Being a specialist in infectious diseases right now is an interesting experience. Added to the usual challenges of our everyday practice — caring for people receiving transplants or chemotherapy, those with HIV, surgical infections, tropical diseases, and others — we now must manage a deluge of coronavirus-related questions from friends, family, and colleagues.
Here are a few recent examples in bold, along with my responses.
Frequently asked questions
My baby has a pediatrician’s appointment next week, and the doctor’s office is right next to the hospital. Is it safe to go?
Should I wear a mask while commuting to work on the T or other public transit?
Only if you’re sick yourself, because the mask will protect others. Otherwise, masks probably don’t do anything to protect you. Here’s what you should do: Wash your hands!
I’ve had a trip planned for a year to Australia and New Zealand and am supposed to leave in early April — should I cancel now and get a partial refund?
Only cancel if the anxiety of going would make you not enjoy the trip.
I’m just back from France and have a bad cough, sore throat, and a chill. How do I know if it’s the flu or coronavirus?
We really can’t tell. Reach out to your doctor and see about getting tested for both.
Should I avoid Corona beer?
There’s no coronavirus-linked reason to pass on Corona beer — but in my opinion, it’s not very tasty.
OK, so my friends, family, and colleagues haven’t really asked about that last one — but it is a thing.
Now, there was one actual question that caught me off guard: “What are you afraid of?”
Before responding, let me acknowledge that I am by nature an optimistic person — my family even gave me a T-shirt with the words “half full.”
Plus, we infectious disease specialists are, by our very training and clinical activities, repeatedly handling situations that would make others uncomfortable — such as treating patients with anthrax, SARS, MERS, West Nile, H1N1 influenza, Zika and Ebola in the last 20 years alone.
But several aspects of this incipient pandemic cause me great concern.
5 big concerns
1. Our health care system does not have “surge” capacity. This is especially true during flu season, when many hospitals run at nearly full capacity. Adding a high volume of patients with respiratory infections — all of whom would require private rooms — will severely strain most institutions. It will further block other important hospital activities, such as elective surgeries and transfers from other hospitals. This is already happening in northern Italy.
2. Here in the U.S., testing for the new coronavirus was initially sharply limited. For a variety of reasons — misguided policy, regulatory limitations and faulty tests — we only recently started broad testing for coronavirus among people with compatible symptoms — some two months after the disease was first reported. (Initially, only those who had traveled to regions with coronavirus outbreaks were eligible for testing.) While other countries have already conducted thousands or even tens of thousands of tests, as of last week the U.S. had done fewer than 500. While the logjam on testing should end soon, it’s probably too late to prevent extensive community transmission.
3. The people at greatest risk for severe or fatal coronavirus illness are already our most vulnerable patients. Like other viral respiratory tract infections — flu, respiratory syncytial virus, even rhinovirus (cause of the common cold) — older age and concurrent medical problems make coronavirus infection much more serious. Estimates from China suggest the mortality rate among those older than 80 is 15 percent. That’s why the reported identification of cases in a Washington nursing home is particularly worrisome.
4. Hoarding of masks and other protective equipment could stress the supply chain, putting health care workers at risk. All of us in health care accept that exposure to infection is part of our job. But to do so without the appropriate protective supplies cannot be permitted. It is critical that we have access to the specialized N95 masks and other gear, especially during procedures that increase the risk of exposure.
5. Political pressures might make it difficult for public health officials to tell the truth. Does Dr. Anthony Fauci — longtime director of the National Institute of Allergy and Infectious Diseases and someone who has navigated outbreaks for decades — really need to have his statements cleared by Vice President Mike Pence? When Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said a global pandemic was highly likely, only to be contradicted later that day by the president, who should we believe? The Trump administration on Saturday denied muzzling public health officials, but I find these examples troubling.
3 important reasons for optimism
If that list seems like a lot to worry about, let me mention a few things I’m not worried about — and that even give me hope.
1. We know the disease is mild in most people who get it. At least 80 percent, most likely more, won’t have an illness bad enough to warrant hospitalization. We’ll have a better idea once testing is more broadly applied, but it would not surprise me if the widely cited case fatality rate of 1-2 percent is eventually less than half that.
2. Children seem particularly protected from severe coronavirus disease. Many of the sniffles and colds kids experience are due to existing milder coronavirus strains, possibly giving them partial immunity to this more serious new threat.
3. There has been extraordinary global cooperation from doctors, scientists, and public health officials. In most cases, this has included remarkable sharing of clinical data and research. It is wonderful to see the medical community responding in such a unified voice, all of us trying to solve this new problem.
Guess I can still wear my “half full” T-shirt.
Paul Sax is an infectious disease physician who blogs HIV and ID Observations, a part of NEJM Journal Watch. This article originally appeared in WBUR’s CommonHealth.
Image credit: Shutterstock.com
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