Covid-19 Missive Six, March 27th

3240 cases today in MA, 823 more than yesterday. 35 deaths.

The hospitals have been feverishly working to get ready – turning many of us into telemedicine docs, converting endoscopy suites into ICUs, cancelling all elective or delay-able surgeries so that there are fewer people in the hospital and more doctors and nurses to help, asking for MDs and nurses to volunteer to be “deployed” to units outside their usual field, getting ready for the surge, trying to avoid the NYC nightmare of patients laying in lobbies and the very real specter of running out of ventilators.

Remember a few weeks ago when it was all about Wuhan and Italy and you had to self-quarantine if you’d been there? Well now the “whole world is Wuhan” and if you are coming to MA from anywhere (especially New York!) (and Florida!) (and everywhere!) our governor is now asking everyone to self-quarantine for 14 days. On behalf of the now well over 300 health care workers who have tested positive in the Boston area, please, please, remind your friends who have driven or flown back here about this new rule. It’s probably not enforceable but maybe public pressure will help.

There is still a huge need at all hospitals for PPE. (Remember when nobody knew what PPE was?) If you are antsy to do something, raise money so these poor health care workers can have the right masks and gloves. In the meantime, anything you have hiding in your basement will be happily accepted at Cambridge Health Alliance Hospitals or BMC or Emerson or really anywhere.

So now some of us are going to start to get sick. How does it go? 90% of the time there’s a fever. And cough and shortness of breath (medical abbreviation = SOB and it really is an SOB feeling) with often significant pain around the chest like a band. Fatigue/exhaustion in 30%. Sore throat in 10% in China but maybe more here. GI symptoms in 5% in China but maybe more here. Runny nose/sneezing in only a very small number – if you’re only sneezing with a “cold in your nose” you might well be safe. And then this weird loss of smell in a good chunk.

What do you do? Mostly stay home and wait it out. There is more testing now (29,371 tests so far), so you could call your primary care and talk it over and see if you can get an order for testing. There’s now drive-by clinics and “respiratory clinics” at a lot of clinics and hospitals, but your PCP might just recommend you wait it out, just like you wait out a cold or the flu: tylenol and ibuprofen (things like motrin and advil (ibuprofen) are fine – there’s no scientific evidence they make it worse), OTC cold remedies, cough drops, tea (and whiskey?), rest, fluids. Take your temperature at least twice a day and write it down.

And then, after a couple of days or a week, if you’re fine, you’re fine (some days after fever/symptoms gone), and this is how it is for 80% of people. But sometimes after a week you get suddenly definitely worse – way short of breath, dizziness, weakness – and this is a MAJOR WARNING SIGN and and you should seek serious medical help immediately. Not an urgent care, not an curbside consult with your aunt the podiatrist, but a visit with your PCP or an ER, because you may well be in the ~20% who end up in the hospital.

I get a lot of questions about groceries and packages. Honestly, I think that’s barking up the wrong tree. Yes, fragments of viral RNA are found on packages and yes, sometimes whole viruses are found on surfaces. But we have no idea if those things can infect you, plus if you clean those surfaces, or wash your hands afterwards: problem solved. I honestly believe packages are not the threat. PEOPLE are the threat. People who continue to get close to each other and close to you and people who violate quarantines – they are what is going to infect you.

This is going to be a long long siege. We need to figure out how to be our best selves, our very best selves.

One thing I have learned in my life is that an epic crisis sometimes makes people turn into the most primal childhood version of themselves. Sometimes that’s functional but mostly it is not.

We need to bring out the grown-up in all of us – the responsible person of integrity who handles delayed gratification and nearly overwhelming stress by constantly reminding ourselves that this too shall pass and that all nights are finite and that this really truly will come to an end. But we also need to constantly reminding ourselves that we need to come out of this knowing we are all in this together and that we did everything – absolutely everything – we could to keep patients and health care workers from dying.

We need to say “There was really only one thing I could control, and that was me staying home. I nearly went crazy/screamed out loud/wept incessantly/never slept/slept too much/ honestly hated my spouse for a while/honestly looked at my kids like I’ve never looked at them before/fainted with boredom/ate too much/ate too little/screamed at the kids/yelled in front of the kids/let the kids turn into screen monsters/almost went-out-for-a-ride-and-I never-went-back but there was one thing I could do so I did it. I stayed the heck home.”

Stay home. And stay well, please, please, please my darlings.