March 8th, 2020
As a physician I have some thoughts...
In light of the first identified Coronavirus(COVID19) case in Suffolk County, New York:
For the average person....stop worrying about your own safety, or that of your children...it is highly likely that you and your children will be fine(The statistics are showing that children generally handle this infection really well).
It’s your elderly parent.....and friends with respiratory diseases, and other chronic diseases....and immunosuppressive conditions that we doctors are worried about.
While we remain uncertain about how widespread this disease will become, it is somewhat predictable, and at this point we must assume a proactive posture.
The promotion of EARLY and thoughtful local planning and action will cost far less than watchful waiting.
Accept that there will be a period of abnormalcy(Read that again and internalize it)
We will quickly learn, and develop tools to fight this.....I am certain about that.
We know who the most vulnerable are(that is a blessing!) and we can act to protect them.
We are looking for the tip, but what does the base of the iceberg look like?
The focus of attention to this point has been fully on the identification and quarantine of the very ill patients with Coronavirus and those with known direct exposure to them.
However, until we know the full spectrum of disease that this Coronavirus causes, I believe an essential measure for limiting the spread of the illness will involve addressing the bulk (approx. 80%)... those with milder symptoms, who will remain unidentified for the foreseeable future until there is abundant testing capability.
Given what will likely be “multiple faces” of Novel Coronavirus(COVID19) with many possibly presenting as mild URI(Upper Respiratory Infection), the discussion should also focus on how to keep patients with any uncomplicated URI out of the offices and emergency rooms, where our more vulnerable patients will be, and about physician support and guidance(including Medicare reimbursement for phone based physician assessment and treatment, without the necessity of a video component, which many people, especially elderly will not have access to), so that we can treat stable patients remotely.
Our plan for curtailing the spread to our most vulnerable patients (who will be the ones at our medical offices and hospitals) MUST include keeping all stable patients with essentially any mild URI presentation away from treatment facilities in an attempt to prevent them from being overloaded, so that those severely affected by this illness and the many other dangerous illnesses that occur routinely can be treated effectively and efficiently.
Public communications must address this issue now with strong language, so that the public is aware that the vast majority of people who get this illness are likely to have relatively mild symptoms, and the manner with which they conduct themselves will have a major role in determining how widespread this disease becomes, and the toll it takes on those most vulnerable.
John F. BYRNE, M.D
Board Cert. /Allergy and Clinical Immunology