March 19, 2020

Spring Equinox

Seattle in spring is one of my favorite places, and there is no place lovelier when it is sunny. Spring starts here early and lasts late, which of course, means summer doesn’t arrive until the 5th of July. And lucky for me, I had today, the spring equinox, off. Sort of. Regular days off seem to disappear in an epidemic. I did sleep a little later but not much, because I got up for a video conference about Telemedicine that I start using Monday. Since it was a gorgeous day without a cloud in the sky, I took off for a walk through the neighborhood, noticing the cherry blossoms soon to open and the star magnolias already blooming. A line of bright Daffodils at the corner house brightened the street. Lots of people were also out enjoying the sun, happy to be outside.

And then my phone exploded with texts. The world has shifted. The past few days have had an uptick in positive tests. Word came in the community of a beloved store owner dying. I spoke with a patient yesterday who had a family member die at home. And then overnight, the results seem to have tripled. The doc on call needed help to reach people. So I went home to help. Tough call to send one to the hospital because he was worsening, and I called the ER to let them know he was coming, talking with the ER doc who resignedly told me the hospital is full, that they are holding people in the ER until there is space. And now another patient is coming in for them to care for. I felt like a priest, hearing confession. And then he said: do you know that half of the people in our ICU with COVID-19 are younger than 50?

The CDC report today supports that data point. This is not ‘Just the flu’. It can kill people and kill quickly. People are usually OK, but miserable, the first 6-7 days. And then, for reasons we don’t understand, 5% of the time, an inflammatory cascade begins and people may develop ARDS (adult respiratory distress syndrome) which can develop unexpectedly and quickly, usually in those with risk factors, but occasionally in healthy people. This inflammatory overreaction is what causes lung failure and possible death.

This is truly scary information and I am sorry for that. I want you to also understand what to look for if suddenly you or a loved one are getting worse. It happens after about 5-7 days. We are also not always able to predict to whom it might happen. And yet, most people do OK. Yes, more common in older people with risk factors, but it can still happen in young people who are healthy. And we are running out of ICU beds and respirators. And that is why slowing the curve is key. And why younger people need help to understand that this is different and more virulent than the flu. Why we need leaders in every city, every county, every state, every country to guide us through this and not say that we are overreacting.

Spring arrived officially while I was writing this. In the Pacific Northwest the length of our days will accelerate, it is my favorite time of year. And despite the work and the fear and the sadness, I hope to still enjoy as much of this land and sky as I can, every minute is precious.

Wash your hands.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm