I am a physician and the Medical Director for the Emergency Department and Emergency Medical Services here at Buena Vista Regional Medical Center. I wanted to take a moment to address our community about the novel Coronavirus, or COVID-19. These are scary times for all of us, and there is a lot of uncertainty and bad information out there. These are also extraordinary times; as we have not seen a pandemic of this magnitude in our country in living memory. However, we are orchestrating a response on a scale that can only be described as historic, and for good reason.
First, I would like to talk a bit about COVID-19 and the risks it poses. I frequently hear comments along the lines of – Doc, I had a terrible cough that matched these symptoms back in November, it was probably Corona! I will tell you that is absolutely not the case, and I hope that becomes clear when I explain the numbers. We are just finishing one of the most awful influenza seasons we have seen in a long time. People were incredibly ill and it was so prevalent we often stopped testing. Those that we did test in our clinics and hospitals sometimes had negative tests – but the simple influenza swab tends to have a fairly high number of false negatives. COVID-19 is a very different virus from Influenza, but for most people it will look similar. It is a respiratory virus, generally associated with some combination of fevers, chills, body aches, cough, fatigue, sore throat, diarrhea, and abdominal pain. Half of patients don’t even have fevers. This makes it even more difficult for us to screen and test for it. What they are reporting is that most people have these relatively mild symptoms and recover. However, 10-15% of people with the virus go on to develop hypoxia (low blood oxygen levels) or shortness of breath that requires hospitalization, and about half of those may require a ventilator or Intensive Care Unit admission. Overall we are currently seeing around a 2% death rate in the United States—to put it into perspective influenza only has a 0.2% death rate. This is incredibly serious but I want to stress that most people do extremely well with this virus, 98% of people who contract this virus survive!
So who is at risk to develop complications? Thankfully, it appears our children do incredibly well with this virus. Often they don’t even know it as any more than a mild cold. So far there has not been even one death reported WORLDWIDE of a child under 9! Older children seem to have about the same complication rates as influenza. While children do great with the virus, they SPREAD IT LIKE CRAZY. This virus is extremely contagious, more so than even influenza. Same is true of adults in their 20s. Very minimal, if any symptoms, but they are the number one source of spreading this pandemic worldwide. Adults aged 30-60 also do very well with the virus overall, though they do still have some risk. As we get older, the risk of death and complications gets larger. In our population over the age of 70, the mortality jumps to almost 8% of infected people. Over age 80, it jumps to almost 15%, or roughly 1 in 7 adults who contract the virus. The risk is also higher for people with other medical conditions: people on chemotherapy, with a history of diabetes, heart disease, etc. This becomes the most key part of our response – protecting those that are more vulnerable amongst us. They are our parents, neighbors, coworkers, and friends.
This is where we start talking about “flattening the curve”. I am sure many of you have heard this term or seen the info graphic shared that looks at coronavirus projections – a whole bunch of cases at once, versus the same number spread out over time. We know that sooner or later it will be in all of our cities and towns. But the difference will be in how fast it spreads and how much it taxes our healthcare system at one time. The more we can slow this virus down across the US, the more resources we have for those that are severely ill. The faster the cases mount, the more strain it puts on the system, and we start to lose our ability to save the critically ill due to lack of resources. Whether that be because we do not have ventilators, our nurses and physicians are ill, or we do not have enough of the medicines we need to help people. By “flattening the curve” we can spread out the impact and handle it one piece at a time. This is where we start talking about social distancing, closing down schools, and shutting down bars and dining in restaurants. These measures seem extreme, I get it. They will have major impacts on our economy and every community. However we are talking about saving hundreds of thousands, if not millions of lives. When they looked at implementing these measures, they looked at how other countries are handling COVID. We look at countries like Italy, whose nightmarish case rates are skyrocketing along with their death rates now over 8%. They took a much delayed approach to these policies and now their healthcare system is on the verge of collapse. And then we look to countries like Germany, Singapore and South Korea. Their case rates started on similar trajectories, but through quarantine and isolation they were able to drastically halt the progression of this disease and are currently seeing mortality rates of less than 1%. There are many case studies we can cite from the Spanish Flu Pandemic of 1920 as well that showed tremendous differences between cities and states that took these measures and those that did not. We can impact this pandemic, but it will take all of us.
So what are we doing here at BVRMC? You’ll see many changes here, and things will continue to be fluid as the entire country is learning as we go. First, we are severely limiting visitors into the hospital. Obviously, if you need to be here, you need to be here. We are closed our coffee shop, we are restricting our cafeteria, and we are keeping children away as much as possible. We will be limiting the number of people visiting to the medical and OB floors. We are asking only one person accompany patients to the Emergency Room and will be trying to keep people from even sitting in our waiting room. We would ask that people try to reduce unnecessary emergency room visits for minor complaints, work notes, or things that could wait for normal clinic hours. We will never turn people away, but we want to minimize your risk as well. If you think you may have COVID-19 we ask that you call ahead so we can be prepared. We have set up a screening point outside of our ER and will be able to screen patients that meet criteria without ever bring them inside the hospital. We still have limited tests in the state of Iowa, and we need to be judicious in who we test. Right now you need to have symptoms and be a higher risk patient. If you are young and healthy with mild symptoms, our message will still be you should go home and self-quarantine for 14 days. Hopefully we will be able to expand our testing in the near future.
But what can you do? The biggest thing is DON’T PANIC, we will get through this together. Stay home. Practice social distancing—limiting groups to less than 10 people whenever possible. We canceled schools so we could limit interactions, so this doesn’t mean your kids should be having sleepovers with 8 of their friends. Wash your hands and cover your cough. IF YOU ARE SICK, STAY HOME. If you are over 65 or have medical conditions, stay home and avoid crowds. Offer to go get groceries or necessities for your neighbors that should not be going out. We are all worried and stressed, these are unprecedented times. But that doesn’t mean we can’t be Iowa Nice. A little patience and compassion go a long way. I told a friend the other day we need to treat this like a tornado or any other natural disaster. As Iowans, in those times we come together (maybe not literally, in this case – social distancing!) and we help our neighbors. We look out for each other. We will do well getting through this virus and we will come out stronger for it on the other side.
Dr. Garrett Feddersen