April 1, 2020
Dear Friends and Family,
I’m used to dealing with dangerous diseases. I’ve been an emergency room doctor for forty-one years, providing medical care in large and small facilities across the globe. I’ve worked in a leper colony in India, a malaria clinic on the Amazon River, an orphanage in Maputo, and a waterless hospital in Kenya. I’ve treated malaria, plague, tularemia, typhus, typhoid, brucellosis, and a large number of patients who had infectious diseases I couldn’t diagnosis. Even here in America I’ve been exposed to bugs of all kinds, from flu to chicken pox, from Legionarie’s Disease to meningococcal meningitis.
I say all this to emphasize that COVID ranks near the top of the list of dangerous infections. The purpose of this letter is to help people understand how this infection is transmitted and urge everyone to take proper precautions.
The COVID virus threat is real, the danger palpable. As an example of this pandemic at its worse, here’s part of a blog from a fellow ER doctor working in New Orleans. Warning, it’s horrific.
Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into Covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday. Today those 50 beds are full. They are opening 30 more by Friday.
The expected duration of intubation for this disease is between two to four weeks. Of those who deteriorate to requiring intubation, the mortality rate runs around 70%.
South Mississippi isn’t facing this kind of crisis … dare I say “yet.” I’ve certainly seen cases of the disease. Here’s a brief summary of the symptoms and progression of COVID.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias (back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, and fatigue.
Day 5 of symptoms- increased shortness of breath with bilateral viral pneumonia from direct viral damage to lung parenchyma.
Day 10- Either improvement, or cytokine storm leading to acute lung failure known as Adult Respiratory Distress Syndrome and multiorgan failure. You can literally watch it happen in a matter of hours.
81% of those infected have mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
The COVID virus requires moisture to survive. It’s mixed in spit droplets aerosolized by coughing, talking, and even breathing. After leaving the mouth of an infected person, the droplets swirl outward for a few feet, hang around a bit, and then dry out, killing the virus. If the water droplets land on another person’s eyes, nose, or mouth, they can enter the body and create infection. If it lands anywhere else, such as on hands, clothing, or hard surfaces, the virus will die when the moisture is gone. Wearing a mask (of any kind) and glasses whenever you are near another person is the easiest and best protection – not 100% by any means, but a big help. Staying six-feet away will help too.
There’s a small chance of getting the virus in other ways. Theoretically, if someone has sneezed near a doorknob, or into their hand and touches a doorknob, and then you touch the doorknob while it’s still wet, and then touch your eyes, nose, or mouth, you could become infected. Two lessons here: one, it’s difficult to get except through breathing in the virus and, two, wash your hands frequently.
To control the spread of the virus, stay home if you can. When you do go out, wear a mask or even a handkerchief over your face both to protect yourself and others. Other things you can do to help: don’t hoard and do donate money online for food kitchens. If you can sew, make some homemade masks for yourself and others. We ran into one woman at Hobby Lobby who was buying material to make 100 masks to donate to nursing homes and first providers. You don’t really need the super-duper N95.
Eventually this crisis will end in one of three ways. First, the population will gain herd immunity, that means, most everyone will have had the virus and developed antibodies so that the virus won’t survive without new people to infect. It took one year for the Spanish Flu to die out in the 1918 epidemic. Secondly, we may just find a treatment. So far, the treatments suggested, such as chloroquine, Plaquenil, or Zithromax, are unproven and probably not helpful. Based on the history of Herpes and HIV, it usually takes several years to find effective anti-virals. Third, a vaccine might be developed. That usually takes over a year, so about the time the virus is going to die out anyway.
Meanwhile here are some interesting preventative treatments I’ve read about:
- Gargle with vinegar to kill the virus in your mouth.
- Take a bath in bleach.
- Use essential oil massages and consume high doses of Vitamin C.
Those three are the “April Fool’s” part of this letter. Remember, the virus is spread by airborne droplets. Gargling won’t help, bleach will damage your skin, and homeopathic remedies have no proven value against the virus. COVID is not transferred by toilet seats or newspapers or fast foods. It might get in your hair or on your clothes, but will die there quickly.
I love my job and will go to work as long as I’m allowed and able to do so. I hope that of the many patients I’ll see, you won’t be one struck by this illness. Stay secluded. Use facial masks. Wash your hands frequently.
And send notes of encouragement to your friends and loved ones.
Philip L. Levin, MD