COVID-19: What I am Worried About

Recently, I was interviewed for an article about hospital surge capacity in Idaho. I indicated that I was not worried about that right now – we have many options to expand the number of beds for treatment of COVID-19 patients. At the time, we had no hospitalized patients with COVID-19 in Idaho, and while I had many things to worry about, that was not in the top 25 of my worry list.

That prompted the expected next question – would I share my top 25 worries on my blog? No, I won’t share the entire list. That just wouldn’t be responsible. People are already fearful and I don’t want to add to those fears with things that people don’t need to spend time and emotional energy worrying about. There are plenty of us worrying about the technical things. I just want the public to worry about the things that will cause them to take actions to make themselves and their families safer.

So, I am going to share some of the things I am worried about. I am going to start by just pointing out a few things that you are worried about that I am not. Maybe you can take these off your list of worries. Toilet paper. I assure you. We are going to have sufficient toilet paper. In fact, there is no reason at this time to believe that our commercial grocery supply chain is going to be disrupted. Sure, we have grocery stores with some bare shelves, but that was because of an irrational run on the stores. Production has already increased, and distributors anticipate that store inventories will be restored next month. Masks. I have written before that there is no need for you to wear a mask (unless you are infected or suspected to be infected or you are a health care professional). It won’t help prevent you from contracting coronavirus, and in fact, it may increase your chances.

What I am afraid of:

1. Politics has no place in the management of an emergency. I have never before in my professional life ever doubted the public health guidance we have received from the federal government. There have been occasions that I have questioned it during this health crisis. Most of my concerns have arisen from comments and actions taken by politicians. And, we have heard promises made and not kept.

During my long career as a CEO, I have had the occasion on quite a number of occasions to have to lead our organization through emergencies, public health threats and natural disasters. We would set up incident command and I never ran the command center. I left that to people who were more experienced and expert and who can handle the thousands of logistical issues that arise. Certainly, I would visit the command center and I would make the decisions that would carry the most risk or make the most impact. However, I stayed out of the details and trusted my experts.

2. We need better communication. It is really hard to over-communicate during a crisis. Yes, our state and federal government set up websites and issue guidance, but people and businesses often don’t know what that guidance means for their circumstances or their businesses. I probably spend 10 hours a day answering questions and providing advice to people and companies, even though there are many people who are far more expert than me, because people don’t know who to turn to or how to reach someone from the state or federal government that can provide them with advice. Very few parents and business leaders understand public health and are equipped to understand what they need to do to protect their families or their employees. Plus, a lot of public health guidance doesn’t make sense. Why would the CDC say gatherings of 50 people or more should be avoided, but schools should not close. There is a reason, but few other than infectious disease or epidemiology experts would understand why that might be.

3. We were not prepared and we should have been. This is the third novel coronavirus that has jumped from animals to humans. After SARS in 2002 – 2003, we knew it was only a matter of time before a new strain would emerge. Yet, we decreased funding for our national pandemic response, eliminated the top expert dedicated to preparing us for a pandemic, and even though we were far underway with the development of a vaccine against the coronavirus, we cut off all funding that would have allowed it to be fully tested and ready for deployment in the future. Now, starting from scratch, we are 12 -18 months away from a vaccine. (that is still record time, but there was no reason this should not have been completed.) I hope that when this is all over, that the countries of the world will put pressure on China to prohibit the exotic animal markets that appear to have provided the opportunity for two of these three novel strains to jump from animals to humans.

4. The federal government has failed us and our health care providers. The first case of COVID-19 was announced 12/31/19. I am writing this in the middle of March and every state has a severe shortage of testing capability and providers have a severe shortage of testing supplies needed to procure samples for testing. One might think, well it is a new infection, obviously, it takes time to develop these new tests. To an extent that is true, but let’s put it in perspective. South Korea performed more tests in one day than we have during the entire time we have been testing in the United States.

On one hand, perhaps the lack of testing is less critical, because there really aren’t any known treatments for COVID-19, so does it matter? It turns out it does. First, in cases that we admit to the hospital because the person is sick and we just don’t know whether the person might have COVID-19, we are using a lot of a very limited supply of personal protective equipment (PPE). These include gowns, gloves, facemasks, etc. that are expensive and in short supply. The longer it takes to get a test result, the longer we have to keep the patient under this intensive isolation. Additionally, for those who aren’t very sick, unless they have a known exposure or concerning travel history, we just don’t have the capacity to test them. So, we send them home for self-isolation. But, without confirmation of COVID-19, we are assuming that most of these cases are colds and flus – and they probably are. But, because of this low concern, we have not routinely advised that all family members need to stay home and self-isolate, as well. We now have reason to believe that family members may in fact be one of the major sources of spread of this virus.

Because of this limited testing capacity and the limited testing supplies, if you are well, we simply cannot afford to use up a testing kit to test you. And, even if you are sick, unless you have had a known exposure or have traveled to a high-risk country or are sick enough that you need to be hospitalized, we are usually not going to have enough supplies to test you. So, please just stay home, self-isolate, take medications for symptom relief, and remain home for at least a week, and specifically for 3 days following the resolution of your symptoms. I am confident that we eventually will have more testing capability, but for now, do all of us a favor and just stay home.

5. Lack of personal protective equipment (PPE). I said at the beginning of this blog piece that I was not yet spending a lot of time worrying about hospital surge capabilities. I know we can greatly increase our number of beds. However, the lack of PPE does concern me. If we don’t have enough PPE, and we don’t, it does not matter how many beds we have because we will not have staff who can be adequately protected to care for these patients.

Partly because of irrational buying up of masks and other supplies by people for home use and people coming into hospitals and clinics and stealing these supplies, health care providers are facing shortages. For two weeks I have been pleading for the President to declare a national state of emergency in order to free up our strategic national stockpiles. First, I was told that wasn’t necessary because Congress appropriated $8.3 billion in funding for preparedness. But, I pointed out it was not a money issue. Hospitals and urgent care clinics could not get the supplies even if they could pay for them. Suppliers and distributors indicated that they have supplies, but could not dip into those until an emergency was declared. Last week, I was thrilled that the President declared an emergency. This week I am deeply disappointed that only small amounts of the strategic national stockpiles have been released and that today, the President encouraged health care providers to use their typical, private supply chains (which I already indicated cannot keep up with our demand). This is going to have devastating effects in Washington state and New York if the federal government cannot figure out how to mobilize the strategic national stockpile.

6. Sustainability. There have been a lot of schools and businesses talking about closing for 2 weeks, a month or 2 months. No one knows how this story ends, but let me tell you I have not encountered an expert yet who thinks this will be over in 2 months. I hope that the disease activity will decline over the summer months, but I fear that we will be dealing with this infection until we reach levels of immunity that can only be achieved through vaccination and therefore, I think we will be dealing with this infection for another year or two. I hope I am wrong. I did hear the President say that he thought this would end in July, August or September, but I simply can’t figure out why that would be, except for one potential explanation that I find very unlikely. Therefore, I worry about our ability to sustain social distancing. I worry about our elderly and those with chronic medical conditions being largely confined to home for that period of time. It is hard to contemplate school closures for that length of time (though there are many of us who feel that is not necessary and might not even be beneficial).

So, let me conclude. There are a lot of things I am worried about, but it would not be responsible to share all those things. I believe in productive worrying. Don’t have people worrying about things they can’t do anything about and let’s leave the worrying about things that aren’t going to impact people’s daily lives to the many outstanding leaders and professionals that are worrying about these things.

While I have a number of frustrations with our federal government’s response, let me tell you that Governor Little has shown true leadership. Further, I have been impressed by the many state and public health officials and workers who have worked long hours and tirelessly to confront this crisis and keep Idahoans safe. We are incredibly fortunate to have the expertise that we have in our Idaho Department of Health and Welfare.

And, let me say this about Idaho hospitals, clinics, physicians, nurse practitioners, physician assistants, laboratory scientists, infection control practitioners, nurses, respiratory therapists, radiology technologists and technicians, pharmacists, phlebotomists, EMS, receptionists, and everyone else who come into work every day to take care of Idahoans. Keep in mind we have people avoiding events, pulling children out of school, and otherwise freaking out, yet these health care workers come to work to see and evaluate all the patients with respiratory symptoms and fever, placing themselves at risk because that is what we do. We care for people. We do it nights when you are asleep. We do it on the weekends when you are home and off work. And, we do it holidays. These people inspire me with their selflessness, their caring, their compassion and their dedication to helping others. And, many times, their spouse or other family members are at home supporting their loved one in their chosen profession, but hoping that they remain safe and healthy. Thank you health care professionals – some of the most amazing people you will ever meet.

6 thoughts on “COVID-19: What I am Worried About

  1. glenn bothwell md retired ER. My son and his friends say that chloroquines have shown great benefit in China and share 2 articles on the net from Phd’s and Md’s. Has anybody read any reliable source on antimalarials for coronal rx’s. He says pts are getting doc’s to rx and are stocking up before pharms run out.

    On Mon, Mar 16, 2020 at 10:11 PM Dr. Pate’s blog wrote:

    > ceopate posted: ” Recently, I was interviewed for an article about > hospital surge capacity in Idaho. I indicated that I was not worried about > that right now – we have many options to expand the number of beds for > treatment of COVID-19 patients. At the time, we had no hosp” >

    Like

  2. Hi Dr. Bothwell,

    These drugs remain investigational for purposes of COVID-19, but there is reason to believe that they may be effective for more serious cases of COVID-19, such as those with pneumonia or cytokine release syndrome, the latter because of the immunomodulating properties of these drugs. There is some suggestion that hydroxychloroquome may be more effective than chloroquine. I also understand that we may already be facing shortages. At this point, we would not recommend people stock up on these drugs, but leave them available for patients serious enough to be hospitalized.

    Like

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