March 31, 2020: A View of This Pandemic from the Healthcare Perspctive

 
    Photo from Twitter.    

     I am a medical doctor and have been retired 11 years. I don't have a medical license anymore so I am not helping with this pandemic. And my knowledge has certainly waned in those 11 years. But my son is an MD. He is Chief of General Surgery in a large Midwestern University Healthcare Organization. He works very hard normally and I often worry about him and all of his responsibilites as a busy general surgeon, director of various sub departments of the Surgical Dept, as active member of multiple national surgical organizations, and as Chief of the Department. Well, now he has a huge burden on top of all that mentioned above. Elective surgery of course has been stopped so a large source of his income has dried up. Now he just does emergent surgery. That means every surgical case is an unknown and big risk. The patient is very sick, otherwise surgery would not be necessary. This makes every case much more anxiety producing. Add to that COV 2. The patient might be infected which until recently would be unknown to the surgeon and his staff. He was looking forward to a short test that can give a result in 15 minutes. He has that now but that does not take away the risk of doing surgery on an infected patient. There is some indication that for fear of causing aerosols of infected material in the OR, electric cautery should not be used. This increases the risk and the time of the surgical operation with more bleeding risk as well.  On the phone recently he told me he operated on a patient that morning and that patient's test had been negative. He was doing another surgery later on Sunday and didn't yet know the COV 2 status of that patient.

     Remember that this man and all his surgtcal colleagues and staff go into the hospital every day where dozens of infected patients are entering the ER, being evaluated and many of them being admitted to the hospital, to ICU, etc. My son enters all of these regions to see sick patients of his own whom are pre op or postop for other reasons. Think of the level of his exposure to this virus every day. My son is 49 years old and at the peak of his surgical career. But he has Type II diabetes mellitus. He is just on a single medication, metformin, and he follows his diet, exercises, and controls his blood sugar meticulously. His usual Hemoglobin A1C is 6.3 which is very good for a diabetic. Still we know that just having diabetes does add some risk of complications should he get the disease. He knows this every day as he enters the hospital, or his office, or the ER, or the OR.

    On top of all this anxiety, he is the Chief and has to direct the 35 or so surgeons that are in his department. He has to think about all the ramifications of this pandemic on his department. And he has to participate in hospital meetings that try to plan for the surge, as they are calling it now. In his city, the surge is expected in about 2 weeks, but they already have a lot of ICU beds taken up by COVID 19 patients. There has been the usual shortage of Personal Protective Equipment, (PPE). The hospital had already taken enlightened steps to preserve N95 masks, by limiting each individual worker in the number used and were trying to sterilize the masks by exposing them to UV light for a period of time. My son made the comment that because of the high costs of medical care in this country, he as the Chief of Surgery had benn encouraged to cut costs again and again. One of the ways this could be done was to decrease the inventory of PPE. The hospital had done a good job of this. Now there was a shortage and no storage to back up the new intense needs. I am sure that the meetings of the leaders of this hospital are very intense, and there is no doubt discussion of the worsening spread and the increase of patients that will appear deathly ill with COVID 19.

     There is no doubt that the job my son has loved and has devoted his whole life to without any other interests beside his family, has now become a daily source of anxiety and despair. The pandemic situation has not spared my son's homelife. His two sons, 13 and 10, are home from school and trying to engage in some degree of virtual learning. But they are missing their school friends and cannot participate in sports and music lessons, and other activities that basically define these young boys at this stage of their life. My daughter in law teaches pharmacy at a local college and is now teaching virtually from home. She is also trying to manage her son's studies, and to manage the household. In addition, she has just gone through a trauma. Her stepfather has died from a fall and head injury leaving her slightly demented mother alone and unable to take care of herself. She has made 4 or 5 trips down to the south of the US to the funeral, and to visit the family. And after arranging by phone a nursing home for her mother, she had to drive down to the south again this past week to get her mother admitted and moved in. Her mother, with some agitational mental issues, will have to be quarantined in her room for 2 weeks. My daughter in law has no idea how this will turn out.

     As you can imagine, when my son comes home from his work, things are not calm and easy at home either. He worries about all that his family is going through at this time as well. When I spoke with him, on Sunday, I heard the stress in his voice. He has always been a very hard worker, and I have always worried about him taking on too much for one doctor, for one human being to handle. But I had never heard the tone in his voice that I heard on Sunday. He spoke softer than ever, and there was a note of despair in his voice. My second son had talked to him a couple days before and had been told that this brave doctor had lost 12 pounds since this pandemic had hit our country. His anxiety was preventing him from sleep. He had only been getting 2 hours of sleep a night for various reasons, but no doubt largely from worry. When he spoke with his brother, he had finally been able to sleep a couple of nights for 6 hours. He had taken the time to organize and get all the family finances in order to have it prepared for his wife in case something would happen to him. He is certain that he is going to get this virus and he is deathly afraid it will cause complications because of his diabetes. I tried to tell him that he had only had diabetes for a couple years and not like me and others of my age, it had not taken a toll yet on his body. Also he maintains meticulour control of his blood sugars as I have said. But all of this weighs greatly on his mind. I am worried that he is almost at the breaking point.

     Then I see nurses on TV crying about their experiences in the ER and in taking care of the very sick COVID 19 patients. Our death rate rises. And the number of infected and therefore the number of very sick continues to rise. There is not really an end in sight yet for our healthcare workers, and our first responders. I just wanted to present to the public a view of what life is like in a doctor's or for that matter any hosptal worker's role right now. These are people with the bravery of the first line infantry soldier on D day.  We will never repay them for what they are doing in every city in our country.

      Please God, bless them and help them do their job, and protect them not only from the virus but also from the worry and despair that sits next to them every minute of every day and of some nights. Please provide the support and calm that only you can supply. Amen

    

March 27, 2020  "Safer at Home"

     Our Governor Evers has locked us down a little more. He has recommended that all non essential workers stay home, except for trips to the grocery store or to pick up take out, the former ideally only every 2 weeks. Grocery stores are making time in the morning of some days entirely for elderly and those with preexisting conditions who still remain the most vulnerable to this disease in terms of death rates. We now know that young people also get the disease and end up in the hospital with it but they still seem to withstand the deadly effect on the lungs better. Essential workers are healthcare workers, pharmacy and drugstore workers, food supply workers at stores and at restaurants who do take out, first responders, goods transport, gas stations, energy workers, certain manufacturing workers making things necessary for safety, life, and supplies for all things needed in this emergency, home repair, news reporters and radio and TV workers,  mass transit, airlines, cleaners and maintenance as well as waste management and garbage handling, and infrastructure. These businesses vary somewhat from state to state. For example, the production and sale of marijuana is deemed essential in California. Basically each state has decided what they deem essential for the safety of people's lives, and maintenance of their ability to stay safely in their homes.

     New York state and especially New York City and surrounds are the epicenters currently in our country and our country now leads all countries in numbers of cases.  It should be noted that we hold this record, mostly because we are dong more testing than any other country. And yet we still are probably missing the vast majority of the cases.. The actual number of infected is probably a multiplier of 5 or even 10 times this number of confirmed cases. Italy still leads the death toll and it is still mysterious why Italy has such a high death rate. We now have over 137,000 cases in the US and 2400 deaths. Every state has cases. Other highly effected areas are Florida, Louisiana, Washington State, and California. Chicago is also effected heavily. All of these areas are on different time lines toward their peak of cases based on how much they were seeded by travelers early and then how soon they began to close down schools, large events, and businesses.

     Testing has advanced and not only can tests be pretty easily done, there is now a rapid test that gives a result in 15 minutes. My son, who is Chief of General Surgery at a large Midwestern University Health system, was especially anxious for that. He felt that without knowing whether a surgical patient was COVID 19 positive or not would endanger the entire operating room staff. To speed surgery electric cautery is widely used to stop bleeding during surgery, but this creates an aerosol that could be very infectious. On a COVID 19 positive case, perhaps cautery would not be used and this would lengthen the surgical time often dramatically and make for more surgical risk. Also testing now can be done by the patient in their drive through car, utilizing mostly just the anterior nose and throat which would induce less coughing and sneezing. Therefore the collecting healthcare worker doesn't need to wear as much Personal Protective Equipment (PPE), saving it for in hospital and clinic workers.

     The shortage of this PPE has been a problem across the entire country. My son told me that their hospital was reusing N95 masks and using a period of UV light exposure to sterilize the masks inside a plastic bag. Multiple companies, especially garment makers have retooled to make N95 masks. 3M, the largest producer of these masks has hugely increased its output and is teaching other companies how to make them. Various local people here and there are making cloth masks and even stuffing them with feminine hygiene pads or coffee filters and providing them for some protection, not meeting hospital standards, but useful in other sites where there is required exposure to a large number of people. Small distilleries are using wasted amounts in their drinking alcohol production to produce hand sanitizers and are delivering them to local hospitals and other places that are in need. Various large manufacturers are retooling to make more venilators which are always in short supply

     One thing that President Trump and his team have done very well is to involve the private sector in answering the many shortages and needs of the pandemic. Now private labs have stepped up to make rapid testing kits. Already the virus has been RNA sequenced and within 2 months the first group of people have gotten a vaccine for its first trial, totally skipping trial in animals. It also has been found that antimalarials may help treat this disease. Someone noted that countries or areas in Africa and in South America where people are on antimalarials don't seem to have many cases. A study was done in France that is very promising. These drugs are already being used and our government is allowing this as long as these patients are part of a study to get the data as the drugs are used. There is also a new antiviral, called remdesovir, ?sp. Many individual people and small groups of people have started to make masks and sew full body suits that protect our health care workers. Individuals and very small companies even with just s single 3D printer are making face shields. In other words, the movement against this virus and protection against it has been a combination of government management and gathering of the most up to date and wisest knowledge, of the private capitalistic production abilities of our big companies, and the small but just as dedicated efforts of tiny businesses and individual people. This massive effort though not making itself effective just yet on the illness numbers, will in the end defeat the virus. Our form of government and current leadership combined with our capitalistic economy will win in the long run.

     The former paragraph sounds very positive and it is. But there is no doubt that we are taking a big hit both in illness which is overwhelming our healthcare system and has at least temporarily destroyed our economy. It is going to take a long time to come back from this. And my husband and I are no doubt going to be isolated in our home for many months even after others are going back to a more normal life because we are at so high a risk that we cannot take a chance on becoming infected.

     One of the interesting things that has made a lot of news is the run on toilet paper. Why was that the one item that people hoarded and worried so about not having enough? This is still a mystery and will remain so, I guess. Another run on goods was the dramatically increased sale of guns and ammunition. There is certainly more reason behind this buying spree. This pandemic has led the prepper like me and many other people in addition to worrying about the disease and how to protect against getting it and the economic loss the mitigation of the disease has caused, to begin to think about what this combination could cause if it advances much further in society. That fear is that we would have a breakdown in society and great civil unrest. Preppers worry about protecting what they have gathered to weather this pandemic from those who might come to take what they have. Hence people want to buy a gun.

     I am a prepper and I admit it. Some people laugh at this fact about me. If they could see me not worrying about getting to a grocery store now and just digging into my supply of freeze dried food, they would laugh less. But one thing I did not have was a gun. I did join a range club, take two courses on shooting, one for beginning shooters and one for learning about Conceal and Carry. I have shot two different hand guns a few times at the range, but I had never taken the step to buy a gun. I decided this was the time to do that. However, I had waited a little long, Many stores were out of 9 mm handguns. Then I tried to get some ammo and at least two gun stores that I called had none on their shelves. Finally I found a range and gunstore down in Racine, WI and was able to get a gun held for me as well as 2 boxes of 9 mm ammo, though I had only one choice there. The more expensive copper or brass coated shells were sold out. I just had to take metal jacket which I think is nickel. Then I could not take the gun with me that day, because there was a backup at the Department of the government that ok's background checks. I waited in the store a short time but the background check was put on delay. Two days later it had passed and I had to drive back down to Racine to pick up my gun. Soooo...... though I had planned to buy a gun all along, like many others, I was affected by the mass fear and effects of mob mentality and I went out and bought a gun. I didn't buy any toilet paper though so I didn't totally lose rational judgement.

     I am going to do a little research on the drugs that might be useful for COVID 19, and on the vaccines.  In the next report here I will try to give you some up to date info. There is some hope there. It is just gong to take some time to accomplish this.

     Stay safe out there and practice the hygiene and physical distancing from others recommended by all health scientists. But don't practice social distancing. Call your loved ones. Call those you haven't talked to in years. Send emails, texts, and even snail mail cards to raise other spirits. And we will get through this.

March 20, 2020:  The Pandemic

   
Notice the above date. An interesting combination of numbers. Maybe our numerology expert can give us some information on their significance. Well, we are certainly right now as I write this and as you read this experiencing a fantasmagoric event which shall be forever recorded in history. We are experiencing a very frightening pandemic of the Coronavirus Covid 19.

      It started in China in probably December but the Chinese Communist Party hid its presence from the rest of the world. We did not learn of it until the very end of December, 2019. Now there were two previous Coronavirus epidemics that were not so bad. In 2001 to 2002, SARS, Severe Acute Respiratory syndrome, started also in China and did spread around the world but not to any great extent. It seemed to peter out on its own and did not harm economies of the world. Then in 2012 to 2014, MERS, Middle Eastern Respiratory Syndrome, started in Saudi Arabia and might have had something to do with camels. It stayed mostly in that area, though there were two cases in the US in 2014. But fortunately that one also died out. In the beginning, the hope was that this novel Coronavirus would act the same way. However, China was hit very hard especially in the province in which it started. Then we heard of cases spreading in South Korea and elsewhere in southeast Asia. Our President, Donald Trump, made a fairly early decision to shut down the US to Chinese travelers especially from this province but also in general. Our west coast particularly receives large numbers of Chinese nationals daily and the fear was that this would rapidly import the virus to our country. Indeed, Trump faced harsh criticism for doing this so early. He was called racist, xenophobic, and even Nazi, for this decision. However, he went on to make light of the risk to our country. There is no doubt he was trying to reassure and calm the American people, but he was blamed for being slow to mount an all out protective and aggressive war on this disease. The problem was complicated by the fact that for the last 30 years, much of our manufacturing has been moved to China and we depend on them for all sorts of parts, and indeed large percentages of our pharmaceuticals, and even our hygienic protective gear like face masks. Meanwhile, the virus hit Italy dramatically because they had not shut down their borders. We have continued to close our borders, but the virus is here, as it is all over the world. It is a health, economic, and worldwide disaster. At this point in time, none of us know what will happen from here.

Since one week ago today, there have been hourly changes in our status in the US. Currently everything is closed: all sports activities, schools, gym, restaurants and bars, and many many non essential businesses and services. The State of California is on a modified lockdown, with people only going out for food, or health care. Likewise New York City is locked down in the same way. In addition, there are hot spots in New Jersey, Florida, Washington State, and the Los Angeles and San Francisco area. Wisconsin is just starting the climb of cases with our first 3 deaths in the last 2 days and with about a thousand confirmed cases. This disease seems to be at least 3 times as contagious as Influenza, and it especially become lethal for our seniors and those with underlying health problems. Those are the ones who mostly die, but young people can also get sick enough to be hospitalized. Yet many young people get a relatively mild cough and cold but with fever. There is evidence that some almost don't realize they have this disease but shed the virus, a very dangerous situation. 

      Well, to try to avoid what is happening in Italy and Europe, and Iran, as well as China and southeast Asia, our economy is being closed down. The stock market has lost almost a third of its value from 3 weeks ago. And it is expected that there will be many more cases that are beginning to overwhelm our supply of ventilators and our protective health gear for the first responders and health care workers. There is huge debate about how to handle this. I feel that some good things are being done: the private sector is being called in to replace and add to the manufacturing of these health items that are in short supply. Hospital ships and even the possibility of cruise ships being moved to New York, San Francisco, LA, and maybe Miami to provide more hospital rooms. But our health care workers without enough protection are going to get sick themselves and there will be no one to staff these ships. Car companies are saying they can retool to make ventilators, but that will take some time. The Federal Reserve is doing what it can with interest rates, and Congress is slowly passing bills to provide money, to stimulate the economy and help people who are out of work. Tax day has been postponed to July 15. Prisoners who are due for release are being let out of prison because the virus is getting into the prisons. Meanwhile fear of civil unrest has made most gun shops sell out and ammunition is no where to be found. Well, I can't even  begin to log here all the effects of this virus and our government's response to try to save lives.

     Well, I guess I would like to chronicle my reaction to all this. It think it is very typical of the average person over 65 in this country. We began to hear a lot about this about 10 days ago. Still we had no confirmed cases in the Milwaukee area and no evidence that there was community spread. All cases to that time had been tied to either international travel, or to national travel to hotspots in the US. These cases were still being isolated and their contacts were still being traced and self quarantined at home. A week ago Wednesday I drove by the grocery store and the parking lot was full. There was an obvious panic buying spree going on. I joined the panic a little bit though I had stocked up a few days before. The comical portion of this whole event was that people were wheeling cartloads of toilet paper to their cars. We have never discovered what that was. Hand sanitizers, disinfectant wipes, and rubbing alcohol were to next to fly off the shelves.

     That was the first sign to me that we were in big trouble, much worse than just a normal flu season. It was being emphasized so strongly that we oldies were so much more at risk for lethal complications. No one knew entirely why, but statistics seemed to prove this. And Italy being one of the oldest countries in the world, citizen age wise, had death rate running very high, maybe 8 to 10 per cent.

     One night last week, I lay awake thinking about what I would do if one of us got sick. I have somewhat of a special case. My husband is mild to moderately demented  and would not be able to take care of me if I got the disease. I am having trouble explaining to him how we need to keep the outside out of the house and not contaminate surfaces in the house with things that have come from outside. I will say that he is washing his hands more than usual. If he got the disease, first of all he is at high risk for complications and severe disease because he is 83 years old, and has moderate renal failure in addition to the dementia. How would I take care of him without getting the disease myself. I began to run through some things I could do in my mind: use separate bathrooms, separate bedrooms, keep our areas apart, continue to wipe down all surfaces even more than I am now. I would be totally isolated in my efforts with no family in the area and no one to turn to. All of these thoughts kept me from sleeping.

     In addition, coincident with this, perhaps because of me being on my feet more and running more errands to try to get ready for this event, I developed worse left sided back pain with radiation of an
intense ache into my lateral left thigh and upper left calf. Clearly I had a pinched nerve in my back. I went to see my internist who agreed with me and gave me a Medrol dosepack. Great! Now I was on an immunosuppressive dose of prednisolone while a lethal disease is beginning to run rampant. At my Spirit Mind body group a week ago Thursday, I didn't hang around afterwards and on Friday at my water aerobics class I participated well away from others in the water and refused to play Canasta. After all, playing cards for 3 hours passing these cards from person to person without touching our faces, seemed very unhealthy to me. The next day, Saturday, I decided we would self quarantine except for having to go out to get groceries, or gas. I also have had to go out to get a prescription for gabapentin for my back when the Medrol Dosepak gone, my pain began to come back. When I go out for these necessary trips, I wear an N95 mask I have saved since my retirement 11 years ago, and I wear plastic gloves. Of course, being a physician, I understand sterile precautions and so I try to wipe down the inside of the car and door handles, and leave the packages that I can sit in the cold garage for 24 hours so  that any virus particles on the paper bags can disappear. I handle the plastic bags and plastic wrap with care and dispose of it with care and wash my hands all the time. When I come into the house I wipe off  the doorknobs and take off my coat and put that one aside for 2 to 3 day and use a different coat to go outside the house the next time. I immediately wash my hands then.

    When I have to go to the bank, I just drive through. I use some alcohol in my car and cotton balls to wipe down the air tube carrier and to wipe down my ID after if I have to put that in the air tube container. If I use my credit card in a store I wipe it down with alcohol afterwards. It really becomes exceedingly anxiety producing to remember the order in which to do all this. I have no idea if I am exercising over kill for this virus or not, but I know that we just cannot get this bug. I could not handle it emotionally within our little household. Suddenly I know how a pathological germophobe feels.

     Our sons and their families are also going through some sort of hell. My younger son has a 2 year old and his wife is 5 months pregnant and very nervous about all this. They live in California, which is a hot spot. They are practicing all these safe practices as well and my son is reading all about whatever new info comes out. Sometimes this might be a little encouraging but mostly it just adds to the fears. My oldest son is of course Chief of General Surgery at a midwestern University Hospital and is in the thick of things. He predicted last week that all elective surgery would be curtailed to preserve ventilators, hospital beds, and supplies and indeed that has happened.  This will mean a great reduction in income, and he will likely have to go into the trenches to care for the sick.  His wife teaches pharmacy and though the school is closed, she may be called in to deal with pharmaceuticals in the hospital. Their two boys at 13 and 10 are home alone and dealing with that. I worry about all of them.

     No one can predict in any reliable fashion how long this will go on. It is true that our country is behind others in the onset of this spread here. That is because we closed our borders early. But we are having logarithmic increases in the infected and in deaths now. On an optomistic side, most agree with how the President is handling this and government in combination with the private sector are stepping up to help out. All of our experts and our President and Vice President are thinking outside the box to try to think of thousands of ways to help contain the virus and its spread, help the economy, and to help all those who have been sidelined at home and have no income coming in due to that fact. We are seeing thousands of little acts of kindness and ways to help people. Since many churches are closing, one priest held drive through confession in the parking lot. Everything is being done electronically and more and more ideas are coming forth to supply more electronic help. We have a new neighborhood hotline on our phones and people are volunteering to make runs to some of the few drive through restaurants to pick up food  for anyone in the neighborhood to help support those restaurants. Perhaps we can maintain some degree of perspective and also hope that this will be over soon.

     I plan to start posting every day or so describing our life under these circumstances. If nothing else I think it will have historic interest for readers who find my work many years later. That probably will be one little old lady like me who is interested in genealogical work and wants to know what her ancestors' lives were like during this historic time.