A ER doctors take on Covid 19

savage170 · April 25, 2020 01:31

"David Lang

I am an ER physician and I have been reading everyone's take on the Covid 19 pandemic for the last 2 months and having worked directly with it every day, thought I would share the way I see it. Sorry that this is long, but I have a lot to say.

Shutting down our borders when we did was a great move. It probably should have been done sooner actually. Shutting down everything else when we did was also a bold and wise move. Initially, the information on the virus was suspect at best, and we needed to prevent our hospitals from getting overwhelmed. Unfortunately that did happen in several larger cities such as NYC, New Orleans, Detroit and Washington state.

The reality of the situation in most other areas of the country, however, is far different. Most rural hospitals, like the one I work in have seen few if any cases. Unfortunately most hospitals have also severely limited the access to our health care system to people with anything but potentially Covid related symptoms. Initially this was a wise and prudent move. We had no way of predicting how bad things were going to get. But every week, we are getting more reliable information that this virus has already spread much more than we initially thought but the death rate is much less than we thought. The feared deluge of Covid patients, outside of a few hot spots has not yet materialized.

The initial estimates talked about hundreds of thousands of deaths from Covid. But as we get more information and as we see the benefits of self-quarantining those estimates are being consistently being down graded. The most recent estimate I saw today was 60k deaths. This may seem like a large number, and it is, especially if a family member or a friend is in this group. But a bit of perspective is warranted. According to the CDC data, the average number of people who die from influenza over the last 10 years was around 37k. In 2018 it was over 60k. Furthermore we have a vaccine for the seasonal flu, but many people refuse to take it.

Furthermore, and this may sound callous, but as far as what steps we should take during a pandemic depends greatly on who is getting sick and who is dying. The vast majority of CoVid deaths (and influenza deaths) are elderly patients and those with other medical conditions, particularly diabetes and obesity or those with any type of immune compromise. The chance of dying from CoVid if you are under 60 and otherwise healthy is extremely small. Yes, there are cases of young healthy people dying but these, while tragic, are outliers. Most younger, healthy people will get mild illness or have no symptoms at all. Knowing this, it makes great sense to protect those who are most vulnerable. We all do this every year during flu season. If we have elderly parents or grandparents or friends with other illnesses we often have them stay home if possible. We wouldn't drop our sick kids off at grandma's house or have your aunt with lymphoma watch them while you are on vacation. But we wouldn't prevent young healthy people from going to work.

Another issue is what we are calling a CoVid death. As physicians we fill out a death certificates on any patient who dies while under our care. We are asked to put down a main cause of death and any other possible contributing causes. So for example if a patient dies in my ER from a heart attack, that would be listed as the main cause of death, but we would also need to list diabetes, hypertension or any other condition that MAY have contributed to the death. Many elderly patients have many serious medical conditions. If they had CoVid on top of that, what is the cause of death? Is CoVid the main cause? If a patient with CoVid gets hit by a bus, is that a CoVid death? That may sound absurd, but I have heard of physicians being pressured to add CoVid to the death certificates in cases like this. Furthermore there is, as you know, a lack of testing ability. If someone dies and has flu like symptoms, but never got tested, physicians are being pressured to add Covid to the death certificate for presumed CoVid. This would also skew the statistics and make having a sensible plan to combat the virus difficult.

However, the main problem I see is that were are focusing entirely on preventing CoVid deaths. While this is a noble goal, many other patients with other serious conditions are being ignored or are falling through the cracks of our health care system. Most of our clinics and hospitals are having such low volumes because we have stopped most elective or non urgent procedures. These are what keep hospitals open and in business. Nurses, staff and even physicians are being furloughed. We have turned our clinics into what seem like armed military institutions. Clinics are surrounded by barricades, large warning signs and crime scene tape. You will be greeted at door by someone in a hazmat suit who takes your temperature and asks if you have coughed in the last month. I am intimidated just showing up for work. Imagine how patients feel.

Often in the last month I have seen patients in my ER who come in with potentially serious conditions that have been having symptoms for several days. I ask why they didn't come in sooner. They say either that they thought we were too busy and they didn't want to bother us or they thought that we had people dying of CoVid lining every hallway of the hospital and they didn't want to get sick. I have seen patients with diabetes and heart failure out of control because they couldn't get in to see their doctor. What if your breast cancer is missed because you couldn't get a mammogram or your colon cancer was missed because you couldn't get a colonoscopy? We are seeing actual harm to actual patients because they are being prevented from getting the care they need. This needs to be balanced with the damage from CoVid. Furthermore, I fear once CoVid is conquered we will see a huge rush of very sick patients to clinics and hospitals that are short staffed because nurses and staff have been laid off.

We are making strides in getting video visits up and running and this is helpful, but many of the older patients I see in my ER still have flip phones. I doubt they will be pulling off a Facetime call or a Zoom conference anytime soon.

And we can't ignore the economy. Millions are out of work. Government bailouts with money we don't have. This doesn't just affect the 401k values for the 1%. This affects everyone. My brother in law is a HS teacher and he told me that more than one of his students expressed concern that their family would lose their home as both of their parents are out of work. This is in a fairly affluent part of town, so I am sure it is much worse in other areas. We can buy time with bailouts for a short time, but not much longer. Millions are out of work and or needing to go to food banks. Poverty is real and a major source of illness and death.

Mental health is suffering. I am seeing this in my ER also. Loneliness and lack of human connection is a major problem for anyone, but especially those suffering from underlying mental illness. Binging on Netflix can only go so far. We are also seeing a surge in domestic violence from people cooped up with their families for too long. This will only get worse as the weather gets nicer.

Don't get me started on people who wear gloves all day, This makes zero sense. This just drags the same bacteria and viruses around as if you had no gloves. The check out person at the grocery store wears the same gloves for hours. Unless she changes them after each customer it is useless. She would be better off with a container of hand sanitizer and washing her hands every few minutes. And wearing a mask that doesn't cover your nose is pointless. The best way to not get Covid is to wash your hands regularly and not touch your face.

I have no doubt that CoVid was here long before the first official case was found. The initial cases in Wuhan were in October and November and there was no shortage of people coming here and travelling to Europe from that area during that time frame. During the last part of 2019 and the early part of this year, I saw an unusual amount of patients in my ER with severe flu like symptoms who tested negative for influenza A and/or had the vaccine. I get the fact that the flu swab is not always accurate and the flu shot isn't 100% effective, but the amount of people like this I saw was very strange. I have talked to many of my colleagues who noticed the same thing and have seen many physicians online reporting the same thing. This is relevant and fits with the data that were are seeing more people who show exposure to the virus and who are possibly at least somewhat immune to further infection.

There are two main way to defeat any illness or pandemic. One is to wait until the virus naturally dies out. With influenza this happens when the weather gets warmer and the virus becomes less virulent. It seems this doesn't happen as much with CoVid. The other way is by making most people immune. This can happen with a vaccine, but this won't be here for many months if at all. The other way is by herd immunity where most of a society has had the illness and is theoretically immune. That is why it is a good thing if many more people than we thought have been infected and potentially immune.

So what would I recommend that we do?

1) Make sure we have enough protective gear for our health care workers and others regularly are exposed to the public.

2) Work diligently to find treatments and a vaccine for CoVid.

3) Continue to quarantine as elderly and vulnerable as much as possible, but make sure they have the support they need.

4) Get our clinics and hospitals running more normally when and where it is possible. We can't jeopardize every other patient to focus on CoVid.

5) Use masks and gloves as you see fit or if you are vulnerable, but use them wisely and properly.

6) Start getting society back to normal quickly. There is no reason a small store can't be open but hundreds of people are jammed into WalMart and Home Depot. Open restaurants with tables spread out. Open hair salons. These things can start to save our economy and let us develop the herd immunity we need to stop the virus. And yes, I am aware that this will cause a spike in CoVid cases but the damage from this I believe will be far less than the damage for keeping things shut down much longer.

7) And for the love of God, STOP HOARDING TOILET PAPER!!!"

A ER doctors take on Covid 19

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