by HOWARD J. LUKS, MD, JOEL TOPF, MD, ETHAN J. WEISS, MD, WENDY SUE SWANSON, MD, BRYAN VARTABEDIAN, MD, CARRIE DIULUS, MD, NANCY YEN SHIPLEY, MD, AND DR. ERIC LEVI
“Everything we do before a pandemic will seem alarmist. Everything we do after will seem inadequate.”
– Michael Leavitt
The COVID-19 pandemic has reached a point where containment is no longer possible. The COVID-19 threat is real, and rapidly getting worse. Many of you are very nervous; some are unsure of the validity of the information you are reading. As physician leaders, we felt it was important to craft a resource you can rely on as being scientifically accurate and one which contains as much actionable information and guidance as possible.
Accurate, actionable information during an epidemic can save lives. Physicians are on the front line of this epidemic. Not only are we treating the sick, but we are also cringing at the misinformation spread through both traditional broadcast and social media. Evidence matters. Unfortunately, evidence is often slow, methodical, and boring and has a tough time against clicky headlines and exaggeration. We believe that an accurate representation of the current COVID-19 pandemic followed by a set of actionable steps you, your loved ones, politicians, and local officials can utilize is of paramount importance and ultimately could save tens of thousands of lives.
There are only 2,177 cases: Why is everyone so worried?
If only a snapshot in time had relevance, then perhaps stating that only there are “only” 2,177 cases (March 14, 2020) would be relevant and somewhat comforting. Italy has over 15,000 cases today; they only had a few hundred cases a week ago. Stating that we only have 1,600 cases today is absolutely irrelevant in the face of a pandemic virus spreading under exponential conditions. We will help put the term exponential spread into context down below.
Exponential spread
Exponential math is very hard to grasp. Every person with the COVID-19 virus infects approximately two people. Some less, some more. The infection rate doubles every six days. That means that if 50,000 people have the virus today, then in 6 days, 100,000 people will have it. In another 12 days it’s 400,000 and less than two weeks later it’s over a million people. We have 330 million people in the US. The experts expect that 40-70% of people will be infected. Exponential growth does not take that long to get to those scary high numbers. Every six days, we delay the number of infections double. This YouTube video does a great job of explaining this.
What should we do? The importance of social isolation.
Containment of COVID-19 is no longer possible. The virus is already in the country and is currently spreading. We need to slow the spread. Mitigation is the best current strategy. It involves strict social isolation. If 50% of the U.S. population becomes infected, 5% of infected people will need a ventilator in an ICU, and if we have only a limited number of ventilators available in the country, you can quickly see the issue at hand.
This is an extremely time-sensitive and serious issue that needs to be addressed now. We can’t simply manufacture the number of ventilators necessary. We need to slow the spread and decrease the overall rate at which people will be coming to the hospital.
We use the description: We must flatten the curve. That means that we need to slow the rate of infection so that the number of people who need hospital services remains in the range that our health care system can supply. In mitigation, we are no longer trying to contain the virus; we are merely trying to slow the rate of infection to keep the health care system from collapsing.
Who should follow our suggested social isolation measures? EVERYONE. If you do not need to go out for a mission-critical purpose, do not. Again, you WILL be saving the lives of at-risk members of your own family, as well as people you will never have the pleasure of meeting.
All of you can save lives starting now.
The actions you take starting today will save the lives of people you will never meet.
Mitigation measures for COVID-19
- Support your schools’ decisions to close: Proactive school closings save more lives than reactive school closings. Your schools should close now … before infections are present. Closed schools do not mean playdates for children – this counteracts the social distancing the school closures are meant to create in the first place.
- 6 feet: The COVID-19 virus spreads through droplets. They can move 6 feet before gravity brings them to earth. Stay 6 feet away from people if you need to go outside.
- Meticulous hand washing: Wash thoroughly and wash often. Alcohol-based hand sanitizer works well if your hands are otherwise clean.
- Do not touch your face. This is hard. This is a learned skill: Practice often.
- Clean doorknobs, toilets, cellphones, countertops, refrigerator handles, and so on many times each day. The virus could live on certain surfaces for 4-72 hours.
- If you can work from home, work from home.
- No tournaments, no sports events, no soccer, baseball, dance, volleyball, softball, gymnastics, concerts, martial arts, etc. We don’t care how much they claim they will clean the equipment.
- Cancel vacation travel. We know you planned this for a long time. You will be saving many lives by doing so … perhaps someone you know.
- Cancel weddings/ bar/bat mitzvahs, birthday parties, and so on. Help other people live so they can celebrate future events too.
- If you are over 60 years old, you should stay home. You should only go out if there is a critical need.
- If you have parents/grandparents in a nursing home, you should consider moving them home for now.
- Do not congregate in a restaurant, bar, etc. Again, you will save the lives of people you will never meet.
- If you feel sick, stay home. It doesn’t matter if you don’t feel too sick. Going to work will put countless other people at risk of suffering or dying.
- Cancel all business travel. Your life and the lives of others are more important.
- Expect supply chain issues: Work with your doctor to try to get a three month supply of medication.
- Many grocery stores have order ahead options with either pick up or delivery. There are online grocery delivery services available in many areas. Wash your hands thoroughly after unpacking groceries.