Medicine For People!

April 2020: COVID-19 Update

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  • Executive Summary
  • Office Operations during the Lockdown
  • Essential YouTube Video
  • The Diamond Princess
  • Fatality Rates
  • Comparisons Around the Planet
  • More about Viruses and Epidemics in Previous Newsletters
  • Public Health
  • Disasters and Personal Readiness
  • We'll Get Through This

Executive Summary

One virus will not make you sick. You've got to run into a bunch of them. The more of them you contact, the more likely you are to catch it and the sicker you will be. So to keep your own risk down, be careful what you touch, wash your hands, keep your distance, use your head.

You and your friends may be among the many who carry the virus without knowing it. To protect your loved ones, cover your mouth when you cough and wear a mask. The mask will also help you keep your hands away from your face in case you have touched the wrong thing. You don't need a medical-grade mask. Although some of the virus survives on surfaces for a few days, it starts dying right away so don't turn yourself into a hermit.

The death rate is lower than you would guess from the news articles. Every day in New York State about 415 people die. Most don't make the newspapers. Yesterday about 500 died from COVID-19. New York hospitals and morgues don't have the extra capacity to handle that, so it deserves the front page. That is tragic for each of those persons and their loved ones, and frightening for the remaining 19.5 million New Yorkers, but most of us will wind up among the survivors.

Office Operations during the Lockdown

I'm coming to work at 8:30 or 9 am; I'm guarding my sleep time. Staff will be in earlier as needed for those of you who need earlier service.

Just like any other medical office, we're asking you to help us reduce transmission of illness:

  • Cough and a fever over 100.4 degrees? Call 360-344-3094 to reach the Jefferson Healthcare Covid-19 hotline.
  • Cough without a fever? Call us. Wear a mask when you come to the clinic. If you don't have one, we'll come out to your car to give it to you.
  • No cough? When you come, please enter and accept our invitation to wash your hands.
  • We will be wearing masks and taking protective measures during your visit. Please don't take it personally. We don't want to give this virus to you any more than you want to give it us.
  • When physical examination is not needed, we'll render care via telemedicine, if agreeable to you. It is easiest by telephone. If you've something to show me, we can use Zoom. It's user-friendly; all you need to do is follow the instructions on your laptop screen. Please call us to set up an appointment.

Essential YouTube Video

What is our risk? How bad is it going to be? Are we over-reacting? Dr. Ioannidis, a Stanford physician, addresses these questions. You will feel better for watching it.

The Diamond Princess

Dr. Ioannidis points out that even in a population with high exposure to the virus, such as the 3,711 passengers and crew members cooped up on the cruise ship Diamond Princess, the death rate was about 0.3%.

Had you been a passenger on the Diamond Princess, the odds...

  • of the virus infecting you was 19%
  • of it making you ill to any degree 10%
  • of it making you seriously ill 0.4%
  • of it killing you 0.3%

These numbers are a little more recent than those given by professor Ioannidis in his video.

The joke goes that cruise ship passengers are usually newly-weds or nearly-deads. Almost all who died were 70 years of age or older. Death on a cruise ship is common enough that they all have a morgue sufficient for one to three people.

I'm not suggesting you avoid cruises. The Diamond Princess simply gave us a unique opportunity to isolate a population and tabulate everything that happened to that population.

Fatality Rates

The population fatality rate is the death rate among the whole population. Onboard the Diamond Princess, that is the 0.3%.

The case fatality rate is the number of deaths among those infected. Onboard the Diamond Princess, that is at this writing about 1.7%.

Comparisons Around the Planet

The Center for Evidence Based Medicine tracks the case-fatality rates in different countries.

Let's look at the numbers on this as of April 4th, 2020.

Numbers as of April 4, 2020

  Total Population Cases Deaths Cases per million people Case fatality rate
South Korea 51,500,000 10062 174 200 1.7%
Germany 82,800,000 89126 1200 1100 1.3%
New York state 19,540,000 114775 3914 5900 3.4%

South Korea has far fewer cases than Germany or New York because they started testing early and widely to make sure infected people didn't spread the illness. They have been able to keep their economy going much better than we have as a result.

Germany has the best case fatality rate because they have excess capacity in their ICUs and a health care system that all can access, so sick people aren't out spreading the disease. They lagged South Korea on the testing but are far ahead of us.

The land of the free and the home of the brave has neither of those things.

More About Viruses and Epidemics in Previous Newsletters

Remember the anthrax scare of 2001? Tom Locke, MD, our Public Health Officer, briefed us then, as he is briefing us now, about how to handle the situation.

Since the anthrax scare, we've seen SARS, swine flu, MERS, Ebola and now the new coronavirus. Check out Wikipedia for about 40 or 50 other epidemics of viruses and bacteria.1 Most of these didn't reach our shores. Some did. This one is making the biggest splash.

Public Health

You may grouse about public health when they insist you build your septic system correctly, or when you have a side effect from an immunization, but no medical endeavor has saved more lives. No matter how serious any social problem gets, you'd better pray that those sanitation trucks stay on the road. If your child expresses an interest in those jobs, or in any aspect of public health, I'd encourage them. No matter what the disaster, they will be essential workers.

Our own Public Health Department coordinates with the Washington State Department of Health. Each works every day to enhance our readiness for emergencies such as the coronavirus.

Disasters and Personal Readiness

Disasters and disruptions are inevitable and we each have a duty to be responsible for ourselves and not push it off on our neighbors. Please spend part of your lockdown time making a list of what you'll need to do to prepare for the next emergency. Take the actions you can start on now and finish when we can get out and around once more.

We'll Get Through This

There's not a lot of glitz in public health. Right now, it's focused on identification of people with contagious illness such as COVID-19, quarantine, contact tracing, development of a vaccine, convincing people to accept the vaccine, sanitizing work surfaces, hand washing, doorknobs and a thousand other down-to-earth measures.

It's day-to-day work and it's gonna take a village.

Thanks to Jill Buhler Rienstra for timely editorial assistance.

Endnotes

[1] https://en.wikipedia.org/wiki/List_of_epidemics#21st_century

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.