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COVID-19

March 20, 2020

Information about COVID-19 From Dr. Eric M. Alcouloumre, Emergency Medicine Physician at Hoag Memorial Hospital:

 

“Hi, all.  I know there a lot of resources and a lot of information out there, but I’m finding that many of my friends and family members still remain confused about what it is we are facing.  At their request, I will add my understandings to the discussion and hope that you find it helpful, especially in the context of the California governor’s stay-at-home order.

 

Let me start by saying this shit is real.  We might turn out to get lucky in California as we learn from what occurred in other states and countries that have already been overwhelmed by COVID-19 before our caseload skyrockets.  There is no question that we will be better off if we over-prepare than if we under-prepare, because the equation is truly one of life and death.

 

It won’t be long before somebody you know actually is confirmed to be positive, and many of you may contract the virus yourself.  For most of us, it will be a mild illness and a lot of fear.  Some people who get the virus will get pneumonia and end up in the hospital.  Some people who get this virus will die.

 

At this point, sick or not . . . tested or not . . . we reduce the risk to ourselves and our loved ones by following the simple rules that you have heard hundreds of times in the past few weeks:

 

SOCIAL DISTANCING

 

WASH YOUR HANDS

 

Despite much of what you may have heard, the virus is pretty fragile and if you religiously and compulsively wash your hands with soap and water for 20 seconds, you have mitigated a significant amount of your risk.  If you are distancing yourself from others (6 feet is the rule), you have further mitigated your risk of both receiving and transmitting the virus.

 

People are very concerned about picking up the disease from asymptomatic carriers.  My experts tell me this is not likely to be that big of a source of spread, as the disease is spread primarily by droplets created by coughing and sneezing.  So, simply and obviously, if both carrier and potential recipient are socially distancing  and washing their hands, the likelihood of spread is very low.

 

You do not need to wear a mask.  The mask is not impervious to the virus, and you are more likely to touch the mask, pick up virus off of the outside of the mask and transfer it to your hands and ultimately back to your face.  Also, as you have undoubtedly heard, we are likely to face a mask shortage in the hospitals where we will need them most before this crisis is over.  The exception is if you are coughing and sneezing and possibly have the disease and are around others—in that situation, you should wear the mask to protect others as you might keep droplets from entering the environment around you.  But . . . no surprise . . . it is more important that you maintain social distance and wash your hands! (I’m not done repeating that yet.)

 

The average incubation period for the virus is 5 days, but the range can be 2 to 14 days.  For most people, the first week is a bit like a mild cold.  In the second week, a dry cough develops and again for most people . . . like 85% of us . . . no big deal.  The group that gets sick starts to get short of breath and may progress to pneumonia.  These are the people that will need our hospital resources and should go in for evaluation and treatment.  For most of the others . . .  stay at home, social distancing, and wash your hands!

 

And what about testing?  Recognize that there are a lot of opinions about this, and as the test becomes more available, those opinions and the current rules may change.  Many of my friends and family are frustrated that they can’t get tested and want to know why.  I will do my best to explain and will leave the politics out of it as much as possible.

 

Had we responded back in January with universal testing (which was not available), we might have been able to identify carriers, isolate them, and stop the spread of the disease.  That did not occur.  The value of early testing would have been for us to identify if there was community spread of the disease (as opposed to those with travel risk) when we could have done something about it short of what we are doing now.  We know there is community spread now, and we know it is everywhere.  That horse has left the barn.

 

If today you have no symptoms or mild symptoms and have a positive test, you will need to socially distance yourself and wash your hands.

 

If today you have no symptoms or mild symptoms and have a negative test, you will need to socially distance yourself and wash your hands.

 

If today you have symptoms and are getting short of breath, you should see a doctor and be evaluated which may or may not include a test depending upon the results of that evaluation.  Although you should socially distance yourself and wash your hands, you might require hospitalization.  If that occurs, the test result might be important as your treatment could change . . . for example, you might receive the study drug remdesivir, which we have at Hoag.  So for this situation, the test matters.

 

We are currently not testing people who are worried, think they were exposed, or have no or mild symptoms because regardless of the test result, there is no change in treatment and all of them need to socially distance themselves and wash their hands.  Furthermore, despite what you may have been lead to believe, the capacity to do the test is still limited.  The more tests performed, the greater the impact on the turn around times for the lab to complete the tests and results will take longer to come back for those in whom the results might matter.

 

So if you were at Trader Joe’s last week and heard somebody cough and don’t feel great today, please do not run out and try to get a test.  Do you know what you need to do?  SOCIALLY DISTANCE AND WASH YOUR HANDS!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

That being said . . . the test is available and despite my comments, you or your doctor might choose to get it done.  Not everyone will follow the same rules.  You can get the test today, get your results in 2-4 days, and find out it was negative.  You may choose not to wash your hands and socially distance and get the virus after you tested negative.  So the test for everyone (which may have been a good idea before we had it available) may not be such a great idea today, and for some of us may do more harm than good.

 

Please do not buy into the bullshit on social media like blowing your hairdryer up your nose to kill the virus or proving you don’t have it by holding your breath deeply.  If you want to do something that will make a difference and reduce your risk, you should consider social distancing and washing your hands (did I mention that?)

 

There are some important websites that are updated frequently with information and which you might want to follow:

cdc.gov
ochealthinfo.com  

 

Hoag’s community website at hoag.org also has useful information, including more details around the concepts of social distancing and washing your hands.

 

If you look today at the Orange County Public Health website, you will see 53 total cases and so far no deaths in Orange County; unfortunately, we expect those numbers will both go up dramatically in the next few weeks as we catch up to the rest of the world.  I am hopeful that the extreme measures we have put into place will blunt the curve and reduce the spread of the disease so we don’t face the disaster-level situation that we have seen in China, Italy, and Washington.

 

I will still go to work.  It’s a little scary, but I am proud of the efforts that Hoag and its physician, nursing and administrative leadership are taking to protect the community and reduce the risks to me and my staff.  What you do and how you act may have an impact on the daily risk that I and my physician and nursing colleagues will face, and the severity of what we will deal with in the coming weeks.  Please stay at home.  Social distance.  Wash your hands

 

It’s up to you.  It’s up to all of us.”

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