Covid-19 Missive Seven, April 4th

Here is my COVID-19 Missive Number 7, from me as your friend Robin Schoenthaler the cancer-doctor-writing-about-COVID-19 (and feel free to share wherever and however you like).

So the surge has begun.

Massachusetts has 10,400 people who have tested positive for corona, and almost a thousand corona-infected people are in the hospital, and 192 souls are gone. There are another thousand people in the hospital who are “under investigation” (very sick and look like covid but their tests haven’t come back yet) and there have been 8000 positive patients sick at home, and no doubt several times that many people sick but untested at home as well.

Remember March 20? Only two weeks ago today, and we thought it was terrible and horrifying that there were 413 cases with 58 hospitalized and a single sad death. Don’t we long for that peaceful period now?

Hundreds and hundreds of health care workers have tested positive, a hundred and seventy at MGH alone. A combination of community transmission and at some other hospitals the terrible immoral lack of masks and gowns.

Two people in Arlington have died.

And we have just begun. There will be at least several more weeks with all these sickening numbers going up and up and up.

So now all the noise of the past few weeks — the travel precautions and advisories and bans, the increasing declarations of emergencies, the stricter and longer stay-at-homes, the constant confusion over masks, the freakedoutness about home schooling dissolving into a new routine or unschooling — now it settles down into the grindingly difficult work of managing all of this as well as the work of managing all these so-very-sick patients, neighbors, loved ones.

So — again — what will it be like? You or your loved one might have modest symptoms — fever maybe, cough probably, shortness of breath, muscle aches. Maybe sore throat, headache, loss of smell (without allergies, without nose congestion). Probably they muddle through. Maybe they take some tylenol or suck on constant cough drops. Or maybe they’re really wicked sick — the “worst flu of my life.” They take tylenol alternating with motrin every four hours (motrin’s fine), they have a grinding headache, they can’t eat, they’re just super miserable.

And then it passes. They are one of the 80% who never need medical attention. They maybe never even get tested for corona, although one of these days (probably not next week) there will be an antibody test that shows they had it. And then very probably, mostly, they will never have it again. They will have immunity to this version of this corona virus.

But 20% of us who get it will get desperately horribly ill, mostly with pneumonia. It’s all the symptoms of pneumonia: awful cough, terrible shortness of breath, profound weakness, dizziness, can barely eat, severe pain around the chest or maybe the muscles between the scapulas (the rhomboids) or when taking a deep breath.

If this happens, you must must must call your PCP to see about going to an ER. Or you must must must call the ER and tell them you’re coming in. Because if you get super sick super fast (often in the second week) you may be one of now-a-thousand-but-next-week-two-thousand people who end up needing a hospital bed (15%). And maybe a ventilator (5%).

In the meantime, how do you prepare? In your family or household, how are you going to quarantine your sick person for 14 days or more? What room will they stay in? Is there a bathroom that can be just theirs, and if not how are you going to clean the shared bathroom to pieces every time the sick person is in it? Have you stocked a basket with cold/flu remedies and a thermometer and maybe a pulse oximeter? Are there phone cords and computer cords long enough to reach outlets from their bed? Can you make sure they take their temperature several times a day and that you know when it rises (bluetooth thermometers are fantastic for this)? Can you track the severity of their cough (scale of 1-5) and energy (1-5) vs weakness (1-5).? Can you note every time they shower and eat? Each of these gives you a clue as to upturn or down.

Who are you worried about? Your children? They will probably do fine. The encouraging statistics about little ones and young adults in China and Spain and Italy are still encouraging here in the US: they get it, they spread it, but they don’t die of it. But older people, people with heart disease, lung disease, diabetes, immunosuppression? They get it, they get it bad, they can die of it.

What should you do? Three things: protect them (stay the freak home and keep the grandkids away from them), monitor them (regular check-ins, a low level of suspicion), and talk to them about what they would want if they were to get desperately horribly ill. Would they want to be on a ventilator with a 5-30% chance of coming off it? Would they want to be on a ventilator that in a couple of weeks a 35 year old needs, too, and there’s no other ventilators left? Would they want to go on kidney dialysis or a heart/lung machine or to get CPR? Please please please I beg of you talk to your elders. See what they want, hear what their priorities and values are. You may well need to be their voice when they have no voice so you best know what they wanted.

Hopefully for you at this point the sadness about all the stuff at the start of this — the cancelled vacations and opening days and book premieres and career-changing conferences and graduations and all our hopes and dreams from January and February — that has all receded and is taking its place in the hall of regrets and shrugs. Because now even the shock and awe of being home all day with the kids and the terror at potential or real job loss is going to be supplanted by the very stark specter of how to care for our desperately ill and how to face super scary decisions about how and when we get medical care and when we stop.

In the meantime — my friends, we are moving into real true terribleness. But there are little rays of hope. The power of science is moving faster than it ever has before. The MGH Brigham COVID Innovation Team started two weeks ago. They now have 60 employees, seven task forces, two prototypes for new easy-and-quick-to-manufacture masks, and a spectacular new system modeled on one in Korea for doing testing from a self-enclosed booth; it’s already in action at the Brigham. MIT scientists every day have little breakthroughs that can lead to big new ones. Corona testing ability is improving and increasing and getting faster. Antibody tests (not completely vetted or proven but a good start) are already hitting the market. The lessons from Italy and Spain and the rest of Europe are augmenting the science from China and Korea and our doctors and scientists are learning from it all.

But we need to buy a little more time. We need do whatever it takes to keep ourselves safe and functional and more than anything sequestered at home. We need to figure out how to last out the long-term. Whether that means planning out a productive (or at least not destructive) day, or turning off all soul-jarring social media or news notifications, or listening to our kids breathe at night, or talking seriously to our teens about the moral implications of physical distancing, or going on a news fast and doing yoga instead, or giving up on family dinner, or OTOH producing a spectacular family dinner, or having a list of people we call weekly, or concentrating on finding a way to be of real true service, or getting oral histories and oral orders from our elders, or figuring out a way to show our total WORSHIP of the health care workers at the front lines, we need to figure out how to outlast this and give our doctors and scientists time to apply the lessons of all the other losses in our interconnected earthling web and thereby save more of the rest of us.

We need to find our ways to rise up and last.