disrupted our daily lives and brought fears of financial uncertainty to many. While these are valid and serious concerns, the successful implementation of containment measures is critically important to how well or poorly we weather this pandemic from the standpoint of health and the loss of life.
I wrote in previous posts that I believed the mortality rate of this virus would remain relatively low, 1% or less. This was based on data coming from China outside of Hubei province, South Korea, Taiwan and Singapore, all of which implemented very strong containment measures when infection rates were still very low. What we are currently seeing in other countries, such as Italy and Iran, is that failure to contain early on is resulting in much higher mortality rates.
These higher mortality rates are not due to increased virulence of the virus itself but from a massive overwhelming of their national health care infrastructures, which might have been avoided if stronger containment measures had been instituted earlier.
The pattern of risk has not changed. Individuals hardest hit by the virus are still the elderly and those with serious preexisting health conditions (I wrote more about this in my previous post). If, however, there aren’t sufficient hospital beds or equipment and staff to take care of those in need, we will see increased rates of mortality in our country as well.
Current estimates are that 30% of people who become infected will never show symptoms (they will still be contagious, however). 56% Of people will have mild to moderate symptoms and can weather the infection at home. 14% are expected to have severe symptoms and require hospitalization and, of those, 4% are expected to require intensive care.
They key to keeping mortality rates low at this point is to not overwhelm our health care system. This is something we all need to be concerned with and can best be accomplished by limiting the number of direct, in person interactions that we have. This is exactly what the current State guidelines are designed to accomplish. While many of us don’t need to have a high level of concern for ourselves if we become infected, we need to work collectively to protect the most vulnerable amongst us. We can do this, in part, by making every effort to follow State and local guidelines.
For detailed information on current COVID-19 Guidance for Placer County: https://www.placer.ca.gov/6449/Guidance (This is largely identical to the State guidance).
Focus on building health now
Many of us will become infected with COVID-19. In one of his recent press conferences governor Newsom estimated that 57% of Californians will ultimately become infected. For some this may be soon, for others it may be months from now. This is a virus that is taking its heaviest toll on those with the most compromised immune, cardiac and pulmonary function and, for the most part, having mild to moderate impact on those in relatively good health. Whatever your current level of health, you can begin improving it today. I gave detailed recommendations for improving your immunity quickly in my previous post The Coronavirus: What You Can Do, so I won’t repeat those here.
I would, however, like to add several items:
- Stay connected – the current “shelter in place” order brings with it the potential of creating stress and isolation, both of which have negative impacts on our immunity and our spirit. Reach out to friends and family that are at a distance. Use telephones, Skype, etc. Have long conversations with old friends. Take a walk in nature with friends (while maintaining at least 6 feet of distance). It’s important that we maintain our sense of community and connectedness through these difficult times.
- Limit your exposure to media – while we need to keep informed of essential developments, spending too much time listening to news reports increases stress and anxiety without appreciably making us better informed. I recommend finding one or two news sources that you believe are providing useful, accurate updates and tune in once or twice a day at most.
- Have fun – Make sure to engage in activities that are fun, relaxing and restorative. Watch funny movies (not Contagion) or comedy specials on Netflix. Get outside and get some exercise. Plant a garden. Join an online chat group about something that interests you. Start a craft project. Laughter, happiness and joy are good for both the immune system and the spirit and we all need a break from the intensity of what is transpiring. It will make us better equipped to make good decisions and take appropriate actions when we need to.
Protect those at greatest risk
From what I can see our State government is currently working very hard to meet the increased demand for hospital beds, equipment and personnel that will be required in coming months. We need to be prepared, however, for the possibility that the demand will outstrip the capacity and that the quality of healthcare delivery will suffer. We need to do everything we can to protect those at greatest risk from becoming ill and therefore requiring hospital treatment.
It is important for people who are living with or caring for someone in a high risk category to take extra measures to ensure their safety. Broadly speaking, this involves two interrelated strategies 1) doing your best to eliminate the need for high risk individuals to leave the home, and 2) limiting the chances of exposure to an infected person or object coming into the home.
Setting up a support network of low risk (younger, healthier) family or friends who can help with grocery shopping, picking up medications, etc. is important. Furthermore, those who will be venturing out and coming back home need to take every precaution to avoid becoming infected themselves. If friends or neighbors are helping with shopping, have them leave shopping bags outside the front door, rather than coming into the house.
Remember that transmission can only occur in two ways. The first is through touching an infected object or surface and then touching your mouth or nose. The second is through inhaling respiratory droplets which have been coughed, sneezed or exhaled by an infected person. Washing hands frequently and maintaining at least 6 feet of distance from others when in public places is very important. In circumstances where you can’t maintain 6 feet of distance, such as supermarket check out lines, maintain as much distance as you can.
When bringing objects into the home, such as grocery items or prescriptions, treat them as if they are contaminated with virus and handle them accordingly. When I bring groceries home I take them directly to the kitchen, set down the bags, wash my hands thoroughly, put the groceries away, put the bags away, then wash my hands again. This minimizes the chance of spreading infection from contact with contaminated grocery items.
Recent research has shown that the COVID-19 virus can survive up to 48 hours on cardboard and stainless steel and up to 72 hours on plastic. Ideally, everything coming into the home should be quarantined for 72 hours before handling. This includes mail, packages, groceries and, sadly, produce as well. If you can’t quarantine something, then wash your hands thoroughly after handling it.
Individuals who are involved in the care of a high risk person should wash their hands thoroughly prior to every direct interaction. Ideally, those who are going out into the community and then interacting with those at greater risk should wear protective masks when within six feet. Remember that people become contagious prior to the onset of symptoms so it is impossible to know for sure wether or not you are infected. Act accordingly.
Unfortunately, commercially made face masks are impossible to obtain at this time. There is some research that suggests that even improvised masks made from ordinary fabrics can help reduce transmission of infection. Remember that the COVID-19 virus is transmitted through respiratory droplets so a home made mask of 2 layers of cotton fabric should be able to capture most exhaled droplets. There are tutorials on YouTube on how to make a home made face mask. If you do make face masks, make several of them and wash them frequently.
Where we are now represents a moment in time. The situation is evolving rapidly and there are many things which may change the course of events for the better. Several existing medications are currently being tested for use against COVID-19. If some of them turn out to be effective it could significantly reduce the strain on our hospitals. A vaccine is also currently being tested. Humanity is waking up quickly to the seriousness of this pandemic and work is ongoing in a number of countries to find solutions to the various problems involved.
Remember, when we do our part to reduce the risk of infection for ourselves and our family, and particularly to the elderly and those at greatest risk, we are simultaneously contributing to the best possible outcome for everyone.
A note to our patients
Our clinic is continuing to function at full capacity at this time and we plan on doing so for the duration of this pandemic. In order to protect the safety of our patients and do our part to limit the spread of the virus we are now conducting all appointments via secure video conferencing or telephone. Those receiving therapies that require in person visits will still be seen in our office.
We will still be available during our normal hours to speak with you on the phone and through messaging via our patient portal. If you need supplements we will either mail those to you or set them outside our office in a specified location for pick up. Please let us know if you have any questions.