Thursday, July 9, 2020 | 2 a.m.
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Sometimes you just get tired of listening ... to all the people who know nothing at all.
Or, worse yet, you tire of listening to the people who only want you to know what they tell you for their own reasons. That is the human condition as I understand it.
But, sometimes, the ability to tune out the truth and listen only to what makes each one of us comfortable in our own belief system is what can kill us. Yet, sometimes that truth comes out regardless of how much we try to shield ourselves from it.
I have friends who can’t wait to go out to dinner, mingle with their friends, have business meetings with people who, believe it or not, are not wearing masks and who generally take COVID-19 warnings as a guidance, not a requirement.
I hope they remain the lucky ones. Those are the people who despite so many bad choices are lucky enough not to get sick. But I believe that won’t be the case because eventually science and physics and nature always win out over hope and prayer and ignorance.
I realize people are tired of listening to the talking heads of supposed knowledgeable scientists and medical experts who constantly warn us about the coronavirus pandemic and our need to take effective action.
Just as we tire from the lack of leadership at the national level, which chooses to ignore the problem and foist the solution upon the 50 state governors who, collectively, range from somewhat intelligent leadership to basic political hackery in the service to the political whims of the ignorant Trump White House.
What is a person to do who wants to protect himself, his family and his livelihood when there is no cohesive leadership based on science, medicine and good sense? To whom should he listen when all he wants to do is the “right thing”?
All I know at this point is to whom none of us should be listening, but if I mention his name — again — people will read no further. And read you should because what follows is a heartfelt letter to friends written by a doctor in the trenches who is just reporting what he sees every day and the fears it engenders. It is a bit medically wonky, but I urge everyone to read it through because it represents a truth that cannot be denied from the ground level and it should give each of us a valid reason to act in our own interests — especially when the leadership in this matter is AWOL.
Since this is a private letter to friends and I am reprinting it without permission, I have edited it for names and identifiers, but rest assured it is real and its message is really important. It follows:
“I’m in a hotspot hospital in a hotspot region. We just converted the entire second floor of our hospital to COVID-19 care.
We have just under 70 patients with COVID-19 in a hospital with less than 400 beds. It is the same at other hospitals in our region. We spent yesterday deciding the ethical way to divide up limited remdesivir for the hospital patients. My incoming interns for our IM resident were exposed to COVID two weeks ago during their computer chart training; apparently 100% of our computer trainers had COVID-19. One intern tested positive seven days later and I insisted we retest them all again, as there are almost certainly other cases with minimal symptoms. I raided my household and took my entire supply of face shields to the hospital for the residents to wear on their first day, and I paid $1,000 of my own money to equip all of my residents with medical-grade face shields. I require all residents to wear a surgical mask or N95 with face shield if they are within 6 feet of another human, patient or coworker.
Roughly 20% of our inpatients die. Only 30% of our ventilated patients survive. (We try to avoid ventilation at all costs. Some people insist on being full code and decompensate despite high flow with face mask, proning, dexamethasone, antibiotics, and a cocktail of famotidine, zinc, vitamin D, vitamin C, NAC, and melatonin — we throw everything we can at each case, so long as it won’t hurt them.)
My administrative assistant, who sits adjacent to the interns, just went home with COVID symptoms.
In the Southwest, we are experiencing catastrophic exponential growth. I have had multiple families — siblings, parent-child, spouses — admitted with COVID-19. I had a young adult come in satting 78% on room air; he had been sequestering himself in his bedroom for a week to avoid infecting his elderly parents, with whom he lived. His sister, the only person he saw outside his immediate household in the 10 days prior to onset of fever, cough, and dyspnea, also had fevers but had tested “negative” at another large hospital so he thought it was safe to visit her. (Sigh. The Quest PCR test is about 80% sensitive, we think — it had emergency approval, so sensitivity data was not required. The Cepheid rapid COVID PCR test is 98.5% sensitive but is in short supply due to limited reagent availability.)
I’m glad some of you are sheltered from what unbridled COVID-19 looks like. It’s a hell show. This is *July*. What do you think my hospital will look like in winter? ...
This is real. Doctors in places with proper public health responses will see few cases in their hospitals — like UCSF — but let me tell you something: The laws of physics and biology don’t change. If you’re in an unaffected region, an introduction and poor governance and low use of physical distancing and masks will give you an exponential increase in no time flat (i.e. 2-4 weeks). That’s pandemic math. And 20% of the population infected needs a hospital. You *will* run out of beds with an unbridled pandemic. There is almost ZERO preexisting immunity to SARS-CoV-2. There may be some “priming” of T-cell responses due to exposure to other “benign” beta-coronaviruses, but we have no idea if that explains the 20-40% of people who seem to get minimal symptoms. Asymptomatic infected persons, however, can, and do, spread COVID to those who die from it.
By the way: I’ve seen scary CT scans of the lungs that look like terrible interstitial pneumonia in a patient who had ZERO symptoms and SaO2 94% on room air. She came in for palpitations and the intern overnight got a chest CT for cardiac reasons. We didn’t know it was COVID until her test came back 36 hours later. So “asymptomatic” does not mean “no biological activity.” The virus replicates furiously in people who feel fine. Kids can spread this as easily as grown-ups, even if they feel OK.
Related: I’ve talked to two previously healthy young adult patients who are 3 and 4 months, respectively, post their acute COVID. They continue to have cough, night sweats, fever, fatigue. How many survivors have “post-COVID syndrome”? We don’t know. Less than 20% but we’re not sure. I’ve asked my hospital to allow me to establish a post-COVID clinic to care for and study survivors. Both NIH and UW are planning similar efforts based on my dialogues with them.
Autopsies show anoxic brain injury in many patients who died of COVID, not to mention microthrombi throughout the lungs and megakaryocytes in massive infiltrations in their hearts and other organs. People get heart failure, lung fibrosis, and permanent kidney injury from COVID-19. This is a disease of the vascular systems, and it can affect any organ, with lungs and kidneys being especially at risk.
In early May, thanks to lockdown, our census of 60 came down to 10 COVID cases, and for a brief moment, I actually had hope that the worst nightmares I had about COVID, as a biohazard virology-trained hospitalist, would not come to pass. Then we reopened, without test/trace/isolate systems anywhere close to adequate. Eight weeks ago my county decided to make masks “optional,” despite most doctors begging them not to do that. Now we’re worse than we were in April. And it’s getting worse every day.
You wanna see if COVID is real? Come walk on my COVID ward with me. It’s real. Hearing people talk about it as if it’s an exaggeration is, well, rage-inducing, honestly. Denial is the most common reaction to a pandemic. Denial is how the U.S. will wind up with 1.1 million deaths instead of 30,000. I saw AIDS denialists get killed by their belief that HIV “isn’t real, it’s a pharma conspiracy of the medical industrial complex.” Yeah, right, if you say so. I watched patients with those beliefs die.
The hardest part about this is every new case I treat exposes me. I have assiduous hot zone technique. But no technique is bulletproof. If you keep exposing me to case after case, eventually, the virus will get through my defenses. I am on the younger side but have my own health issues. I don’t expect to do well if I get infected.
For now, I keep going to work. I’m one of the few pushing forward on COVID clinical trials, basic science, public health messaging and diagnostic studies at my hospital. I feel a responsibility to keep going. I wake up with nightmares every morning at 4 a.m. But I’m going to keep going for now. I feel very alone a lot of the time. People are not taking this seriously, and it’s costing lives.”
Brian Greenspun is editor, publisher and owner of the Sun.
