Well, things have escalated quite quickly since I last wrote. Our understanding of COVID-19 appears to be changing at lightning speed, and I figure a brief update would be wise. I will continue to pull most of my data from the official WHO data, which insofar appears to have been the gold standard and can be tracked easily at https://www.worldometers.info/coronavirus/ .
A personal aside: I have been activated by my program as a member of the COVID surge team. We are pulling residents off non-essential programs and deploying us to the hospital to deal with increased demand for admissions to general wards floors. I am in charge of a 16-patient team at Parkland Memorial Hospital in the center of Dallas, Texas. Parkland is one of the largest hospitals in the state of Texas, and we are just now seeing an increase in COVID-related admissions. Every 4th night (for an indefinite amount of time), I stay at the hospital overnight after my day shift (traditionally called a “Call night”, a traditional 30-hour shift) and continue to admit patients to the wards services overnight. I have encountered many positive and non-positive patients, but it is not yet the onslaught of COVID I have expected. Other life-threatening diseases (cancer, heart disease) have not taken a break during this outbreak, and we will continue to mobilize and fight them as we had before.
Some Bad News:
Two weeks ago, when I said we are likely underestimating prevalence worldwide by 3-fold, I was wrong: We were probably underestimating it by closer to 10-fold. The number of patients who are completely asymptomatic with the disease is much higher than we expected. A rather interesting cohort-study from Singapore showed as many as 1 in 6 of people who acquire COVID-19 never display any symptoms, which makes tracking the disease much harder, because we don’t know who to test. We have a limited number of testing kits, which makes testing everyone difficult.
Us flattening the curve (by socially distancing) will make the disease exist in our society for longer: This will not be over soon. Exactly how long, no one can really say. Italy is hopefully peaking over the next few days, then they should see a down-turn in COVID infections. The Italians appear to have suffered the brunt of this disease insofar, with thousands dead (and the military needing to help unload the coffins from some heavily affected hospitals). New York City is likely in for a long battle, but appears to be taking the appropriate precautions and mobilizing their workforce.
We still have a lack of testing kits: It is difficult to test everyone. We have limited local testing to those with fevers, but since many patients are asymptomatic, we are unlikely to be appropriately screening everyone.
Some Good News:China and South Korea appear to be defeating the disease: More patients are recovering from the disease than are being found newly infected. They are likely a few weeks (if not months) ahead of us.
We are the richest nation in the world, with an incredible ability to battle this disease; if we commit to it: We are seeing factories be modified and start to churn out PPE (personal protective equipment) at lightning speed. In 1941, when the Japanese bombed pearl harbor, we were producing 300 M3 tanks a year. By 1942, we were making 10’000 (an increase of 3,233%). We are mobilizing in many of the same ways now.
My advice and some random thoughts going forward:-Try to stay inside if you can, limit groups as much as possible, follow the guidelines of your local government.-We need our “essential services” more than ever now. Our farmers, power company equipment operators, package deliverers, gas station and grocery store attendants are our new heroes. Thank you for continuing to keep this country functioning. – If you have underlying health issues or are elderly (>65), I would strongly recommend you stay inside as much as possible.- Please continue to wash your hands daily
A serious concern: Many people are infatuated with a small poorly-done study showing some possible benefit from HCQ (hydroxychloroquine, also known as Plaquenil) and azithromycin (AZA, a z-pack) helping to speed viral clearance. This study was not done in a randomized fashion (meaning the doctors did not make any attempt to make the compared groups equal) and was not analyzed in the correct way (Intention-To-Treat) meaning the doctors were allowed to exclude roughly whoever they wanted to from being included in the final statistics. HCQ/aza might be of some benefit, but WE DON’T KNOW THAT YET. We do know is that HCQ/AZA can induce serious heart arrhythmias (Torsades de Pointes, a type of ventricular arrhythmia) in random people. We are currently doing the trial THE RIGHT WAY at multiple centers across the US and should have results soon.
God bless, stay safe. We will win. We will defeat this. Life will get back to normal, I just can’t say when yet.
-Dr. Ross Schumacher is a 2009 honors graduate of South Spencer High School, and received his M.D. from Indiana University School of Medicine. On March 16th, he was awarded UT Southwestern’s highest honor (Alpha-Omega-Alpha) for his performance during his residency, then on March 17th he was assigned to their COVID surge team. He lives in Dallas, Texas with his new wife Victoria.