March 6, 2020

Covid-19, March 6, 2020
Helped by the Fremont Troll today.

My update is early today. Jamie and I are taking off in our Metris van to camp at Deception Pass (appropriate name for today) on Whidby Island for some forest bathing. Looking forward to the quiet and virus free.

Things as expected are swiftly heating up. The spread of the virus is not contained. CROI (one of the most important infectious disease meetings of the year) which was planned for next week in Boston was just cancelled. 

Alarming to hear that the Rhode Island cases are all traced to a group that traveled to Italy. That means travel to an affected area is risky, which is more clear than ever.

My clinic has instituted two Acute Respiratory Clinics in separate sites from our main multi-specialty clinics and are triaging people to go there. I saw half my usual patients in clinic yesterday partly from that diversion and partly from cancellations due to concern of exposure. However, I feel much less exposed then before (since I am over 60). I have debated with myself about volunteering to work at the clinics since they need providers and think I will- I will have good protection. Interesting that the ones seen yesterday for illness, out of 25, 8 had positive flu tests, 5 had positive strep tests, and only 9 were deemed to meet criteria for testing. Results will still take 72 hours due to back log. This means influenza is still here and clouding the picture.

The one thing I want to emphasize today is about trying to slow the spread down:
In HIV care, we have the concept of “Community Viral Load” which means that if you get people with HIV treated so the “viral load”, the amount of virus in their blood, goes to undetectable, the transmission rate goes way down because you have a lot less virus circulating to infect others. You can translate this in the opposite effect of this epidemic. The more people infected, the more transmission goes up, especially since this is so much easier to transmit. The news is SO varied that I have heard people say “since it is not so bad in healthy young adults, why don’t I just get infected and get immunity?” Bad idea. This will escalate the epidemic and make the more vulnerable likely to get it. It is true that most people do fine- 80% have mild cases, but still 20% are more serious and the sickest are 10%. And keep in mind that I know of cases in the ICU of younger healthy folks. The statistics in Washington state are still showing low rates but I do know that there are cases in the ICU at Swedish and other hospitals that are not counted because they don’t have confirmed positive tests.

People really do need to take this seriously because slowing it down will allow the health care system to not be completely overwhelmed. Spreading out the serious cases will make a difference. We only have so many beds and so many respirators available. 

With that serious note, I am taking off for the weekend. Stay healthy and wash your hands!

PS my notes yesterday about people taking prednisone should not scare people that use inhalers and nasal sprays to control their asthma and allergies. But when it is used in high doses for COPD and other respiratory illnesses, it helps but not in Covid 19, it seems to worsen it.

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