Your social media feed is filled with conflicting information about COVID-19. The government is giving mixed messages. You probably have some serious questions about the spread of the coronavirus. Is this all just media hype? Will I be under mandatory quarantine in the weeks ahead? Should I let my children visit their grandparents?
McClatchy spoke with three physicians at some of the nation’s top university public health schools to get their insights.
Below are excerpts from interviews with Dr. Jonathan Fielding of the UCLA Fielding School of Public Health, Dr. Joshua Sharfstein, a vice dean at Johns Hopkins Bloomberg School of Public Health, and Dr. John Swartzberg, a professor emeritus at UC Berkeley School of Public Health.
Their interviews have been edited for brevity and clarity.
The unseen wave
Sharfstein: You’re only seeing the beginning part of the wave. There are several reasons for that. One of the reasons is there hasn’t been as much testing as we would like. The second reason for that is that there’s a lag between when people get exposed and when they get infected. It’s longer for this virus than, say, for flu. You get sick a week later. The third reason for that is even if you get sick a week later, it might be two weeks before you get really sick enough to need more healthcare.
It’s easy to look at where things stand now and say, “Oh I don’t see the problem,” but the reason that public health people are nervous is that they know that this is really just the first part. What happened in Italy was people were kind of blasé about it, perhaps, and didn’t think it was coming, and it has swamped their hospital system.
Are hospitals ready?
Swartzberg: Hospitals are starting to run out of equipment to protect the healthcare workers as well as isolation rooms to adequately keep others in the hospital safe. Although we’re not running out of ventilators yet, unless there’s mitigation, we will be running out of ventilators.
(For more information about the profound risk of ventilator shortages, read this McClatchy story).
I’ve talked to a hospital in the Bay Area that’s really up to its limits right now in terms of caring for patients in the intensive care unit. Look at what happened in Italy. It’s a Western country. It has a sophisticated medical system. It has fabulous doctors. And they’re completely overwhelmed. There’s every reason to expect that to happen here. There’s nothing special about us.
What you can do
Fielding: We’re already getting people to do the things they need to do, which is social distancing, which is washing hands, which is not touching noses and faces. Using bleach or liquid soap to wash down hard surfaces that may get touched by multiple parties. I don’t know how many people you’ve shaken hands with the last few days, but I bet not very many, if any.
Sharfstein: The time to change your routine is now. This is not a drill. No. 1: Wash your hands often with soap for 20 seconds. No. 2: Stay home if you’re sick. That’s very important. No. 3: Cough in your sleeve. Really start to change your routine so you’re reducing your exposure to a lot of people. Telework if you can. Anything you can do without major hardship, you should be trying to do. It’s now everyone’s job to do those things, and what individuals do is going to matter a lot.
Mandatory quarantines and travel bans?
Fielding: Even though there’s a national emergency, we will not be as draconian as China, which stopped the movement of as many as 700 million people. I do think we are going to see some clamping down pretty well on movement, but I’d be surprised if a government says, “You can’t go from Los Angeles County to Orange County or from Sacramento to whatever’s next to Sacramento.”
Sharfstein: Lock-down orders are really going to have a hard time working. We’re going to have to do this voluntarily.
Sorry, but don’t visit your grandparents
Swartzberg: It’s painful advice. It’s very painful advice, but my advice is you shouldn’t be visiting them. They shouldn’t be seeing their grandchildren and their great-grandchildren. I hate to say that. Let me give you a personal example. Both my son and daughter-in-law who live here in the East Bay are both physicians. He’s an emergency room physician and an internist. She’s an internist. They’re both caring for patients with COVID-19. My son is seeing patients in the emergency room with this disease. They have two children, our granddaughters. We’ve made the decision to only visit with us outside. We’re not touching each other when we see each other. We’re not giving the people we love the most in our world hugs. And that’s because I know and they know that’s an easy way to transmit the virus. For them, fortunately, they’re very healthy and my granddaughters are very healthy. But my wife and I are in our seventies, and while we’re very healthy, we are in that risk group for having serious morbidity and mortality.
Stay in touch with the elderly
Sharfstein: Don’t stay away from them emotionally. People can get lonely.
Fielding: One of the things I would hope we start to see is people thinking of their home not just as a castle but as part of a community. There will be people who are elderly who can’t get out to get any food or any prescriptions and it will be nice if healthy people in that community were concerned about them and helping them, and if it’s urgent getting them to a doctor’s appointment or whatever it is. I’d like to see that happen, but we don’t have much history of that at least not broadly in the United States.
Whom to trust?
Sharfstein: In times of crisis, every paranoid fear comes out, so it shouldn’t just be the government talking. It should be the government, plus hospitals. It should be corporate leaders. It can be entertainment figures. It can be church leaders. If you leave the messaging to the government alone, you’re a sitting duck for that kind of problem. The mixed messages coming out of the federal government are really concerning. With mixed messages, people tend to lapse back into what’s easiest for them to believe. Hopefully, it won’t get communities turning into Italy to shake people from that.
Fielding: You want to show people the information that shows how many people have died from this and show them who is at particular risk for this. But the statistics don’t always work. Sometimes narratives work better. “I had a friend who got it, and they were on a ventilator for three days.” That might be more telling than just talking about the statistics.
Swartzberg: Social media is about the worst place to learn about COVID-19 in general. I can’t tell you how many missives are claiming things that aren’t true. One was claiming to be from a member of the board of trustees of Stanford University. It was completely bogus and nonsense. If you could, ask the people who died in China, South Korea, Iran and Italy if this is a hoax.
‘Prevention is invisible’
Swartzberg: When something is prevented, of course, nobody recognizes they were saved from something terrible. As a physician, if I immunize someone, and the next year they didn’t get pneumonia, they wouldn’t necessarily call me and say, “Thank you so much for preventing that.” But if I have a patient with acute appendicitis, and I immediately diagnose the disease and send him to a surgeon and he is well in 24 hours, that patient is so grateful. Prevention is invisible when it works.
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