Coronavirus: 4 Questions to Consider as the Global Pandemic Escalates in our Communities

 In A Changing Planet, Environmental Health, Health & Wellbeing, Healthcare Workforce of the Future

 

 

 

What do these numbers mean? Who is really affected? What can we do?

Thoughts from a nurse practitioner on the frontlines of healthcare

 

ER Nurse Practitioner

 

Hello friends,

As the World Health Organization reports this week that the Coronavirus is now considered a Global Pandemic and the New York Times sent out headlines yesterday that U.S. Cases of Coronavirus Surpass 1,000, I thought it might be a good time to sit down and write a few thoughts to share with my friends and community. I am certainly no expert in epidemiology or viral diseases, but I am a nurse practitioner who works in the frontlines of our healthcare system: the Emergency Roomand I also have a passion for public health, spending most of my life traveling and now running an international health program, MedTreks in Kenya.

There has been a lot of talk of “flattening the bell curve” as we watch communities all over the world begin to be placed on lock-down. What does this mean? 

As I spent most of yesterday speaking with loved ones about the coronavirus (COVID-19) outbreak, I thought I would summarize my key points in a post, that hopefully might provide some helpful information for those who aren’t in the healthcare system or for those who don’t have the time or emotional bandwidth to keep up to date on all the rapidly evolving news stories.

 

Here are the 4 questions I addressed yesterday with my dear ones and I will provide my thoughts on these in the post:

 

    • What do all these numbers mean? How many people are actually dying from this virus? 
    • Is anyone doing a good job at controlling this outbreak? Can we learn something from South Korea? 
    • Who is ultimately at risk? What should be our priorities? Can my child still go to the playground?
    • Should I cancel my spring break plans?  How careful should I really be?
    • Should I let my child still go to the playground and school?

 

 

All good questions…let’s take a breath, look at the scientific evidence, review some of the basics and then enjoy our lives…here we go! 

 

 

 

I have provided my favorite resources on COVID-19 at the end of this post. All the turquoise links are clickable to help navigate you directly to the source.  It is important that we keep the facts straight and the fear factor as low as we can at this point. That said, the situation is rapidly changing and what is posted today might change by tomorrow morning. I will do my best to update my friends and the MedTreks community with resources and thoughts as best I can in the following weeks.

I hope this post is helpful.

Warmly,

~Ari, MedTreks Director 

1. What do all these numbers mean?

The numbers are starting to increase and the fear in our communities is almost palpable. So first, let’s address this numbers game:

Two days ago, the  New York Times sent out a headline that stated U.S Corona cases surpass over 1,000.

A friend asked a really good question: why such a spike in numbers all of a sudden? 

 

Because we are only just starting to expand our testing in the United States.

 

Many of us still don’t have testing readily available in our facilities. For example, the shifts I worked this past week in the ER, we were only testing the patients who were

sick enough to require hospitalization.

 

What does this mean? 

It means the virus could be very well circulating in our communities (very likely at this point) and we really have no clue because all the patients who are not sick enough to require hospital admission, are not getting tested and then getting sent home with regular standard precautions that we give everyone with the flu. Is this bad? Not necessarily, many argue that the precautions for the flu are the exact same we need to take with COVID-19 (more on this later).

So then why are we worried? 

Two things:

  1. Not testing people means that people are spreading the virus without knowing it. They are going home to their elderly grandparents and potentially exposing those who are more vulnerable to the virus.
  2. It dramatically affects our numbers…include this hype about FATALITY RATE – let’s spend some time to break this down. 

 

Fatality Rate: How many people are really dying from this?

Truth: we really have no idea because we have not implemented widespread testing. At this point, taking my hospital for example, if we only test the severely sick patients, then, of course, the ratio of deaths to confirmed cases would be a lot higher- because we are not including all of the other patients who we sent home and are doing just fine. It is an inaccurate picture if we are ONLY testing really sick patients because their outcomes will likely be poorer.

 

For example:

The mortality rate for the Coronavirus has been projected to be anywhere from 0.6-30% (in some reports), with the World Health Organization currently claiming 3.4%.

 

This is strictly a numbers game and it is a moving target. 

 

South Korea Coronavirus

 

2. Is anyone doing a good job at controlling this outbreak? Can we learn something from South Korea? 

 

Well, as our friends at MedCram have pointed out, we might have something to learn from South Korea. They have been performing rigorous testing (unlike our country) for some time now. They have tested over 200,000 people…meaning that their numbers of who have tested positive to the number of deaths related to the virus, gives us a more accurate picture of what the death to the number of cases confirmed really is. The reports coming from South Korea now are showing that the fatality rate is more like 0.6%, which is lower than the WHO report of 3.4%.

Takehome:

The numbers that are coming in the news right now are relative.

Keep sticking to what we know: the majority of people still do JUST FINE with this virus.

Let’s keep watching the experts & the evidence: Worldometer

At this time on March 12th, 6 pm: there have been 134,521 cases confirmed and 68,927 of those cases are recovered.

 

 

3. Who is ultimately at risk?

We have all heard that the elderly and people with underlying medical conditions like heart and lung disease. But the reality is: we are ALL AT RISK. This is now a global pandemic and it is up to ALL OF US to be diligent at helping to stop the spread of the virus, or what we have heard about “Flattening the Curve”. 

Should we go on lockdown in our homes? 

We haven’t received this advice from the authorities at this time, so no, not yet. But it does mean: 

  • Understanding HOW this virus is transmitted and participating in behaviors that are suggested will be crucial in stopping the spread of COVID-19

We have all heard the terms over and over again: 

“Droplet Transmission”

“Cough Etiquette”

“Social Distancing”

“Hand Hygiene”

We all know the recommendations: 1. wipe down surfaces, wash hands for 20 seconds, use hand sanitizer with 60% alcohol, stay at least 6 ft from others, cover your cough and sneeze…

 

But if we choose to go out into the community, what does this really look like:

For those of us who are younger and healthy: it means we start thinking about others who are more vulnerable and changing our behaviors to protect THEM. 

  • Maybe skip the gym or community yoga class and work on a home routine
  • Clean surfaces like shopping carts, tables at restaurants, doorknobs – before AND after you use them
  • Keep hand sanitizer in your car- use it constantly
  • Teach your children a song about how to wash their hands effectively
  • Maybe postpone the family dinner with the grandparents

 

Can my child still go to the playground?

Schools are starting to postpone classes and online format is being implemented..but what about the playground? The answer to this question might change as soon as tomorrow morning. We know that children are Petri dishes of bacteria, some good and some bad. Maybe it is time to have your child kick a soccer ball in the open field rather than participate in storytime at the library or climb all over the jungle gym…and maybe they should stop cuddling so close to grandma and grandpa. Remember: children are less affected by this (thankfully!), but they are still carriers for the virus and can spread it to others.

Speaking of school children, this interesting article explains how Taiwan applies their public health lessons that they learned during the 2003 SARS outbreak, to the current COVID-19 pandemic.

 

 

Coronavirus outbreak

 

 

Ok, but what if I or my family get sick?

It likely will happen and you may or may not have the Coronavirus…but regardless, the basic precautions still stand:

  • Avoid going out into public, crowded spaces
  • Have someone pick up your groceries or order Door Dash (we have to find ways to support our local businesses in these times!)
  • If you are sick enough to want to go to the ER or Clinic- please call ahead and inform them you are coming

 

A friend asked me yesterday if I was scared of the Coronavirus working in the ER. I am not scared for my personal health: I am lucky, I am young and healthy.

What is scary to me: 

Our current healthcare system is already operating at max capacities. Even before COVID-19, hospital beds were full and we now regularly see emergency room patients in the hallway or at the side of the waiting room. When we start testing and more numbers spike, we are going to have more people go into the Emergency Department for treatment and some of these cases will need a higher level of care like Intensive Care Units, leaving fewer beds available for all the other patients who need critical care treatment from their chronic illnesses like heart failure or from a severe accident like a bad car accident.

 

 

COVID outbreak italy

 

 

4. What about Spring Break next week?

Should I cancel my trip to Mexico? Can I still take that road trip to San Francisco?

 

The global climate for travel right now is constantly changing. This morning the U.S. State Department just advised U.S. citizens to reconsider travel abroad due to the global impact of COVID-19. This is a significant change from when I even began writing this post 4 hrs prior. The point is times are changing, rapidly.  At this point, the best thing I recommend is keeping a close eye on the CDC travel warning list for Coronavirus.

Avoiding all international travel might be the next best step in slowing this epidemic. For those of you who are still considering their Spring Break plans to a “low-risk” country at this point in time, here are some thoughts:

  1. If you know you likely will worry constantly on your trip during these uncertain times- it is probably a good idea to postpone your trip
  2. If you are in a higher risk category for health, it might be a good time to reschedule or redesign your itinerary
  3. If you do plan to go on your trip – consider the effects on your life, work and family if the country went on lockdown or you had to undergo a mandatory quarantine…either at home or overseas.
  4. If you have considered various scenarios in this rapidly changing environment and still want to get to the beach in Mexico- then go for it! Here are a few more tips:
    1. Purchase travel insurance that includes medical evacuation insurance – make sure the small print clarifies that it will take you to the destination of your choice rather than the closest medical facility, which may not exactly be what you had in mind when you are on the coast in Kenya.
    2. Enroll in the State Departments STEP Program: this allows U.S. citizens to enroll with the nearest U.S embassy or consulate and you receive important updates about safety and travel-related plans pertaining to your destination. 

What about local road trips for Spring Break?

I am heading to San Francisco this weekend. At this point in time, our country is not on lockdown, travel with certain cautions would be my suggestion.

Definitely limit the amount of time spent in crowded areas (grocery stores, restaurants, libraries)

Make hand washing your favorite thing to do: after basically any activity. Put some hand sanitizer in your car, using it every time you leave/enter your car.

 

 

Takeaways: 

 

This virus is new. We know it is different and rapidly spreading…we don’t really have any idea how bad it is going to get..but it will get worse before it gets better. Time to sit down and rethink some of the plans you have made for the next few months, realizing that the situation may change and having a spirit of flexibility is the one thing that will keep us all sane.

Most cases are mild: especially in children and young adults.

Being frozen with fear is not the solution. Stick to the facts. Keep watching the science from the experts. If you are sick, stay home. If you are worried, call your healthcare provider. If you can stay out of the ER, that is best.

Back to the basics. We have had many public health disasters in the past…we get through them, but more successfully if we implement the basic public health hygiene practices..all the time.

 

I will do my best to share updates and thoughts over the next few weeks. These are uncertain times but it is so important to not drown ourselves in fear. Take care of yourself, your loved ones and be constantly thinking about: what is the best thing I can do for my community today? 

I hope this was helpful. Resources below. 

~ Ari 

 

 

Resources 

 

Here are the best sources to keep an eye on as this continues to progress 

Fake news and pseudoscience are rampant these days and they are especially harmful during these uncertain times. Try to stick to FACTS & SCIENCE. Please.

 

World Health Organization

They are the experts. I like taking a look at the Situation Reports

Centers for Disease Control (CDC)

I share the CDC website with patients and loved ones constantly-, especially for travel-related questions. They have designed some helpful handouts and infographics as well.

Worldometer:

I like checking this report daily as it gives some of the most up to date numbers.

MedCram:

I may be biased but these guys are rocking some daily video updates related to the Coronavirus. I get tired of reading news articles- they tend to cover the most up to date and fascinating articles related to COVID-19. You can also find their free videos on YouTube.

 

 

If you need a little quick review of the COVID-19 virus, here ya go! 

Is the Coronavirus really like the flu?

Let’s start with a few basics…

What is Coronavirus?

The disease is now called: COVID-19

The virus strain is: SARS-CoV-2

This virus is part of a family of viruses known as the Coronaviruses (4 of these viruses are common in causing what we know as the “common cold”)

What are the symptoms:

fever, cough, congestion and/or difficulty breathing.

When do symptoms occur:

2-14 days after virus exposure

Is the Coronavirus new? 

This particular strain, the SARS-CoV-2 is new yes. Likely originating in bats. This virus is spreading so quickly because unlike other viral illnesses that have been around longer, our populations have not developed an immune response to it, known as “herd immunity”. It is highly contagious. And there is currently no vaccine.

 

What does “Droplet Transmission” mean? How is the virus spread? Should I be wearing a mask?

“Droplet Transmission” – meaning the virus is spread through droplets, from sneezing and coughing. This is also the case for other viruses like flu.

So what about a mask: the average “surgical” mask that you purchase at the local pharmacy, will only help if YOU are the one that has respiratory symptoms- so summary: this protects OTHERS from getting sick from the virus particles that you cough or sneeze into the environment. Wearing a mask when you are not sick, does not protect you from others transmitting the virus to you (unless it is a more fancy mask like an N-95)

Some data suggest that the virus could be spread through airborne transmission, meaning the smaller particles that emerge from sneezing or breathing, could remain in the air for longer periods of time and be transmitted to the next person…the data is unclear on this at this time. 

 

Why should I be wiping surfaces?

It is called “Contact Transmission”– something that a lot of us forget about when we are out about during our day. Basically someone sneezes get their virus droplets on a surface such as a counter, a doorknob or the handles of a treadmill…and those virus droplets can survive on these inanimate objects for up to a week (or even longer, we don’t really know yet)!

I don’t like using bleach- is that the best product? 

The Environmental Protection Agency has a list of disinfectants that is worth taking a look at.

Ok but yeah…I get it, wipe the snot off the kitchen table..so why is Costco and every other grocery store out of toilet paper? 

Good question…yet one more reason to wash your hands and not shake hands with others while there is a toilet paper shortage 🙂

 

Hand Hygiene: most of us do it wrong, every single day.

*** The Best way to wash your hands: takes 40-60 seconds. wet hands and wrists with water, keep hands lower than elbows, apply soap products in the palm of your hand. Rub hands together for 15 seconds, interlace fingers and rub back and forth, clean under fingernails, scrub wrists and thumbs, rinse hands under running water. Dry with a paper towel. Use a clean paper towel to turn off the water faucet and open the bathroom door.

 

We already talked about wiping down all surfaces frequently- the follow up is also don’t touch your face with your hands...which is harder than you think it might be!

What about Cough Etiquette? That basically means coughing into a sleeve or tissue and wearing a mask when you are sick with upper respiratory symptoms.

Time for a new greeting– avoid shaking hands, maybe forever? It’s really not the most hygienic practice anyways…I think we can learn from other cultures on this one and start implementing the bow or prayer position as a greeting.

Crowd distancing: this basically means having 6ft of the distance between you and someone else..but it also means, avoiding large gatherings if possible. It also means that if you are sick or not feeling well…skip your yoga, do home workouts rather than going to the gym, have someone else pick up your groceries- basically stay home, rest. It is the best solution for EVERYONE.

 

COVID-19 outbreak

 

Hoping you all move through these next months healthy, motivated & empowered. 

 

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