Tag Archives: Pandemic

578,319….and Silence

The Red Bird by Stasys Eidrigevicius. (Screen capture)

More than 7000 physicians united through more than 40 WhatsApp groups, and suddenly silence. It is as if the global medical community with whom I have connected has become complacent, accepting of disappointment, disease, and death. Such is, perhaps, the effect of six months and more of COVID-19.

Disappointment, because in many countries, medical leaders had failed to prepare satisfactorily for a pandemic that others had predicted. Disappointment because leading medical journals with their shark tank-like editorial boards succumbed to publishing sub-par scientific material. Disappointment because we don’t know if hospitals have the necessary means to satisfactorily protect health care personnel or care for thousands of newly infected patients.

Disease is terrible because when we are ill, we are not the same as when we are healthy. We see the world differently, and for some of us, values change, and priorities are redistributed. Life takes on a different meaning, and may even lose its meaning altogether. The struggle back to a different reality is challenging, but if health is restored, everything can seem “normal” again…until next time.

Death is in the news every day, but not as loudly in the headlines (578,319 COVID-19 related deaths worldwide today, while numerous countries resume partial shutdowns1). Perhaps the medical community accepts this cruel reality, and the general public has perhaps become too complacent. Societies are radically divided, not only into rich and poor, privileged and not, but also into young and old, with the over-60 or those with comorbidities relegating themselves to self-imposed isolation. In contrast, younger generations strive to live as they used to, for life must go on, and they are the future.

With these thoughts in mind, I watched with even greater sensibility than usual, the truthfully realistic virtual exposition of the photographic-film Paris-Vilnius. The Spectacular Silence, by French/Lithuanian artist Yolita René (http://paris-vilnius.fr). Accompanied by a magnificent piano score by Dominykas Digimas and a collection of Pulitzer-prize worthy contemporary photos, the artist/author uses the painting of a masked, red bird named Coronavirus 2020, as a leitmotif that reminds us of the presence of COVID-19 in our lives today, and of the sometimes bleak but always poetic temporality of our existences. 

I am both an observer and a witness as dozens of images from The spectacular silence cross my computer screen. These stills reflect my own feelings about Absence, Solitude, Distance, Resonance, and finally, Masks. These face-covers are of all types and shapes and forms. They remind me of our natural diversity and human fragility, of our ability to love and to unite, and of our desires to connect with others in order to find greater meaning in our lives.

References

  1. https://ourworldindata.org/covid-deaths#what-is-the-total-number-of-confirmed-deaths

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We need to wear masks

Photo, H. Colt

The curve flattened across California. Many stores and restaurants reopened. Folks who had been trapped indoors for months flocked to the beach with their families. But now in Orange County, where I live, the number of people infected with SARS-CoV-2, the respiratory virus responsible for the COVID-19 pandemic, is increasing, hospital beds are being filled, and public health officials (those who are courageous enough) are sounding the alarm. 

It’s a second wave, but it’s one we can prepare for, with common sense.

While the situation is fluid, we have a greater understanding of Coronavirus than we had at the start of the pandemic. We know transmission occurs mostly by large droplets, like ones that can be stopped by wearing a mask. We also know transmission occurs from fine aerosols, which is why health care personnel use special N95 masks and other protective gear. Transmission occurs from contact with contaminated surfaces, which is why we use disinfectants, alcohol-based hand sanitizers, and practice physical distancing.   

So, with all we know about spreading the virus, I was surprised to see that most people in my town, both locals and visiting tourists, are not wearing masks. I wrote a brief letter that was published in our local paper1. In it, I shared the following story:

“My mask protects you, and your mask protects me,” I said to one young couple standing next to me by the ice cream shop. 

“Chill,” they said, not in a mean way as they pulled their masks up from below their chins to cover their faces.

I thanked them and explained how older people like myself were at a higher risk of becoming severely ill if we catch Coronavirus. I share this statistic with Blacks, Native Americans, and Hispanics, as well as with those who have heart disease, chronic kidney disease, or diabetes. In fact, care fatality rates increase with age and number of comorbidities2.

The last thing we want is to see our health care facilities overburdened with a surge of critically ill patients.

Wearing a mask3 when we are near others is a generous act of kindness that might be the most effective way to protect against COVID-19 infection. 

An increasing number of scientific studies help support this proposition. Both the CDC and WHO now recommend face-masks to the general public4. The WHO reversed its position regarding mask-wearing based on a meta-analysis of 172 papers by Chu et al4. Mitze et al.5 concluded that masks might reduce daily growth rate in the number of infection by more than 40%, and Stutt et al., in their mathematical models, note that when masks are used by the public all the time, the effective reproductive number, Re, can be decreased below 1, leading to mitigation of epidemic spread6.

‘My mask protects you, your mask protects me,’ may be the secret to surfing the second wave of this pandemic safely.

Addendum: Since this writing, the Governor of California and the California Department of Public Health issued guidelines mandating face coverings in “high-risk” situations (https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-128.aspx).

References

  1. Colt HG. Stu News, Laguna Beach, June 17, 2020
  2. https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis 
  3. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-and-face-masks
  4. Chu DK., et al. Physical distancing, facemasks, and eye protection to prevent person-to-person transmission of SARs-CoV-2 and COVID-19: a systematic review and meta-analysis. The Lancet. June 1, https://doi.org/10.1016/S0140-6736(20)31142-9.
  5. Mitze T et al. Face masks considerably reduce COVID-19 cases in Germany: A synthetic control method approach. Institute of Labor Economics, June 2020. ZA DP No. 13319.
  6. Stutt ROJH et al. A modeling framework to assess the likely effectiveness of facemasks in combination with “lock-down” in managing the COVID-19 pandemic. The Royal Society Publishing, May 2020. ROJHS, 0000-0002-1765-2633.

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The Coming Storm

(Clouds over New York City. Photo courtesy C. Lehr)

The COVID-19 pandemic is not over. If that sounds like news, it is. I am not fooled by the hundreds of people walking around my town without masks, nor by the now neglected practice of physical distancing. I am not fooled by the reassurances from Nursing Home directors and hospital administrators who say the virus is controlled, and I am not listening to government officials from any nation who neglect to keep us informed of a possible increase in numbers of deaths.

This is not to say I am not pleased. I am relieved the pandemic has not caused as many deaths as originally predicted. I am delighted that most of the people I know who are over the age of sixty, or those with past medical histories such as heart disease and diabetes are choosing to wait and see, rather than attend public gatherings and eat in restaurants. 

I am glad that some health care personnel have taken responsibility for their own safety and well-being, rather than trust all decisions to an all too often incompetent, hierarchal leadership with different agendas. But I am sad that according to at least one recent report, more than 600 health care workers in the United States have already died from SARS-CoV-21

The US Centers for Disease Control says that in California, where I reside, about 6% of all hospital beds are occupied by patients with COVID-19. Overall, patients with and without COVID-19 occupy only 64% of ICU beds2. This leaves our hospitals with a small safety margin in case a second wave strikes in the next weeks.

SARS-CoV-2 is transmissible by individuals who are ill, presymptomatic, or totally without signs of disease. Viral load depends on frequency, duration, and type of exposure (droplets, respirable aerosols, and fomites). Recent events and the opening of our economies create opportunities for infection. If many medical scientists and public health officials advocate physical distancing and mask-wearing, it is because their concerns for public safety are free from most of the constraints placed on politicians, economists, and social policy-makers responsible for the public good.

As health care professionals, we have a responsibility to do no harm. However, to advocate physical distancing adversely affects the economy. To advocate social isolation adversely affects mental health and puts a strain on family dynamics. To advocate precautionary measures in the workplace and not follow our own advice outside makes us hypocrites.

References

1. https://khn.org/news/exclusive-investigation-nearly-600-and-counting-us-health-workers-have-died-of-covid-19/
2. https://www.cdc.gov/nhsn/covid19/report-patient-impact.html

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Children and COVID-19

Screen shot cover IASC

Honesty, Respect, and Reassurance. These three cardinal rules for sharing bad news with children are worth remembering. 

Thankfully, kids don’t often get COVID-19. Less than 2.5% of cases are reported worldwide. When children are infected, they usually become only mildly ill, though asymptomatic infections are not uncommon1. In one study from the Wuhan Children’s Hospital, only 171 of 1391 children (12.3%) assessed and tested for SARS CoV-2 were confirmed to be infected with SARS CoV 2 (median age 6.7 years), with 3 requiring intensive care support and mechanical ventilation and 1 death (all three had numerous comorbidities)2.

Of course, telling a child they are ill is one of the most difficult tasks a health care provider, social worker, parent, or family member might be asked to do. We are fortunate that such a task is only rarely required in today’s COVID-19 pandemic. Teaching all children about the effects and potential impact of COVID-19, on the other hand, is for many of us an almost daily responsibility.

Sometimes, it may be necessary to talk about why a family member or friend was rushed to the hospital. Other times, we may need to explain what is seen or heard on the news or the internet. Children also communicate with each other via social media. Like us, they share stories and are readily exposed to fake news, scary headlines, and other information that may cause fear, panic, or misunderstanding.

In order to address the psychosocial and mental health needs of children everywhere during the COVID-19 pandemic, the Inter-Agency-Standing Committee of the United Nations (IASC) consulted with more than 1700 teachers, caregivers, parents, and children from around the world. Their goal was to write a story created for and by children. This story was published by the IASC under a Creative Commons Attribution so that all users could reproduce, translate and adapt the Work for non-commercial purposes, provided the Work is appropriately cited. 

The story is, My Hero Is You: How Kids Can Fight COVID-19.3 This illustrated storybook is meant to be either read to or read with children by an adult. The book can be downloaded for free from the IASC website (see reference 3) as well as from the UNICEF website at https://www.unicef.org/coronavirus/my-hero-you. The UNICEF website also contains helpful links to sections such as “what teenagers need to know,” or “what parents might want to share with their children”.

Numerous translations are already available and downloadable from the above-named websites. I am very proud to say that others are in progress from contributors to our COVIDBRONCH initiative.

Stay well, and stay safe.

References

  1. Ong JSM et al. Coronavirus Disease 2019 in Critically ill children: A narrative review of the literature. Pediatric Crit Care Med prep 2020. DOI: 10.1097/PCC.0000000000002376.
  2. Lu X et al.. SARS C New Engl J Med, March 18, 2020. DOI: 10.1056/NEJMc2005073.
  3. My hero is you. How kids can fight COVID-19. IASC publication. Helen Patuck (story and illustrations). https://interagencystandingcommittee.org/system/files/2020-04/My%20Hero%20is%20You%2C%20Storybook%20for%20Children%20on%20COVID-19.pdf

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Thoughtless, or selfish, that is the question.

(Personal photos Twitter/WhatsApp)

Shakespeare once wrote, “To be, or not to be, that is the question.” Today, we must ask a different question: “Are people thoughtless, or are they simply selfish?”

Despite orders for social distancing and self-isolation to mitigate transmission of COVD-19 in virtually every country, crowds continue to gather in public places, shop in large numbers, and fraternize in neighborhoods throwing Coronavirus block parties. This weekend, the Municipal Fishmarket at The Wharf, in Washington DC, was packed with hundreds of people until the police intervened to shut it down. Even in Dhaka, Bangladesh, millions returned to work until the government issued an official country-wide lockdown, and at a Walmart superstore in Yreka, California, a woman coughed and spat at an employee who asked her to back away at the check-out counter.

How many deaths does it take before people come to their senses? To paraphrase Bob Dylan, “The answer, my friend, is blowing in the wind. The answer is blowing in the wind.”
 
Dr. Deborah Birx, Ambassador-at-large and Coordinator for US Government Activities to Combat HIV/AIDS, is also a vital member of the US Government’s Anti-Coronavirus Taskforce. “The next two weeks are extraordinarily important,” she said on Saturday, April 4. “This is the moment not to be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe…”

“But I have a family of four to feed,” whined one friend.
“I love food too much,” said another. 
Both are justifying their numerous trips to buy groceries this week.

Neither of my friends is thoughtless. In fact, I have often admired their common sense. This leaves me with only one conclusion; but, what do I do with such information. Do I have a moral duty to persuade them to act responsibly because I am a doctor, or might I simply point out that we are a village, and we will win, or go down together. For all of us, regardless of our profession, this is a defining moment in history. Each and every one of us will recall where we were and what we were doing during this global crisis. Irrespective of our individual roles and responsibilities, we are accountable to each other.

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