Coronavirus: Where do we go from here?

Today in my work email there was a priority message from the Massachusetts Department of Health:

“As of March 13, Massachusetts has begun to see some initial evidence of community spread of COVID-19 and the Department of Public Health (DPH) has made recommendations consistent with a transition into the community mitigation phase of the response.“

They make it sounds like community spread just started, but here on the ground, we’ve had a pretty good idea that it’s been going on for weeks. Can’t prove it, though, because of the ongoing lack of tests. Yesterday the collective voices of frustrated healthcare providers, public health experts, and local officials across the country forced the politicians to acknowledge the issue and take some action. I’m proud to have been one of those voices. What was achieved? At least, there will be funding to the private companies working (vying?) to create tests. And Congresswoman Katie Porter got the CDC to agree to pay for patients’ testing.

Meanwhile, teaching hospitals around the country have pulled together ace teams to try to create their own tests. A process that usually takes months is being condensed down to days. It’s a complex task requiring a big team and a lot of equipment, and the government hadn’t been helping much. It’s a pretty amazing feat, and fascinating science. If you want to geek out about it, there’s a whole section on this in this super-informative MGH video conference from yesterday titled A Coordinated, Boston-wide Response to COVID-19 and featuring a lot of really smart experts.

Meantime, there’s now 123 confirmed cases in Massachusetts, which really means a couple thousand of actual cases. (Want to know exactly how many actual cases are likely? This article by Tomas Pueyo at Medium is very good, especially if you like graphs.) Hospitals are having to get creative in order to handle the overflow. Case in point: My own clinic space, home away from home for fifteen providers, has been appropriated and repurposed into a respiratory virus evaluation clinic. Our schedules were largely cleared, and some of us will continue to see patients in a few exam rooms “donated” by another clinic, some of us will manage patients by phone and virtual visit, and some will just work in the respiratory evaluation clinic.

So things are heating up… What can people do now to cool it down?

There’s a hashtag trending now: #StayTheFuckHome. And that, my friends, is where we go from here.

Here’s one illustration why. Here’s the 1918 flu epidemic, with the numbers of cases in Philadelphia vs St. Louis. Guess which mayor enacted mandatory social distancing early on?

Every single day more without mandatory social distancing allows the virus to keep spreading, a lot:

Why does it matter? Hospitals in Italy are running out of beds, equipment, and medical staff are nearing exhaustion. They already ran out of enough ventilators and doctors have to choose which patient gets a chance at life. We are well on our way on a similar trajectory. Today, the CDC put out several modeled scenarios, all of which sound pretty bad: They estimate that between 160 and 210 million Americans could get infected, with between 200,000 to over a million deaths. If that’s not scary, think about what’s in between those numbers: Hospitalization. Over 20 million people may need hospital-level care, and we’ve only got 925,000 hospital beds in the country.

I think people are starting to get it. Our district closed the schools, a move that I applaud. Friends (and Facebook friends) who had been skeptical or even glib are hunkering down (if they can). It’s this more practical attitude that needs to go viral.

Where did we go today? Well, except for the pediatricians’ office and the pharmacy, we stayed home. My clinic was cancelled, and I spent the day responding to many, many patient messages. Our kids were home from school (one of them has a non-febrile-non-respiratory illness), and between Hubby and my mother, they were covered. (Aren’t we glad it’s not football season!) We’re lucky, yes, I am aware of that. We need protections for hourly workers and small businesses, to support them through this ordeal, for sure.

So stay the fuck home, guys, if you can. Wash your hands with soap and warm water often. If you do go out, for God’s sake don’t touch your face, or anyone else. Take care of each other.

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For solid info on how to prevent the spread of illness, I like this basic info from the CDC.

My alma mater the Johns Hopkins School of Public Health has the coolest interactive map of worldwide coronavirus statistics.