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Posts Tagged ‘COVID issues’

The COVID-19 virus as seen by an NIH electron microscope. Its reality is deceptively almost beautiful.

 

How many would deny the invisible terror of COVID-19 and rent a room here or anywhere else? This is Ft. Myers, Fla. 3/20/20.

By Paul Goldfinger, MD

 

As long as man has had religion, there have been debates about whether there is a god. And that debate has always revolved around whether one can believe in something that cannot be seen.  In ancient times the weather or fate or life itself was, for some, indirect evidence of a god.  But not everyone accepted that argument.

In modern times we have no problem accepting the invisible reality of a child’s voice materializing in a cell phone, or the ability to watch a video on our phone or computer or TV.  We can turn on a light without seeing electricity.  And we can watch a live press conference from the Oval Office thanks to the invisible Wi-Fi.

The COVID-19 virus cannot be seen with the naked eye, but it is quite vivid under the gaze of an electron microscope.  But does everyone agree that this terror, invisible to the naked eye, actually exists?

Now we have an epidemic–a situation where an invisible force can terrorize us, make us sick, ruin our lives or even kill us.

But the concept of an invisible terror is not new.  All of us have known since childhood that if we have a cold, we shouldn’t cough in someone’s face. During the Black Plague, no one knew about microorganisms, but we came to accept the invisible germ concept when vaccinations stopped polio and smallpox.

Yet, despite thousands of deaths already from this world-wide epidemic, there are some who cannot believe what they cannot see. Yesterday, on the news, we heard some interviews with college kids on spring break.  They were not going to deny the promised pleasures of spring break “partying.”   One said, “We have been planning this trip to Miami for months, so we are not going home.”  This college student is denying the existence of the invisible threat that threatens her life and many people around her.

And there is a rising risk of this virus among the young who have been thought of being at low risk.

That is why government, to some extent, has to force or strongly urge public health principles on all of us, despite our traditional American value of liberty.    In China, they sent the army to Wuhan and shut down the entire city, and if you didn’t accept their mandates, then you would pay a very tangible price.

For the most part we don’t force people to accept the latest invisible terror restrictions, but in some places, for example in California ‘s Orange County or Colorado, the law has forcibly isolated some towns.  Telluride, a famous Colorado ski resort, now has mandatory closing of all ski facilities and all restaurants.  So, in a growing number of places, whether you can see the virus or not, you will be told what to do for the sake of everyone’s safety.  And public pressure at the local level is another means of urging cooperation.

In America we object to public health laws that might be enforced by police or military (martial law) and that would have to be a last resort.

Some people think that the fuss is just contrived intimidation created by the media*, but the evidence of this incredibly real and life threatening invisible terror is confirmed by highly reputable sources such as the National Institutes of Health, the CDC (Communicable Disease Center) and the World Health Organization.

But more than kids on Spring Break, there are many folks who, at some level, do not believe in the risk.  They make jokes, go wherever they like, and rub shoulders with groups of friends or relatives. It seems that there is a level of disbelief on the part of many.

Where I am in Florida, a senior community of about 500 small homes, a meeting of the Co-op was called for about 100 people to be held in a smallish community room.  They said that anyone who has health issues should not attend, but everyone else could come.   I publicly called them out on their Facebook page saying that having that meeting was a “mistake” and threatened those in attendance. I even put my MD after my name.

I was pilloried on that page by many citizens  for being critical of management while only one person thanked me for the health information.

I’m afraid that the invisible terror is still misunderstood by many.  A few days later, somehow, people began to wake up, and now you can see very few even taking a walk or riding a bike.  It’s like a ghost town.

The invisible terror is opposed only when everyone does what the public health experts are recommending, and those recommendations may very well become even more stringent and uniform across the country.

We can be somewhat reassured by recalling one tangible victory over invisible terrors when we look at the HIV  (viral) epidemic.  In the beginning those who acquired HIV stood a large chance of evolving into full blown AIDS, a fatal disease.   Now, being positive for HIV can be compatible with a normal life and little risk of AIDS and transmission thanks to new medications which have turned HIV into a chronic condition, with the invisible terror suppressed by modern science, and most of the credit goes to American genius.

* See comment #3 below for some additional information about a possible “media hoax.”

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Florida farmers market. Vendors have cancelled, and shoppers are few. Most are buying produce and practicing social distancing. Paul Goldfinger photo. ©. March 20, 2020. Click to enlarge.

 

Today’s NY Times describes a young lawyer who got a “cold” and then quickly evolved into being in an ICU, in isolation, and on a ventilator.  His COVID test was positive.  His family has no clear idea as to how he acquired the infection. His wife and child are OK.

I have seen only one person wearing a mask here. (Ft. Myers, Florida southwest). Is this person trying to avoid infection, or is she ill and doesn’t want to spread the virus?

CDC says, “If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.”

If the woman above is sick, she should not be out and about.

And  when should individuals be tested?  This issue has not been settled even as tests become more available. And opinions vary around the world.   In the case of the ICU lawyer, his wife and child have not been tested.

Scientists would like to test everybody in order to follow the progress of the epidemic, but that is not possible. It’s not even possible now to test everyone with mild viral type symptoms or everyone who is vulnerable.  Very ill patients do get tested.

The CDC provides the information below, and even they say that there is “more to learn about the virus transmission.”

We have been wondering about the effectiveness of the NPI’s (non-pharmacologic interventions) which refers to all the social spacing, self isolation, public policies of closing stores, beaches, schools, etc. which we are currently implementing.

Can we hope that this will be totally effective;  well it can’t.   We know that from the 1918-19 horrible influenza pandemic.  And epidemiologists who are now looking at the COVID-19 pandemic say that many will still get infected despite our best efforts with NPI’s.

That is why the pharmaceutical industry is working frantically with the government to come up with some anti-viral drugs that might slow this all down.  A vaccine won’t be ready for a long while.

We have been trying to keep up with all the information, but that would be a full time job, and a depressing and anxiety provoking one at that.

So we will try to highlight bits and pieces and concepts on a daily basis with no pretense that we are doing a comprehensive job.

Instead you might think of us as a sort of beacon shining a small light here and there in the middle of a stormy sea.

 

Blogfinger update:  March 20, 2020.  Paul Goldfinger, MD

Source CDC: 

“COVID-19 is an emerging disease and there is more to learn about its transmission, severity, and how it will take shape in the United State. Everyone can do their part to help plan, prepare, and respond to this emerging public health threat.

  • People are thought to be most contagious when they are most symptomatic (the sickest).
  • Some spread might be possible before people show symptoms; there have been reports of this occurring with this new corona virus, but this is not thought to be the main way the virus spreads.

“It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

“How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, spreading continually without stopping.

“The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas.

“Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

“Different parts of the country are seeing different levels of COVID-19 activity. The United States nationally is currently in the initiation phases, but states where community spread is occurring are in the acceleration phase. The duration and severity of each phase can vary depending on the characteristics of the virus and the public health response.

  • CDC and state and local public health laboratories are testing for the virus that causes COVID-19.
  • More and more states are reporting cases of COVID-19 to CDC.
  • U.S. COVID-19 cases include:
    • Imported cases in travelers
    • Cases among close contacts of a known case
    • Community-acquired cases where the source of the infection is unknown.
  • Three U.S. states are experiencing sustained community spread.

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By Paul Goldfinger, MD

 

It’s becoming difficult to deal with all the information that’s out there. As a physician, I am learning along with you, because this sort of epidemic has not been seen before. Even commonplace issues remain unanswered, and that’s because there are so many variations among people, places, experts,  and situations.   Even real experts have much to learn as there are changes from day to day.

So I have been looking for daily facts  that I don’t know much about.

a.  In Italy, the cases requiring hospitalization exceed the capacity of their system.  This is an awful situation.   Strict prevention practices offer some hope for us, but some experts suggest that we are too late with  aggressive practices.

b. Social distancing seems to be fine now,  but social distancing may not be strict enough, and probably the best general advice is to stay home and don’t go out unless your activities are essential, like getting food or medicine.

Italian doctors are telling us to activate a total “lock down” now if we are to avoid a “collapse” like they had in Lombardy.  And a total lockdown won’t help if it is initiated too late and patients start to arrive at  ICU’s in a steady stream.

c. The key to prevention is to remember that human to human contact must be eliminated  or minimized as much as possible.  You may have to avoid even seeing family in person.

d. As experts learn more about the disease, we find out that fatalities are not necessarily due to respiratory failure.   They are seeing liver failure and fatal cardiac arrhythmias.

And they are seeing people who have “recovered” from Corona who are left with permanent lung damage where the shortness of breath doesn’t get better.

e.  What to do if you get sick. This is from the Daily Signal by a physician*: “The point where you start seeing a doctor is when you have trouble breathing. You shouldn’t be gasping for air. Maybe call them a little bit earlier than that, but when you start having trouble breathing, chest pain, and you just can’t move around very much, then that’s a sign that you need help from somebody else, and you should call your doctor for that.”

So many of these sorts of instructions tell you to “call your doctor.”  But this may be difficult to accomplish even in the best of times.  And what if you don’t have a doctor who knows you?  If you go to an ER or Urgi-care, and you are sick, you can infect everyone around you. What then?

This sort of talk is terrifying.  Our ability to do early testing and to expand critical care capacity must be increased.

f. What if you have minor upper respiratory symptoms?   Even if you think “it’s just a cold” you must stay home and stay away from others.   We were at a dinner party last week with 6 people, but 2 showed up with “just a cold.”

Everyone must be responsible, and if a person with “a cold”  is expecting company, such as the cleaning lady or friends, then all of them should be told in advance that someone at home has symptoms, and the company is cancelled.

And the person with a “cold” should be strictly quarantined for 14 days.

You can go to the Daily Signal to read Kevin Pham, MD’s article.*  I recommend it:

A Doctor’s Answers to All Your Questions About COVID-19

 

 

 

 

 

 

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