Posting the following for Aviator Doc, who is hard at work in his Emergency Department. He is up to his eyebrows in patients, as you might expect, and does not have time to shepherd a diary this evening.
Aviator Doc posted this earlier on his Facebook page, and it has gone viral (pun entirely accidental).
He told me to go ahead and post what he wrote, given the urgency and importance of spreading as much good information as humanly possible. I am not blockquoting in order to make this easier to read.
by Aviator Doc:
“As an ER physician, and someone who teaches medicine to PA students, NP students and medical students, I'd like to take a few minutes of your time to explain what you really need to know about this situation we are dealing with in coronavirus. I will try not to inject opinion (even though I tend to be very opinionated) into this as much as possible, since there are plenty of opinions out there, and some of them are horribly wrong. I will try to stick to the science.
First, a lesson in immunology and virology, so you understand what we are dealing with. Again, I'll try to avoid technical terms, and put it in layman's language as much as possible.
Viruses: They may be one of the oldest forms of life, and seem to be as old as cellular life on this planet. They are small, much smaller than bacteria, being on an average only a 100th the size of an average bacterium. They were not discovered until near the end of the 19th century, and were not directly visualized until the invention of the electron microscope in the 1930s.
What viruses are, basically, is a parasite. They are packet of genetic information, enclosed in an envelope of fats and protein. Like most forms of life, including us, they exist to replicate themselves. They have no means of doing this themselves, and do so by injecting themselves into the cells of a host organism, and hijacking their means of reproduction. A virus takes over a cell, and makes thousands of copies of itself. Obviously, being hijacked is not a good thing for the host, since it makes the cell that's infected unable to do it's job.
When you get infected with a virus, your immune system kicks into overdrive, and tries to rid itself of whatever is infecting it. Whatever symptoms you get from an infection are mostly a result of your body waging war on an invader. Also, some symptoms are a result of the virus or bacteria's effort to spread itself to other organisms, like coughing, sneezing, and stuff like diarrhea. An infected organism, a person with the virus, for example, is called a VECTOR, and stuff that you sneeze on, cough on, poop on, barf on, or touch when you are infected is called a 'FOMITE'.
Some viruses spread by what we call 'droplet transmission', which is sneezing or coughing, some do it by exchange of bodily fluids, and some do it by what is called 'fecal-oral' transmission, which sounds disgusting, and is. (There was a famous experiment some years ago where they fed a bunch of toddlers in a daycare some oral dye, that would glow when you shined a black light on it. The idea was to see where the poop went. They came back days later, turned off the lights in the daycare, and literally the entire room, from about waist high down, lit up. So, yeah, 'fecal-oral' really is a thing.
WASH YOUR HANDS.
You with me so far? Good.
Immunology:
As I said above, your immune system exists to protect you from stuff like viruses, bacteria, and other nasties. It does this in various ways, but what it does essentially, is detect the invasion, and launch cellular soldiers to attack the invader. Unfortunately, in some of us, the immune system isn't as great as it needs to be, or used to be. This includes the very young, the very old, and people with autoimmune diseases, or who have to take medicine to suppress their immune system, like transplant patients, or anyone taking stuff like steroids. These are usually the people who are most at risk in epidemics.
Way back in the 1800's the great Louis Pasteur discovered that he could trick the immune system into thinking it was under attack, and make it produce antibodies, one type of those cellular soldiers I was talking about, and by doing so, your body would now instantly recognize an attack by that particular bug, giving you what we call 'immunity'. Some individuals also appear to have natural immunity to certain things.
Treatment:
For bacteria, we have antibiotics, for most of them that we have identified. Unfortunately, there are now resistant organisms, which we have great difficulty treating because they have adapted to the drugs we use to fight them off. One example would be MRSA, or Methicillin Resistant Staph Aureus.
(When your healthcare provider gives you a prescription of antibiotics, FINISH THE DAMN STUFF. Not doing so contributes greatly to the rise of the Superbugs. So does badgering us to give you a prescription for something you don't actually need.)
Treating viruses, though, is a whole ‘nother ballgame.
We really don't have very many effective drugs to treat viruses.
We do have some drugs that are effective for a few things, like Hep C, HIV, shingles, herpes, and a few other things, but mostly, we got nothing. Viral cures just DON'T EXIST for the most part.
Which brings me, finally, to coronavirus.
There is a boatload of information out there, and most of it is wrong or misinterpreted. Especially on Facebook and other social media.
The fact is, there is a lot that we just don't know yet, but we are learning fast. First, it seems to be transmitted by droplet transmission, but there is some evidence that it may be transmitted on fomites (remember, that's an object the infected person has touched or spread the infection onto) as well.
HANDWASHING:
Experimentation is underway to see just how long the virus can live outside the human body, because there is a wide variation among viruses. Some can hang around for a good while, which is why your kid can get, say, flu or RSV from sitting in a buggy at WalMart or Kroger, if you didn't wipe off the thing with those disinfectant wipes at the door. Five minutes before you stuck Junior in there, some other mom or dad just pulled their little person out of there, after he/she coughed, sneezed and snotted all over it. Did I mention fecal-oral transmission? Yeah. That.
THIS is why handwashing, and not getting your yucky, nasty hands around your mouth, nose and eyes are important. They are germ laden.
MASKS:
We use masks in healthcare because we are in close proximity to infected people, and they keep us from inhaling the droplets, and we put them on the patient, to keep them from spraying us and the area with droplets. In some cases we do wear them to prevent US from giving the patient germs. So... Don't wear masks. They are just not that effective out in public. They might make you feel better, but they don't help as much as washing your hands.
QUARANTINE:
Obviously, the best way not to get infected, is to stay away from infected people. Quarantining infected individuals works, but the cat is probably already out of the bag, and we aren't China. We can't lock down over half the country when there are now cases all over the country. Having said that, minimizing your exposure is a good idea. Avoid large crowds, because there will always be some idiot coughing or sneezing and not covering their mouth or nose. Work from home if possible, but of course for most of us, it isn't. Wash your hands, use hand sanitizer, try not to touch your face, and try to maintain a decent personal space.
BY THE NUMBERS:
Again, there are a ton of statistics being thrown around, and the fact is, there are too many variables to have them to be very accurate. The World Health Organization is saying that they are seeing a 3.4% mortality rate.
Globally, this might be correct, but remember, they are dealing with the entire world, which includes a lot of third world countries where the mortality rate is far higher.
Iran, for example, is reporting above an 11% mortality rate.
Also, because the response has been so drastically varied from country to country, the actual number of infected versus died is not uniform and that skews the numbers. Some countries have a pretty good idea of how many infected they have, like South Korea, and others have absolutely no clue.
Like, um... us, for example. We haven't even tested half as many people total as Korea tests DAILY yet.
Anyway, the best model we have to compare ourselves (society wise) to right now is South Korea. They are a first world country with a top notch medical system, where they are doing extensive widespread testing, about 10,000 people a day. They are calculating a mortality rate at about 0.7% which is probably the most accurate we've got right now.
THIS IS REALLY NO WORSE THAN THE FLU, RIGHT?
Wrong.
If the numbers we are seeing in South Korea are accurate, and they appear to be, then this is (possibly) as much as (roughly) SEVEN TIMES worse than the flu, which kills about 50,000 Americans a year. So yeah, this has the potential to be worse than the flu, (Edit: as a friend pointed out, statistically, our samples are not identical, so we don't yet know how we will compare to South Korea, but an epidemiologist friend advises that this is as close to an accurate sample as we have at this time.)
HOWEVER...the point is, it's not the Black Death, either. Or Smallpox, or Anthrax, or Ebola.
And it appears to not be anywhere near the mortality rate of the 1918 Influenza epidemic that had a 2% mortality rate.
So, while there certainly is cause for concern, especially if you are in a high risk group, 99.3 % of us are going to be fine.
So, when you hear the words 'pandemic' it just means that it's very widespread, not that we are about to be living in a "Walking Dead" scenario.
Make sense?
I HAVE A FEVER. SHOULD I GO TO THE HOSPITAL AND GET TESTED?
No. As I said above, we have no cure. We have no vaccine. One is not coming any time soon, no matter what the politicians say. Testing drugs and vaccines is laborious and takes time. LOTS of time. All we can do right now is treat the symptoms, which you can mostly do at home. Take over the counter medicines for the symptoms, and drink lots of fluids. If you are in a high risk group, I'd be more likely to pull the trigger on going to the hospital than someone who is pretty healthy. This seems to be hitting older people the hardest, and happily, mostly leaves kids alone. They get enough bad infections as it is, so that's good.
Now, obviously, if you very become short of breath, cannot keep fluids down, or other serious symptoms, then by all means, go to a healthcare facility. If you go to a hospital ER, you will be seen by a triage nurse, who will take your vital signs, and evaluate you. If you are not critically ill, then you may have to wait to be seen. We expect to be inundated with people who are sick over the next weeks and probably months. We HAVE to see the most critically ill first. That includes stuff we normally see, like strokes, heart attacks, trauma and so forth.
Triage means the most injured and sick get seen first. If you are stable, and otherwise healthy, you may be in for a long wait, if things go the way we suspect. Oh, and don't call the ambulance thinking you get to go to the head of the line. If you are stable, and otherwise healthy, you may get sent straight to the waiting room, plus you just used a resource that might have been needed for someone who was critically injured or ill.
FROM ME, MY ER STAFF (AND PROBABLY EVERY OTHER EMERGENCY ROOM STAFF OUT THERE) TO YOU:
Please be patient with us. We will be working long hours with very sick people, because this IS going to be worse than flu season, by all our predictive models. If you don't NEED to be in the ER, I recommend staying away. If you don't have an infection, you can certainly shop for one in the ER waiting room.
If you are sick, we will see you as soon as we possibly can, but remember, every ER out there has a finite number of rooms and only so much space in our hallways. When those beds are full, they are full, and we have no where to put you, so you sit in the waiting room until someone occupying those beds is discharged or admitted. We wish we had as many rooms and staff as we wanted, but the fact is, we won't. Neither will any other ER, but if you think you can get better service at, say, Mount St. Elsewhere Medical Center, then you are welcome to sit in their waiting room for hours, instead of ours. Honestly, though, all of us are going to be in the same boat pretty soon. We will do the very best we can, so forgive us if we can't get you in a room, or if we aren't there instantly when you hit the call button or need another glass of water. Thanks for your patience and understanding.
LAST:
We are all Americans, whether we are black, white, Asian, Arabic, Native American or lime green.
Whether you are a Republican, Democrat, Socialist, Green, Libertarian, Whig or whatever, we, as Americans, need to pull together because this is going to be a difficult period. Even though I do not believe it's going to be anywhere near a Worst Case Scenario, there is certainly the potential for some significant disruptions in our lives and our society.
We need to be patient and understanding with one another. Lately, I've seen so much hatred, anger and division in our country, that, although I would not have wished this on us, perhaps this is what we needed to create some sense of community again.
Good luck, everyone.”
Written by Aviator Doc.
Wednesday, Mar 11, 2020 · 2:24:04 PM +00:00 · Otteray Scribe
Just heard from Aviator Doc. He posted this as a comment below, but putting it here for everyone to see. AD writes:
Good morning everyone.
I appreciate the input.
There are some very insightful replies, comments, and suggestions that I simply don't have time right now to respond to, but I'll try when I get time.
Couple of quick things though:
Viruses: someone pointed out that viruses aren't actually "life". This is correct if you use the cellular definition of life. Viruses are somewhere in the middle. While they aren't truly "alive" they certainly aren't inanimate objects either.
One of the odd intersections of science and philosophy.
Anyway, I wrote this to be easy to understand, so I glossed over a bit in the process. My apologies to persons who actually read and comprehend on a college level, which will be most of the audience here. I wrote this for Facebook, which is only a rung or two above 4chan.
Masks: I didn't mean to imply that masks are useless, but for most people they aren't near as useful as other precautions. If you are in a high risk group, and may be in an area that infected people are spraying droplets, it could help. We use them, but we have people coughing and sneezing in our faces constantly. (They also barf, pee and poo on us too, but I digress.)
Mortality rates: That number will fluctuate. South Korea has the best data, as of two days ago. They can't even tell us here how many people have been tested. That's pretty pathetic.
Anyway, the overall numbers could be higher if we get widespread infections in the vulnerable populations, like the nursing home in Washington. They got decimated.
They could be much lower, if our response improves, but the current POTUS can't be convinced this is seriously, apparently. On the upside, and quite shockingly, frankly, Pence seems to be dealing with this far better than he did with the HIV outbreak in Indiana, which he totally botched.
Overall though, this was grossly mishandled. China bought us a month. The Trump administration wasted it.
Off my soapbox and back to work.
Good luck, everyone.