COVD-19 Update

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Hello, World of Wellness Community!

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As I’m sure you’ve all noticed the COVID 19 virus is once again rising markedly here in the San Diego area, around the state and in fact, across the country. Some of you are wondering what to do about your children for school next year, whether it’s a good idea to send them back, a good idea to do distance learning, or some mix between the two.

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As your doctor, I have to be honest; I’m finding the decision very difficult myself. I certainly do want to send my daughter back to school; however I don’t think that’s yet a good idea. Taking the totality of the evidence from around the world on what happens when schools are reopened particularly given how high the current virus incidents is in our community, it does not yet seem safe to do that. It is not so much the risk to the children, who will probably – mostly – be fine, but more the risk to the parents of those children their grandparents as well as the teachers and staff in the schools.

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Evidence is showing more and more that children not only 1. get the virus but 2. transmit the virus. They may not do that at rates as high as adults, however children over 10 certainly do, and children under 10 probably transmit it at about half the efficiency as adults. If we had a much lower incidence, with proper precautions, I can see our kids returning to school. But, for now, until we get this virus under control I just don’t see our county health department allowing that to happen. I think the California governor has made a good choice, in keeping the schools closed until a particular area reaches a more safe level of infections in the community.

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You probably want to know more about what the virus does. We would all like to know more, but there’s some things you should be aware of that we already do know. For starters, this is unlike the flu in that you don’t just get the virus and then you’re done. It looks like for substantial part of our population, there will be long-lasting debility and aftereffects from this virus. I cannot tell you how many or what percentage will get those long-lasting effects, but it seems like it happens even in people who had minimal or no apparent symptoms.

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For those who do have the more significant shortness of breath symptoms, who are not hospitalized, we are still seeing people with prolonged debility. I have seen nurses, off work, who cannot yet walk 10 feet without becoming short of breath some six weeks after they were diagnosed. For people who are actually hospitalized in the ICU, and ventilated (on life support), they tend to have much more severe effects.

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Even in patients who are not intubated we do see some long-term lung injury that looks like it may be permanent. We are also seeing cases of early-onset dementia, even psychosis – which is proving very difficult to treat in these patients. For these reasons it is becoming increasingly apparent that “getting to herd immunity” is probably not a good option for our country. Aside from the mortality, which certainly is serious, the prolonged and permanent health effects of Covid-19 infection may have such a financial burden on our country that the shutdown itself will not cost nearly as much as the long-term effects of allowing the virus to run wild.

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Obviously, as a physician, I am more concerned with the health and emotional effects of the virus. I want people to be healthy and to live as long as they are able to. But I’m not unaware that there are financial costs to shutting down, to closing businesses, to putting people out of work. I want you all to know, however, it is worth it, certainly, to wear a mask to try to reduce the transmission of this virus. In countries that have implemented universal mask wearing effectively, like Japan, China, South Korea, the virus is under much better control. Their lives are returning to a more normal course. These are dense, heavily- populated, countries which show us that, even in urban areas, mask wearing reduces the virus transmission significantly. My opinion is that the only way that we are going to come out of this is by reducing the transmission of the virus to the point where it can no longer spread naturally.

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One thing that it is important for you to understand as members of the public, is that every time the virus passes through a human being it can mutate. The more times the virus passes through human beings, the more it mutates. The more it mutates, the less like prior versions of the virus, and the less the immunity that people who have already been sick with the virus can count on. Essentially the faster it goes through a population, the faster changes, and the less it matters that somebody already has had the virus. This is another reason why the hoped-for”herd-immunity” is not a viable solution to this pandemic.

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This has been a long four months. Yes, this is going to go on for longer. Our country has been through even longer crises. We made it through the First World War with a pandemic, the Second World War, the Korean War the Vietnam War, depressions and recessions. I think the hardest thing about this is that we are not able to band together in person like we would normally do and get that in-person support from our friends, our family, our churches.

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The mental health costs of this isolation are noteworthy. To the extent possible, reach out to your friends, your family, make sure they are doing okay. If they are not, give them what support you can. This is a hard time and normal people are breaking down. I, myself, find it very difficult to work in the emergency department taking care of very ill COVID-19 patients, many of whom got the infection from a party, or family members who went to a party, and then come out into a community that largely is not wearing masks. It is disheartening to have gone through so much, and yet find ourselves not just back where we were but in fact in an even worse position. Yet, I am an eternal optimist. I believe in the American ability to pitch in and help one another. I believe in our ability to come together in a crisis.

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I want you to be informed so that you can inform your friends and family, to support them to make the right decisions in terms of social distancing and wearing a mask. Please know that I continue to be here for you, and will answer any questions you may have. This is a complex topic and we are learning more about it all the time. I am doing my best to stay informed, but, as you are probably already aware things change. The medical community’s change in advice over time is not a result of incompetence, but rather a result of learning and understanding more about this virus. There are also many conflicting studies out there. I wade through these and give you the best interpretation and advice I can, based on the quality of the evidence, and what we already know about these types of viruses. If the data changes, my advice will change.

For now, my advice remains simple: wear a mask in public, wash your hands often, limit social contacts as much as possible. Take care of yourselves, physically, mentally and spiritually!

Yours,

Dr. E