We chose the bars over the schools

It appears that the limit of our national vigilance is somewhere around three months. We descended from the unified heights of staying home and supporting those of us on the front lines to a fit-for-cable news battle over the political philosophy of a face covering. It was only three short months after the shut down that many states decided that the crisis was over and the people had had enough. The push to get the economy going again led to the opening up of bars, salons, restaurants, and public beaches. This was in spite of the fact that the cases in those states had not been falling for very long and were far from zero. The coronavirus had different plans. These states are now shutting back down again.

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There Will Be No Second Wave

There has been talk from the very beginning of the pandemic of a concern of a “second wave” of infections that could hit after the first surge dies down. The idea that the virus could come back again after going away is based on historical precedent. The spanish flu had such a pattern. There were 3 distinct waves of illness during that pandemic, starting in March 1918 and subsiding by summer of  1919. The pandemic peaked in the U.S. during the second wave, in the fall of 1918. This highly fatal second wave was responsible for most of the U.S. deaths attributed to the pandemic and was reason for concern with COVID-19. Considering how bad the first wave was it was quite scary to think that this first wave was the “small” bump on the graph. There will be no second wave.

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Do masks really help?

I have had a recent change in uniform at the hospital.  Just like everyone else I continue to wear a surgical mask all the time (unless I’m in my private office) but previously, when going into the COVID-19 patients’ rooms, I would double mask with a surgical mask on top of an N95.  If you want to try this at home, put on an N95 mask then a surgical mask on top of that.  Then put on a gown and gloves.  Next, go into a room with a negative pressure device that makes as much noise as industrial fan.  Alternatively, put a garbage bag over your head, tie it around your neck, turn on a vacuum cleaner, and then try to have conversation with someone who is deathly ill.  You have no idea the extent of the heroism of frontline health workers in this pandemic who suffer through this for hours upon hours, day after day. 

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New (old) drug proven to save lives

He was a very pleasant and healthy 42 year old guy.  He was a bit overweight and had mild diabetes, but otherwise had no real problems.  He had plans to get married in just a few months to his long time girlfriend.  Then the coronavirus hit the nation . Then it hit him.  He got sick in the beginning of May but had it not so bad at first.  He had a mild cough, aches, and fatigue but he wasn’t completely incapacitated.  It was nothing like the horror stories he had seen on TV.

Then, one morning he woke up and something was different.  He had a high fever and felt terrible, much worse than the previous few days.  It was the fact that he was a little short of breath that was most concerning.  Being engaged to a nurse meant that ignoring the symptoms was not an option and he was convinced to go to the ER under a bit of relationship duress.  He got the usual workup – x-ray, blood tests, vital signs.  The ER doc thought about sending him home because he looked so good but his oxygen was a bit lower than normal so, she thought the better of it and he was admitted under observation.

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Is this the second wave?

I’m writing this half asleep having just finished a night shift in the ICU. The air in the hospital had been much more relaxed over the past few weeks. After several weeks of double digit COVID patients in the ICU, we were down to only one. There was a period where the ER had not seen a new case in several days. The masks were getting a bit looser. The situation was even more relaxed around town as the governmental restrictions are easing and we are moving through the “phases”. All the doctors and nurses I know, however, were not at ease. After watching the protests over the killing of George Floyd, we worried about the triggering of a second wave.

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Are asymptomatic carriers a threat?

The issue of asymptomatic spread of SARS CoV-2 has cast a cloud over the pandemic. We as humans are hardwired to fear that which is invisible more than that which is visible. The idea that thousands of individuals could be walking around spreading the virus without knowing it is truly terrifying. I sometimes find myself looking at everyone as as a threat, not just those with a cough. Unfortunately, as with everything else in this pandemic, the virus doesn’t seem to care about our anxieties and is intent on spreading any way it pleases. The day supporting asymptomatic spread has strongly influenced the recommendations for mask wearing that (almost) all of us have been following.

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Don’t believe (almost) anything you read

Human beings really hate uncertainty in a way that impacts our lives in many profound ways. We will predictably choose to stay in a bad situation rather than make a choice of uncertain outcome. How many people have stayed in bad relationships, bad jobs, or bad living environments even going out on their own may make things better but not for certain. It is for this reason that a pandemic such as this is so maddening. This is a new virus that we do not know much about but the situation is so severe that we are desperate for tiny snippets of hope. People understandably expect the information from the scientific authorities to be clear, accurate, and unchanging. Unfortunately the current reality is not conducive to information that is always clear, accurate, or unchanging.

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The virus is mutating!

This post will attempt to answer the following questions:

  1. Is the coronavirus mutating?
  2. What does that mean?
  3. Should I be worried about this?
  4. What can I do if the virus is mutating?

As if things aren’t scary enough with the illness, deaths, fear of invisible virus particles, and economic meltdown the news media has done what they do best and added to our collective anxiety. May 5th there was a report published in the Los Angeles Times that a “a now-dominant strain of the coronavirus could be more contagious than [the] original.”. This was based on the online posting of a pre-print of a research study that describing a new “strain” of the novel coronavirus. This new “strain”, the team wrote, “began spreading in Europe in early February.” Whenever it appeared in a new place, including the U.S., it rapidly rose to dominance. Its success, the team suggested, is likely due to a single mutation, which is now “of urgent concern.”

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Why contact tracing is so crucial

It was what seems like years ago that I locked myself in my basement sick with COVID-19. It was way back when when the numbers were all going up, no one knew how to make a homemade face mask, and most people had never heard of Zoom. While I was down there in my basement feverish and achy I had an experience that I did not put a lot of thought into at the time. I was too bewildered and overwhelmed by the state of the world to pay too much attention but one phone call I received may turn out to be the secret to safely opening our society up again.

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