Take home message: This is a marathon, not a sprint. Take care of yourself, get your sleep, exercise, meditate daily.
Some positive things: the healthcare system is holding up. New York City is the most challenging and military doctors, nurses, and respiratory therapists are helping there. In California, Emergency Rooms are not overcrowded as many individuals with “routine” issues are avoiding the emergency room. One doctor reports people are waiting a little too long on appendicitis—often showing up after a partial rupture has occurred, rather than earlier! Cedars ICU patient census is levelling off, not going up!
How about those antibody tests? We want accurate ones, so it is taking labs and companies times to get this right. We don’t want overlap with the other coronavirus infections that cause colds that people may have already had. We want precise tests, sensitive and specific, to Covid-19. We also need to know how to interpret these tests in the context of this virus. I will keep you posted here and on facebook.
The duration of this illness continues to be troubling for patients, even in mild to moderate cases. Some of my patients are sick for 3-4 weeks, a lot longer than a “flu” and have varied symptoms that come and go and come back during those weeks. Some people bounce back after a week, so there is a lot of variability.
I have attended Cedars-Sinai Zoom conferences and a number of therapeutic agents are being tried and studied, mostly in sicker patients, to fight the virus, to calm the body’s over active immune response to the virus (so-called Cytokine storm), and to help the patient recover. Cedars reports extubating (removing form ventilator) as many people as they are putting on the ventilator, sometimes more, which is a good sign that people can recover, even the sickest. Most people, as I have mentioned don’t get sick enough to be in the hospital and many children have asymptomatic infections or cold-like symptoms. They are likely contagious during these minor illnesses.
When should you contact our office? Really, anytime if you have questions. I am doing telemedicine 3-4 days a week from home or office. I am answering portal questions daily. I see patients in office mostly Monday, a small number who need to be physically seen. We both wear a mask. Possible Covid patients who need a swab and can’t get it elsewhere are now seen in their car, with the window partially rolled down, in the parking lot. I wear full protective gear. I have a limited amount of PPE and a limited number of swabs. EXER Urgent Care is doing parking lot testing at some of their centers with online registration in advance. Testing is still not as available as I think it should be.
Who goes to the hospital? Really—shortness of breath, shortness of breath with walking to the bathroom for example, in the context of fevers, chills, aches, etc. e. a Covid-19 infection. Most people are better off staying home, if not short of breath.
Finally, there are now studies being done to see how many people are infected in California and results should be in soon. This is very important in understanding the rate of infection so we can have more realistic “Fatality rates”. Ignore what you see on the media that compares “confirmed cases” to deaths. “Confirmed” usually means hospitalized or at least they had a Covid-19 swab that was positive. We know most people are not getting that test and are self-isolating at home.
A big risk factor for severity is obesity. If you are overweight, what a great time to lose weight to reduce your risk for a severe Covid case. Healthy eating, daily exercise, lower the calories and carbs. Weigh yourself weekly if you need to lose weight.
Wishing you patience,
David Schechter, M.D. facebook.com/DSMDCulverCity