It has been a month since the first case of SARS-CoV-2 presented in my hospital in South Jersey. The virus has been causing devastation around the globe since December 2019, and before the United States – China, Italy, and Spain suffered the greatest casualties. Like many physicians, I continue to blog in order to spread awareness and also to ensure that we are well-prepared as a society to face an invisible enemy. The U.S. has more confirmed cases of the coronavirus than any other country, and the sad truth is that we are likely nowhere near the apex of this tragedy. Life is forever altered; many including health care professionals are dead, children are home from school, our work and financial lives have been disrupted, our economy decimated, and health care professionals are overwhelmed. To add insult to injury, it has become apparent our country doesn’t have enough personal protective equipment (PPE) or vital equipment like ventilators to support health care professionals. Perhaps our country has no overarching strategy at all; like the rest of the world, we are simply doing out best. The continuous chaos has causes tremendous anxiety in health care professionals about infecting their families and about their own wellbeing. We seem to have all developed intricate decontamination rituals when we come home from shifts, we fear leaving our children as orphans, and a few of us wonder when we will reach a breaking point if we don’t get appropriate PPE. Overall, there seems to be a sense of doom palpable around humans who work in health care. Despite this – nurses, physicians, pharmacists, respiratory therapists, and all the other staff shows up each day because we took an oath. Not some spoken oath at a ceremony or graduation – but the personal oath we meditate on before we step into a patient room and strive to do everything we can. My predictions about COVID-19 1. There is no normal for the foreseeable future We may be fighting a long drawn battle, and even when we gain some ground, the coming winter may bring a second wave of infections. A vaccine seems to be our best hope to ultimately contain this infection, but much uncertainty surrounds its development, availability, and efficacy. 2. Many more people will get sick, and an unfathomable number will die Early in the infection, some pragmatic commentators loved to report that “influenza kills 30 000 people a year” or “car accidents kill many more.” However, even putting aside worst-case scenario modeling that shows “1.7 million people could die” in the United States – some conservative math reveals an alarming possibility: 325 million population x 30 percent of the population infected x 0.5 percent case-fatality rate = 487,500 deaths. I chose 0.5 percent because Germany’s rate has been the lowest (vs. Italy’s 10 percent), and I hope with the tremendous resources of the United States we can make dramatic interventions. From the CDC, the number of deaths per year by cause in the U.S. is as follows: heart disease: 647,457 Cancer: 599,108 Accidents (unintentional injuries): 169,936 Chronic lower respiratory diseases: 160,201 What can we do 1. Immediately fix the supply chain of PPE and drugs/equipment If society can’t protect those who care for patients, this battle is lost. Health care staff are human and obviously susceptible to all diseases, but we should have the appropriate gear to do our jobs. Also, the world’s richest country focus on ensuring patients don’t die from lack of ventilators or potentially lifesaving drugs. 2. Enforce even stricter measures It’s unfathomable that a handful of states still don’t have stay at home orders. In places that do, even though the existing restrictions have been painful – we will have to make even more sacrifices if we want to survive. Although we all need food and supplies to survive, it makes no sense for essential businesses to allow an unrestricted number of shoppers into their stores. Furthermore, businesses need to get over their fear of public perception and get workers actual protective gear. Finally, we all immediate mandates about wearing face masks outside our homes. 3. Protect the vulnerable Although we are all at risk of succumbing to this illness, data clearly shows fatality worsens with increasing age. It is life-threatening for the elderly and immunocompromised to venture out at the present time. Some of us are able to afford delivery services, but what about the rest? Communities need a coordinated response on how we can arrange no-cost delivery of food, vital supplies, and medications to at-risk populations in a timely manner. 4. Prepare for the challenges ahead Human beings across the world have been resilient and ultimately bounced back after devastating wars, natural disasters and mass casualty incidents like shootings. However, the present pandemic has been described as a slow-moving hurricane. School and work closures and unemployment have put unprecedented financial and mental stress on millions of households. It is completely unrealistic to expect that while numbers continue to go up – we can magically restart our lives. This is likely going to get worse, and we need to figure out how to bolster our resilience. As others have pointed out – social distancing doesn’t have to mean social isolation. We live in unprecedented times of technological innovation that allows us to connect with friends, family, and mental health professionals. 5. Support science over politics We are all inevitably paying a price for this pandemic (health or financial). It is in our best interest as a species to listen to scientists and act accordingly, rather than stick to party lines and risk even more horrific outcomes. Varun Verma is an internal medicine physician who blogs at his self-titled site, Varun Verma, M.D. He can be reached on Twitter @VarunVermaMD. Source
