First of all, though I’ve said it before it is worth repeating: I feel honored and privileged to be caring for such a diverse and wonderful group of people. I love being the village doctor because the people in my village regularly impress and amaze me. Over the the last several weeks of caring for you all, in person and over the phone (I love both now!), I’ve been constantly impressed by the resilience, courage and fortitude that each of you is showing during this huge communal trial. Thank you for sharing your stories of perseverance and accomplishment. You all are truly amazing. And to those of you who might actually be suffering more in silence, please pipe up! We want to hear from you, and just talking and sharing concerns can help a lot-it’s certainly helped me. Again, thank y’all.
So what’s new? I have to say that over the course of the pandemic, as I’ve formed various personal opinions on where this was going I have generally then been found to be right or had my opinion validated by broader experience. So I will continue to share my thoughts in the manner of this news letter. Last time I addressed two issues: the personal preventative measures we should all take and the current use of testing for the virus. My favorite article from last week was in the New Yorker, where Dr. Atul Gawande wrote from the perspective of a doctor working in the conditions of a Boston medical center where THOUSANDS of health care workers have cared for even more Covid 19 cases. With reference to all existing scientific data he makes a compelling argument for ongoing adoption of distancing, hand washing, sterilizing surfaces, and using a proper facial covering/mask as measures to effectively curb the spread of the pandemic. I encourage all of you to look for that May 13 article and read it.
He also points out that screening tests will be crucial to understanding and reducing the impact of the pandemic. However, my suspicions about the validity of testing have been confirmed across other sources that these tests are still in evolution. For that reason I suggest testing be used in particular circumstances only, such as actual illness or particular exposures. Both blood and nasal swab tests are available to our member patients (only) here for one hundred dollars per test. If you feel you might need testing just call us. I suspect that by the end of next month we’ll see enough general results to guide us on how useful testing can be for screening all the rest of us. And a recent article in the Journal of the American Medical Association reminds us that we still do not know that having antibodies confers immunity from further infection. In fact, three of four previously studied coronaviruses cause reinfection in people who have antibodies from previous infection.
Lastly, the World Health Organization let out last week what I had already been thinking: that we need to consider a future that includes this virus in a permanent way, as we have already lived with influenza for all of modern memory (and obviously forgot many of the lessons of a century ago). While the SARS outbreak of 2003 was contained to just several thousand cases globally and never spread person to person in the United States, clearly this new infection is everywhere now. Nothing about how this virus has acted or our response to it suggests that we have any capacity to eradicate it. Sadly, I still think that it is an awful virus that causes terrible manifestations, from the respiratory distress syndrome that can be lethal, to the less widespread cases of vascular inflammation in children. Personally, I don’t ever want to get this virus, any more than I care to ever experience the flu again. My approach to living in a world along with influenza viruses has included using masks, gloves and infection precautions when caring for patients suspected of having the flu, and getting my yearly flu vaccine at the beginning of the cold weather season. I vaccinate for two reasons: influenza viruses are in a state of constant mutation, so antibodies from last year might not protect from the next year’s flu; and while antibodies might not protect me from GETTING influenza, they decrease the likelihood that I would DIE from illness related to the flu. I choose life.
SARS-CoV-2, like other corona viruses, is showing a predisposition to mutation that already makes me think of our annual struggle to provide an effective flu vaccine for the upcoming year, a process that really begins more than a year in advance of the vaccine being used when it is distributed. So much of this situation is just too new for us to know how it will play out: everything about this pandemic is in the learning and discovery phase right now. But based on experience and knowledge related to other viruses, preparing for a future with new behaviors aimed at infection control seems in order. Some of us have already been more “germaphobic” than others. I can’t say that before all this I looked at an escalator handrail or a grocery cart handle as anything other than a cesspool of potential infectious exposure; others may not have given touching those things a second thought. In the past I might have gone on the escalator at the airport and then simply forgotten to wash my hands right away, as I did last May of 2019. I also got sick right after that trip. But now I really look at those exposures as more straight up potentially deadly, and I’ll never be that careless again. I refer back to that excellent article by Dr. Gawande. At the end he makes the point that in addition to the four pillars of current strategy: hygiene, distancing, screening and masks, we need a change of CULTURE. Just as it is second nature in the operating room to behave in a way that protects the operative field from contamination, we all need to adopt behaviors that reduce the spread of this virus and limit the impact of the diseases caused by it. These measures need to become automatic and second nature to us.
We are still early in the course of this pandemic; while case rates seem to be dropping locally and nationally overall, it is still unclear if spikes of infection will occur as we ease out of more strict quarantine. Time will tell if people practicing infection control measures suffer less disease than those who take this less seriously. And of course, people who fail to take precautions still benefit from the collective behaviors of all the people that do. Life’s not fair that way. I won’t get into any arguments with people in public who aren’t covering their faces: I’ll simply back away from them and give them more than the suggested six feet of space. I don’t have the energy to try to be “right” about this. It’s gonna take all the energy just to be safe.
Over the decades of the HIV/ AIDS crisis, we learned the concept of “safe sex,” taking certain measures to reduce the risk of contracting the virus and disease. I think we will soon be discussing the concept of a new “safe life,” one that is a more broad culture of infection control measures. This will help us not just with this pandemic, but frankly, the next one as well. We are all together on a learning curve for new way of life. Me and my staff are here for you in this new world; hopefully we all can adapt more successfully than this virus. Viruses change mindlessly; we can make mindful choices that put us ahead of it. I anticipate that we will resume our normal working hours effective June 1st to better meet your needs. I’ll reach out next week to explain the measures we have in place to keep all of us safe moving forward.
For now, stay safe and well; call if you need anything. Hugs.