COVID-19 Update 4/28/20

I write to you with some good news and new hope.  You remain in our thoughts and in our prayers daily as we all work to find our way through the economic turmoil and unrest of the current crisis.  The good news is that yesterday, Governor DeWine announced that we will begin moving toward a more open economy.  Beyond this, there are real gains being made around treatment and strategies.  Some places are experimenting with faster and more aggressive reopening - if Georgia and Alaska are doing well in three weeks, we may see an acceleration of things…if things go badly, everyone will reevaluate.

If you would like to keep up to date with Ohio’s response, there are the 2:00 pm press conferences (every day but Sunday) where the governor lays out what is changing and the next steps.  Additionally, you can always visit the ODH site.

As far as treatment, new best-practices are emerging in how best to balance patient needs surrounding ventilators, oxygen, and other breathing-related devices.  We are not yet at a place where these treatments are enough to make the infection safe, but the mortality rate of the severely ill appears to be falling as we get a better understanding of how to support the most sick ones among us. 

More importantly for most of us, a host of new studies are underway for a whole range of medications.  While there are no effective treatments yet identified and we have found no significant developments on the vaccine front over the past week, interesting studies of antiretrovirals, immune therapies (boosters and suppressants), and a range of support therapies are underway across the globe.  Additionally, new testing methods are continuing to come to market.

Somewhat frustratingly, the federal intervention is getting more unpredictable.  After consulting with the state, we must stop testing because of new restrictions from the FDA on the test we have been using.  We will continue to work to find testing options that will allow us to be as safe as possible as we return to work.

While there are some exciting developments in treatment, there have been some troubling scams and statements about COVID-19 treatments and prevention.  I’d like to take a moment to address some of what we’ve heard.  It is important to remember that while there are meaningful studies, there is no known safe and effective treatment at this time. 

  • Facemasks: Homemade facemasks/face-coverings do very little to filter out viruses that might make you sick if they are already in the air around you.  However, importantly, they do appear to do quite a lot to decrease the amount of virus that an infected person puts out into the air if they are wearing a mask.  For this reason, wearing a mask is now recommended because it helps to decrease the rate of transmission of the virus.  (More on this in the extra-credit below.)  We appreciate when patients wear masks for their office visits.
  • Disinfectants/Bleach: The action that makes disinfectants effective is that they are toxic to living things.  It is great for you to be using them to keep surfaces clean.  For your own skin, soap and warm water are still the best option.  In the case of the disinfectant bleach, it oxidizes proteins and makes them clump up.  It’s actually the same type of damage that happens to eggs when you fry them – the proteins are just jumbled up and they can’t do their job anymore.  (Oxidation is the same process that makes metal rust, wood burn, and pages in a book turn yellow over time – it’s just that bleach does this very quickly.)  While this is great on the surface of something when you want to kill everything that might be living there, it can quickly become fatal if it happens in your body.  Bleach (or any disinfectant for that matter) should never be put into your body (either ingested or injected) specifically because the same thing that makes it work outside your body will kill you.  Think of it as the chemical equivalent of fire – if you apply enough to kill the virus, you will die.  If not, you will only damage yourself and your body will be weakened if/when you are infected.
  • Chloroquine and Hydroxychloroquine:  The studies for these medications are mixed regarding both the risks of the medication and the effectiveness of decreasing death due to COVID-19.  In short, regardless of whether a person is sick, these drugs have significant and dangerous side effects and will kill a portion of the people who take them because of this.  For this reason, they are not recommended as an off-label treatment for this disease (and may not be legally prescribed for COVID-19 in Ohio.) 

While we are in no position to predict the future, we do see signs that real progress is being made.  We remain at your service and focused on ensuring that our community is safe and healthy moving forward.  Thank you for the work that you are doing and the sacrifices you have made to keep us all safe.  As always, we welcome your feedback, critique, questions, and thoughts.
 
Warm regards,
 
Rudi
 
Extra-credit: If you remember the “Hammer and the Dance” article/idea by Tomas Pueyo, it does look like the “hammer” piece of the response is working.  The big question is when to transition to “the dance.”  As a refresher, the hammer is the brutal first stage where we must endure hard isolation and economic loss to buy time for a medical response, testing, and targeted-quarantine infrastructure.  The dance is the part we remain careful, but with the right tools in place, can focus the quarantine on the ill (we can identify them with tests and have the people and processes in place to track down their contacts rapidly.)  The dance lasts until the virus becomes less dangerous (through herd immunity, vaccines, or robust treatment options).

Remember, through all of this, the virus always grows and shrinks exponentially.  We do have scary days ahead and we need courage to face them.  Flare-ups will be dangerous and people will die, but the point of the dance is to make sure that these events are as small as possible and that treatment is well targeted and effective. 

As we figure out next steps, please remember that very little differences change EVERYTHING.  If, together, we average less than one new infection per person who is infected with this new coronavirus, it will rapidly shrink (an exponential curve down).  The moment our behaviors and the virus’ action allows each infected person to infect more than one person, the growth takes off exponentially.  We may get some seasonal help (or we may not).  It appears that masks help trim some rate of spread off.  Certainly, our willingness to sacrifice our own preferences and economic interests to stay inside during these past weeks has trimmed it dramatically.

The critical thing to keep in front of us during this reopening is that there is still a huge benefit to careful and thoughtful behavior.  If we behave in a way where each of us would infect 2 people (during the average 10 day communicable period), a handful of cases rapidly becomes hundreds and everything must close again.  If all of us act in ways that would not infect anyone outside our circle, we will be able to make this work because every flare-up will be contained.