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  • drmarkmurphy

The second week: Morbidity and Mortality Come Home to Roost

This is the week that everything really began to hit home.

The United States is now the new epicenter of the COVID 19 pandemic. We surpassed China as the nation with the most cases in the world this week, and the reported incidence is on the upswing across the country. Georgia is no exception. As of this writing, there are now 1643 confirmed cases in our state, and 56 people have died. Chatham County had its first confirmed case only a week ago. Now, we have nine—but that’s mainly a product of limited testing. It is definitely on the rise in our community. We’ve had health care workers come down with it, others quarantined for it as they wait for testing, and at least one individual I know of has died of a presumptive COVID 19-associated pneumonia. A friend and former high school football teammate of mine is hospitalized with it in an Atlanta ICU.

Our office is open, but we are only seeing urgent patients. Elective visits and procedures have been shut down. We are trying to get a telemedicine service up and running so that we can see patients remotely, but that’s been happening in fits and starts. The city is on limited lockdown—doctor visits, grocery stores, pharmacies and banks are still allowed to be open, and restaurants doing take-out business. Oh, and liquor stores, probably to prevent people from going through alcohol withdrawal (I had a gastroenterologist friend who stated that closing liquor stores in Savannah “cold turkey” might kill more people than COVID 19—and he’s probably right). Beauty and nail salons were initially allowed to be open, but that’s going to end soon. And so we hunker down and wait, for the invisible viral hurricane lurking somewhere off our communicable disease shore.

I’ve become a little paranoid in the past few weeks. I disinfect everything. I even disinfected my disinfectant, washing the little bottle of hand sanitizer that I carry with me because I realized that the bottle’s exterior might have gotten contaminated.

This sort of behavior goes against my very nature. Normally, I don’t worry about much. In fact, I’m a recalcitrant optimist. I think Georgia’s going to win the college football national title pretty much every year, even though the hard data of the past 40 years have consistently refuted that expectation. I eat expired food with reckless abandon, just so long as it doesn’t smell bad or have obvious mold (and moldy cheese is actually an exception to that exclusion, since that mold can be scraped off). I hug everybody I know, shake hands like a politician on the campaign trail, and I will talk at length with anyone who will listen.

But this pandemic has changed me.

I keep my distance. I sanitize every common area before and after use. I feel paranoid if I cough or clear my throat, feeling like I owe everyone around me an explanation (“I’m not sick! My throat is just dry!”). If I pass someone on the street, I don’t look at them as much as I used to—but that makes me feel rude. It goes against my southern upbringing.

I’m worried about how I’m going to behave as I get older. I can almost see myself acting like Howard Hughes in his later years, a relentless glove-wearing germophobe cloistered at home, avoiding all interpersonal contact.

Well, almost.

I saw a projection that COVID 19 cases are expected to peak in Georgia around April 1—April Fool’s Day. That’s somewhat speculative, and a lot of those sorts of projections depend upon the response of the public to social distancing measures. But at least that gives us some sort of target. Right now, it feels like we are adrift. Life as we know it has been brutally interrupted. And no matter what happens, I think our lives are all going to be irrevocably altered after all of this is over.

Somebody asked me how I saw this all ending. I’m no seer, but I’ll take a shot at it.

Certain urban hotspots, like New York, LA, New Orleans and Atlanta, are going to have large numbers of patients in ICUs over the next few weeks. There will be a high death rate in those areas. The social distancing measures we now have in place will hopefully spread some of that out so that the peak won’t be as abrupt, which would allow us more time to get health care workers prepared for the onslaught, with more readily available personal protective equipment (PPE) and, hopefully, more ventilators. It will also allow more research to be completed regarding treatments for symptomatic ambulatory patients, such as the hydroxychloroquine therapy which made the news recently. Right now, buying more time is critical. Northern Italy got overwhelmed because they simply were not ready for the magnitude of what hit them.

Hopefully, COVID 19 testing will become more rapid and more widespread. A 45-minute test for the virus exists right now but is not generally commercially available. Having this testing available would allow the actively infected to be quarantined until they are no longer infected. After the pandemic’s peak, returning life to normal will be largely contingent upon being able to know who has the disease and who does not—and who is at risk for getting it. Lots of people have been exposed without knowing it and are immune (81% of the people infected with COVID 19 have relatively mild symptoms). The UK recently announced that a simple finger-prick test will soon be available which will allow people to determine if they had been exposed and had developed immunity. Once that sort of testing becomes universal, those who are demonstrably immune could return to “business as usual.”

Locally, I think we’ll be through the worst of this by mid-May. Limited business re-opening should be happening by then, but social distancing measures will still be in effect. This summer will likely be the least busy tourist season in memory, for the entire country. People simply won’t want to travel—and that’s probably a good thing.

Ultimately, a vaccine will be available. That’s likely 12-18 months away, though. That’s critical as the virus is showing some signs of seasonality, like the flu. It may be something that is simply part of our lives going forward. Controlling it with vaccination will allow us to develop “herd immunity” as a species, which will substantially reduce the virus’s morbidity and mortality in upcoming years.

The COVID 19 pandemic is the number one public health challenge of all of our collective lifetimes. The odd thing about this? Maybe, just maybe, it will bring us all closer together. Maybe we’ll all finally understand a little bit more that we’re all a little more alike than we are different and learn to treat each other with a little more civility and respect.

I guess, at the core, I’m still an optimist after all.

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