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Coronavirus 9.0

We have now implemented extreme measures. Normal life has been disrupted and we don’t know when it will return. It has been a very strange week in America. Schools closing, major sporting events and seasons cancelled, store shelves emptying, financial markets and retirement accounts decimated as a result of an enemy perhaps as bad as the virus, fear of the virus.

The solace we should have is that there have been declining rates in other countries. That’s not being widely publicized. Neither are recovery rates and negative test results. In addition treatments are showing some efficacy in helping some of our sickest patients. That might ease some of the fear.

A good example of putting such a negative spin on things was the study that showed the virus survives in air for a short period and on surfaces for 3 days. That was widely disseminated because it was scary. The researchers clearly stated that did not mean it could be spread that way. That part gets left out of the media reports.

I really believe everything that we are doing will effectively slow transmission. Its at a great cost though and I fear the stress it’s creating could lead to medical problems down the line that could prove devastating. It would be a terrible irony if these stress inducing moves and fear lead to depressed immunity and higher levels of disease. There may be consequences we can’t really understand yet. We all need to be rational as we confront this.

Everyone dislikes uncertainty and lack of data. Over the next weeks we will get more but so far what we do know has not changed. Mild in most, severe in some, deadly in relatively few. We know who is at highest risk and protecting them should be our highest priority. I am so grateful that children are not in that category.

With expanding testing will come expanding fear that it is exploding. I think we need to differentiate between spread of the virus versus identification of existing cases. Spread is really about understanding rates of increase. You can’t really do that without knowing the current case load. It will become harder to track contacts if our existing burden is higher than we thought. That will make containment much more difficult. I think it will be higher, maybe much higher. That will lead to more fear which is hard to imagine given where we are already.

Many more cases sounds bad but there is a positive side to it. If there are many more cases already and our hospitals are handling it so far maybe the burden will not be as bad as anticipated for them. We have to hope the Italian experience is an outlier. It appears to be. Also identifying more mild cases brings the severity and death rates down. We also know that flu rates of hospitalizations decline this time of year, increasing our capacity right when we need it most.

We have a resource that is by far the best in the world in the US Army and other service branches Medical Corps. I served in the Army Medical Corps for 9 years and can attest that if it comes to needing increased capacity and support they will be up to the challenge.

If we fail, the endpoint will be that it’s here and we will have to learn to live with it. If it comes to that it gets real simple. We would treat it like we do other respiratory diseases we all know that come to our communities and offices in force every year. Pediatricians and primary care providers know them well. RSV, other Coronaviruses, Human Metapneumo virus, Rhinovirus, Strep, Pneumococcus, Mycoplasm, Enterovirus, Parainfluenza, and of course Influenza. There are many strains in each of these groups plus others that we know are out there. At some point in history they all must have been novel. We accept their inevitability every year. Wether there is a test or not we will do what we always do, what our training tells us to do. We get a history, we examine. We treat what we can. We asses the level of care needed. We recommend either go home and get well or go to a higher level of care. As with our other microscopic enemies, with COVID 19 most will go home, some will need the hospital. Some don’t even need to come in, they just need to stay out of the community until they are well. Humans have the ability to win almost all battles with these invaders through the miracle that is the immune system. Those that can’t fight will need our help.

With the full resources of the CDC, The NIH, The State and Federal governments and the private sector at at an incredible gear, one difference will be there will be eventual treatments and a vaccine. That will help but not for right now. We should be very thankful for their tireless efforts.

This unprecedented attempt to mitigate spread of this virus is fueled by an unremitting fear a new pathogen. It is new, yes and it can be terrible in some but it is not like SARS, MERS or Ebola. It is time we stopped fearing it like it is. If any illness like those comes in force, as hard as it is to imagine right now, then we will have much bigger problems.