Thursday, April 30, 2020

Response to the article I shared about COVID, from a nurse friend.

Response to the article I shared about COVID, from a nurse friend.
Not the flu:
As flu season progresses during the winter 5 to 20% of people exposed get a viral infection, 3 to 11% have symptoms.

As people get older, they get symptoms with the flu much less often. Children get ill much more often from the flu compared to adults who have a more developed immune system.

Flu deaths occur mostly in children under the age of 2 and in the very elderly (70 plus). Any age group is more likely to die with the flu if they have chronic medical conditions.

From onset of exposure to illness is 24 to 48 hours. A person can spread the flu before they have symptoms or if they get infected but never develop symptoms but they are much less contagious. Mostly flu is spread while a person has symptoms.

Flu seems to mainly attack the respiratory system. When people develop pneumonia from the flu it usually is in one lobe of the lungs, sometimes it spreads to all the lobes on one side (fun fact 2 lobes on the left, 3 on the right). It is very rare for people to get pneumonia in both lungs from the flu.

Some people have GI symptoms like nausea, vomiting and diarrhea. Flu does not attack other organs like the heart, liver or kidneys.

We know a great deal about the flu because doctors and scientists have studied it for more than a 100-years. There are many treatments for the flu and a yearly vaccine.

Covid 19
Doctors have only been able to study it for less than 4 months. Before that doctors had not even identified the illness caused by covid 19 as a separate illness. Not clear when this really started. Some say the end of December some say earlier.

It is unclear how contagious covid 19 is. It is more contagious that Sars or Mers. It may be less contagious than flu but no one before this year had developed immunity to it. Many more people will catch this than the flu in the next 2 years, after that who knows, but certainly many less.

After exposure to covid 19 people develop symptoms in an average of 5 days. Some
 people have not developed symptoms for as many as 28 days after exposure. Many
 people never develop symptoms or symptoms so mild they don't recall being sick. On the USS Theodore Roosevelt as of 4/24 678 crew members out of 4,068 tested positive. I don't think they tested all of the crew. As many as 60% of those tested positive had no symptoms. It is unclear how contagious people without symptoms are. The population of a Navy ship is much younger than the general population. Also, one assumes none of them have major underlying conditions yet one sailor did die and more may die.

It is clear people without symptoms can spread the disease. It is also clear that the sicker a person is with the disease the more easily they can spread it. That is why more health care workers get Covid 19.

I do not trust much of the data coming out of China but I do trust some of the
 data coming from doctors in China. Much of this data has been confirmed by other
 doctors in the world.

China tested many children, most of the world has not tested many children. Many children tested positive with Covid 19. China did not have any recorded deaths in children. It is unclear why children do not usually get symptoms from Covid 19 nor why they don't die from it. In other countries including the US, there have been reports that children can get unusual blisters on their toes that resemble frostbite blisters. No one knows why this happens. It is very possible that a child with an underlying medical condition could die from covid 19. It is also believed that children can spread covid 19 so schools need to stay closed for now.

If someone has a chronic condition such as Copd and gets the flu and dies, we say they died of the flu. If a person has the flu and died in a car accident, we say they died with the flu. That example is very clear but it is not always easy to determine which way it is. My Mother died during the influenza A epidemic in Dec 2017. She was never tested for the flu nor did she have a chest x-ray to confirm that she had pneumonia as we put her on hospice first. My Dad was tested for the flu and was confirmed to have influenza A at the same time. I am 99% sure she died of pneumonia from the flu but her death certificate says she died of Alzheimer disease as her doctor had no proof she had the flu or pneumonia.

 People who get symptoms from the flu usually get a high fever (greater than 101 degrees), respiratory symptoms and recover in 7 to 10 days.

People who get symptoms from Covid 19 often get high fevers that lasts for many days sometimes as long as 2 weeks.  If they develop pneumonia it is in both lungs which makes this a much more serious disease. Many people take 10 days to 3 weeks to recover from Covid 19.  Some people lose their sense of smell and/or taste. Sometime that is the only symptom they have. No one is sure why. Does Covid 19 infect nerve cells? Covid 19 can invade T cells like HIV disease. This prevents the t cells from working to help kill the virus but unlike HIV covid 19 does not seem to be able to reproduce in the T cells only in respiratory or GI cells. Covid 19 can cause severe kidney damage including people needing dialysis. Covid 19 can damage the heart, how it does that is not clear. Some doctors think that it may attack hemoglobin in the red blood cells but it is not clear this is so or how this happens. Doctors are seeing very tiny clots in the blood of Covid 19. How or why this happens is not clear and how much damage this does to a person is also not clear. This does not happen in the flu.

Many doctors are seeing 2 different types of respiratory symptoms in people with covid 19. One is like the more usual ards they see in severely ill patients with respiratory illness. The other seems more like high altitude sickness. Why do some get one type and others the other? We know how to treat ards but what is the best way to treat the second type?

When people get pneumonia with covid 19 they get scarring in both lungs. It is possible that your body can repair some of this damage but like any scars you get some or most of the damage is permanent. This could lead to permanent disability in some people.

The majority of deaths from Covid 19 are in people over the age of 70. It is estimated that this is 80% of the deaths from covid 19. But 20% of the deaths are under that age, including some in their 20s. Most of these deaths are in people with underlying conditions yet some die with no underlying conditions. If you are exposed to high concentrations of the virus you are both more likely to contract covid 19 and more likely get very sick or die from it. This is why health care workers, and first responders (i.e. police, fire, ems) are more likely to die from covid 19. If you work in conditions that expose you to many people or work close together, you are more likely to catch any viral disease. This means people who live in a city are more likely to get this virus more quickly than those who live in rural areas. But this will spread to rural areas in time.

The other thing about this disease that people don't understand is that the infection spreads in an exponential fashion because it is new. This does not happen in the flu and after Covid 19 has been around for a while won't happen that way again. That is first 1 person gets it then 2 then 4 then 8 etc. Why this is hard to understand is that at first the numbers rise very slowly but later rise very rapidly. If you let this disease spread unchecked suddenly millions, then 10 of millions become infected and deaths increase with them.

Now suppose we did not do the stay at home orders and shut down businesses. Some old people would die and but our economy would be ok right? Not so. What do you think would happen when suddenly people started dying of an unknown disease? It mostly seems to kill old people but your 40-year-old neighbor just died of it. There are no treatments, this causes panic. Your cousin got the disease and said it was the worse illness of his life and everyone thought he was going to die. He got better but only after weeks of being very sick and no one knows how long it will take before he is well enough to go back to work. You do not know just what problems this disease causes strange symptoms are happening to people. Suddenly the hospitals are full and medical people are dying of this disease. The hospitals are turning people away. Patients are on the floor and in every waiting room seat. The bodies are piling up and cannot be removed fast enough.  (This happened in Wuhan). Many people in a meat packing plant get sick and some die. Do you really think business would go on as normal? This pandemic was going to trash our economy anyways.

The question has always been how to limit the number of people who die from this disease and limit the damage to the economy. I personally believe we now have enough data to begin reopen some businesses. Many places which have an increasing number of cases must wait days or weeks longer before starting to reopen. We must reopen slowly and take precautions using the information we have learned. Everyone must wear a facial covering in public. Not an n95 mask but something to stop the flow of air from your lungs to someone else. My mask protects you; your mask protects me. This will slow the spread of the disease greatly. We will need to stay apart as much as possible (six feet apart or 6 feet under). Restaurants start with 25% occupancy. We see how that goes for a couple of months then increase to 50% etc. We must test lots of people constantly to watch if the spread is increasing again. This has not been possible to do in the US until just recently and is still not possible in some places. The supple chain problems have caused trouble getting reagents for the test kits and swabs to do the test. We have just gotten the machines available to do the tests in every state but that is not enough.  As we reopen up, we must expect an increase in cases but keep the number low enough to control the spread to stop exponential growth.

If all people wear facial coverings and social distance, I believe we can reopen all parks, playgrounds and beaches now. But this means we must limit the number of people in these places, enforce the facial covering and distancing rules. That might be hard to do. If we do not reopen businesses using the data, we have we risk starting all over again with unnecessary deaths to our people and more damage to our economy.

Please feel free to share this with all the people you shared the first article with. I would be happy to discuss this further with you. We should not let politics determine how we respond to this pandemic but I am afraid with the division we have today both sides will try to further their agendas. We all need to try and respond as rationally as possible and trust doctors and scientists to guide us.    Anne

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