March 4: I took some time on Instagram stories yesterday, to talk through the way I’m handling the coronavirus conversation. I got some great feedback and was asked for resources, so I’m throwing it out here in a more permanent space. It feels important to keep my mind, heart, body, and family healthy (pun intended) as we navigate uncharted territory in the world of infection control. In order to do that, I’m focusing on two things.
First, I’m trusting the science. As far as we know, COVID-19 is transmitted via droplets with an airborne component. Basically, someone sneezes, coughs, spits, etc., and it hops into your body when you’re in close contact. Additionally, it’s possible for the virus to land and live on a surface that you later touch. This means that at this time, the basic advice for flu prevention works for COVID-19 prevention. Wash your hands often. Avoid touching and hugging and kissing in public. Do not touch your face. Stay home when you’re sick. Keep your kids home when they’re sick.*
Second, I’m trusting the experts. I found myself feeling panicky the other day, when a patient asked for a six-month refill of his medicine “in case of a quarantine.”** I had to step out and talk to my mentor physician just to get my head back on straight. I must be very careful about the content I consume, and also what I share with others. Entire industries are suffering because of the headlines. The fed cut interest rates this week, flights are being canceled, medical supply companies are experiencing shortages, and grocery stores are struggling to keep basics in stock. Being prepared is not the same thing as being panicked, and I’m fighting to stay on the side of reason.
March 13: When we practice social distancing and hand hygiene, we protect the medically fragile. When we pay attention to who’s losing income due to shutdowns, we uncover opportunities to be generous. When we stay home on sick days, we honor our elders. When we take only what we need at the store, we fight back against greed and panic. To consider the other is to wage war on fear by saying, “I am not just in this for myself.” To consider the other is to think like Jesus.
March 17: I know we are overwhelmed by the COVID-19 content at this point, but this week matters if we hope to flatten the curve. Without protective measures, the cases of extremely sick people will overwhelm our hospital systems. With protective measures, we can stagger and slow the spread of disease to the most medically fragile. Right now, it appears as though only 20% of infected individuals require hospitalization. As Italy has shown us, we cannot handle that number all at once. Social distancing and self isolation will help us slow the spread to a steady trickle, so as to preserve hospital staff and resources and therefore save lives. Social distancing is as simple as staying home as much as possible and keeping at least six feet of distance between contacts. Feel free to get outdoors, and support your locally-owned businesses with curbside service!
March 28: hands-down the best account and hope-filled guidance on the virus I’ve seen. It needed its own post. ICU doc in NYC on a Zoom call with family and friends.
March 31: This is going to be a marathon, folks. According to the data, hospital admissions begin somewhere around 7-14 days after community spread starts. Hospitals won’t start to get overwhelmed until weeks after that. Most of our cities didn’t start with travel exposure, so we’re looking at months and months of COVID-19 discussion; lots of us will be sick of talking about it before it even hits our community full force. What we do know right now, though, is that it’s real and it’s intense. As of this writing, one person is dying from COVID-19 every 4 minutes in New York City. Nearly every healthcare provider I’ve heard or seen has reported a gross shortage of necessary equipment, space, and resources. God, help us. It’s important to remember that the hype and intensity of our precautions does not serve to inform us as much as it helps to protect our community at large.
On the topic of self-care, boundaries, and mental health: I’m only reading news headlines once per day, and only on websites that offer live updates from around the world. I’m avoiding TV and anything that doesn’t come from healthcare experts, economic experts, or research experts. I prefer to read the numbers and firsthand accounts from Twitter and other real-time platforms, and I try to filter out opinion pieces and conspiracy theories. I also try to find encouragement, hope, lightheartedness, and even humor each time I open my social media accounts. I prefer Twitter, then Instagram. I avoid Facebook like the virus itself.
May 8: I took some time on Instagram stories, to talk through a few things I’m seeing online, in comparison with what I’m living. I’ve seen a lot of outrage about death certificates, as if physicians are padding numbers by blaming Covid-19 where other causes of deaths might be more appropriate. This very well may be happening somewhere, but I have seen the opposite in my personal practice. I’ve had patients with Covid-19, clearly symptomatic and in my opinion, dying from the disease. However, our physicians have blamed another diagnosis, such as stroke or heart failure, as the cause of death. They do list Covid-19 in the section of contributing factors, just like they would pneumonia or a fracture or anything else that a patient might actively have at time of death. But I see my doctors being very careful about blaming covid as the clear cause of death, even when it appeared clear to me during my assessment.
I’ve also seen some stuff floating around online about coding, which is how providers note the diagnosis in order to bill. This could be in a primary care practice, or an urgent care, or during a hospitalization. I have not seen this. I have seen a code on patient charts with positive diagnosis, and I have seen notes that say things like “presumptive” or “suspected” if a patient’s test result has not yet come back. I think this is just safe and responsible medicine, especially when multiple people are caring for this patient or he/she might be transferred soon. Providers get paid for service time and tests, sure, but not necessarily by the severity of a patient’s diagnosis.
Lastly, I’ve seen a Covid-19 lungs compared to COPD lungs. This is a way for people to say that the medical community is blowing this disease out of proportion and we should all calm down a bit. I haven’t taken care of as many patients with covid as with COPD, but I have listened to enough covid lungs to say with confidence that they are completely different. Covid-19 pneumonia is often bilateral, which is an unusual presentation, and it comes on suddenly and aggressively. COPD is a chronic, often years-long disease where flare-ups are insidious and slower.
As is the case with any topic, I’m fine with dissenting opinions and difficult dialogue. But it feels important to stress the fact that there are experts in the field, as well as people who are in it everyday (not me). It feels important to stress that we should be listening to them.
Yes, the majority of the population will avoid this disease and the majority of folks who contract Covid-19 recover really quickly. That is great news! But as a follower of Jesus, I must look at the big picture. My life is not my own. I belong to Him, but I also am at the service of my neighbor. And while a disease might not pose much of a threat to me, when it is disproportionately affecting (and killing!) people of color and other vulnerable populations like nursing home residents, I must pay attention. It’s my job to pay attention.
It might go without saying, but I’ll say it anyway. We should not take things at face value, when it comes to the news. It’s important to dig and research and ask questions. Someone ALWAYS benefits and someone ALWAYS pays the price, with every headline and law and governmental decision. Hopefully, digging deeper will make us all more compassionate and discerning, like Jesus. But you will never hear or see me say that we should blindly accept any one guideline or recommendation, be it from a news organization or a governmental agency or even a religious group.
Additionally, I want to speak to the conspiracy theories for a quick moment. I’ve been here. I’ve watched and read and boycotted over many an issue in the past fifteen years or so. I’m comfortable in the limbo-like space, where we aren’t sure who to trust and what to believe. The reason I’m comfortable with these conversations is because I can give an answer for the hope in which I have. My foundation is Jesus. The hill I’ll die on is the gospel’s. Everything else is up for grabs and I’m okay with that. But here’s where I’ll ask the million-dollar question. Does it matter? So what if ____ is true? Does it change our approach to mitigating the spread disease, protecting the vulnerable, and keeping the economy afloat? If not, then why argue and waste time on topics that divide? There is much power in aligning ourselves with a common mission and being willing to disagree along the way.
And now, for some resources I find helpful. Last update: June 15, 2020
national and international experts
The Centers for Disease Control & Prevention – situation summary
World Health Organization – Coronavirus
Information is Beautiful – data pack of graphs
COVID Act Now – select your state to see statistics and projections
local experts
(find your local health department and a university nearby that has a medical college)
SC Department of Health & Environmental Control – Coronavirus Disease
Medical University of South Carolina – Coronavirus updates
Alaska Department of Health & Social Services – COVID-19
human experts
Interview with infectious disease specialist and economist – On Point
Website of infectious disease doctor who helped with the Ebola outbreak, complete with podcasts and articles – Dr. Celine Gounder
Thoughts from a PhD professor specializing in infectious disease and human social patterns – Dr. Malia Jones
Interview with two Italian doctors, one of whom has the virus – Here & Now
Helpful information on group panic and toilet paper – CNBC
Thoughts from an infectious disease doctor, with a link to graphs – Dr. Andrew Norwalk
Podcast with lead epidemiologist at University of Chicago – Dr. Emily Landon
Updated podcast ten days later with lead epidemiologist at University of Chicago – Dr. Emily Landon
Firsthand account on PPE (personal protective equipment) and CDC guidelines, from an ER doc in Massachusetts – Dr. Josh Lerner
*Stay home in general right now, per the updated CDC guidelines.
**I do think it’s wise to have 1-2 weeks of groceries and supplies. A short quarantine is recommended for anyone who has been diagnosed or exposed to a positive case.