Two weeks ago, the Burbank-Glendale area had only a handful of known cases. As of April 9, 282 cases. And over the next two weeks, the cases will continue rising, perhaps dramatically, as the novel coronavirus makes itself felt among those of us who had been infected, but without any symptoms until now.
If we’re lucky, April will turn out to be “the cruelest month” rather than May, or June. We need things to turn around before summer, or we’ll see people dying from an oxygen-starved economy alongside those dying from oxygen-starved lungs.
In the meantime, “when we’re in hell, keep marching.” Straight talk and sound advice will help us climb out of the virus pit sooner rather than later, and this is exactly what Dr. Angelique Campen offered to the ZOOMed-in Noon Rotary audience yesterday.
Dr. Campen graduated from UCLA medical school, got certified in emergency medicine and ran St. Joseph’s Emergency Medicine Department for many of her 20 years there. Today, she’s the Chief Financial Officer for St. Joseph’s Emergency Medical Group. “She’s fluent in all things concerning emergency medicine (as well as Italian and Greek)”, said Gregory Madore, President of the host Rotary Club of Burbank Noon.
Most importantly, she’s on the front lines of the fight against this “novel” virus, whose unique methods of attack cannot be found in a medical book, but instead are being discovered in the world’s emergency rooms, be they makeshift or modern.
St. Joseph’s is ready for The Surge
“We’re just starting to see the uptick right now in the emergency department,” said Dr. Campen. Fortunately, “every emergency department in Southern California has been at half volume.” [Providence Saint Joseph’s Medical Center] usually handles 200 emergency patients daily. That number has fallen to 100. Possible reasons: Light freeway traffic leading to fewer accidents, and people becoming reluctant to resort to emergency rooms for fear of catching the virus.
Meanwhile, Saint Joseph’s has been actively preparing for the onslaught of corona cases, paying close attention to the battles of the bug raging across Europe, New York, Detroit and New Orleans. “Half of the entire hospital is set up to offer intensive unit care, if necessary,” said Dr. Campen.
Hospitals typically operate at 90-95% capacity, but elective surgeries have been cancelled, leaving extra room available for fighting the virus. St. Joseph’s made sure they could fill that space with critical equipment. “We have 100 ventilators on hand,” said Dr. Campen. “We usually have had only 20 ventilated patients in the ICU.”
The doctors and nurses also have at their disposal self-contained ventilator helmets (much friendlier than skin-chafing masks) as well as full-body protection when caring for critical patients. The virus will probably have surprises in store (remember, it’s a novel corona virus) but St. Joseph’s has plenty of ammunition.
Understanding the enemy
Dr. Campen points out that there are currently two strains of the virus: one causing fever and diarrhea; and the other, which has gotten most of the press, attacking the respiratory system. “It is mostly a disease of the elderly,” she says. Those over 65 are most at risk, particularly those with pre-existing respiratory conditions like COPD and emphysema, which make up the great majority of those needing a ventilator. (In Dr. Campen’s opinion, many in their 30’s that tested positive are health care workers, for whom being tested is a priority.) “In my experience, everyone under 45 who has been severely ill from the virus has been smoking or vaping,” says Dr. Campen.
One of the newer discoveries is that some virus sufferers have “happy hypoxia;” that is, their lungs are at 70% oxygen- rather than the healthy 90+%–but they report no breathing discomfort. “Putting these people face down helps increase oxygen-carrying capacity of the blood without using the ventilator,” explains Dr. Campen. “The longer a patient is on the ventilator, the greater the chance of lung damage. So ventilators have to be used carefully, and more as a last resort.”
Understanding What’s At Stake
Millions of lives may hang on whether they can receive hospital care if they need it. “In the absence of a vaccine, it takes 60% of the population to achieve herd immunity,” points out Dr. Campen. In round figures, there are 330 million people in the U.S., so 198 million of us would have to be infected before enough of us acquired natural immunity to prevent the further spread of infection. Just for illustration, suppose the death rate were a flulike 0.1% if all patients were able to receive the care they needed, including time in a hospital. But what if large numbers of people could not get needed hospital care because the hospitals were overwhelmed? Then the death rate would go up. If it went up to only 1.1%, that would mean 1.98 million more people would have died.
Left to its own devices, the novel coronavirus can easily overwhelm hospitals and boost the death rate by 1% or more. The virus is a sneaky saboteur that spreads the gasoline far and wide and then lights the match. People catching the virus are without symptoms for five days or more. “And you can spread the virus for up to two days before you yourself start showing symptoms,” said Dr. Campen. That’s a lot of gasoline.
“What we’ve done to slow the spread of the disease has been successful,” said Dr. Campen. Even though a lot of horses had already left the barn, California’s shelter-in-place and social distancing seems to be working. The strategy is reduce the number of cases per day while at the same time increasing the beds available for those needing them until, ideally, every virus sufferer who needs a bed can get one, and the death rate is thereby kept to a minimum. Possibly saving a million or more lives throughout the U.S..
How To Avoid Catching the Coronavirus
To avoid catching the virus, Dr. Campen offers several suggestions:
- The novel corona virus spreads by riding on droplets, which we emit even during ordinary speech. Within a short distance, they fall to the ground, or onto a surface. Hence the admonition to stay at least six feet way from others. “You won’t catch it walking into an empty elevator or along a sidewalk,” states Dr. Campen.
- “Treat every public surface as if it were contaminated. Don’t worry about how long a virus may last on a given surface,” advises Dr. Campen. “You don’t know when a surface was last touched by someone who had the virus. So if you touch the surface, wash your hands.” She adds, “Gloves are more likely to make you sick. Touching a surface and cleaning your hands afterwards is safer.” Also, “You can find traces of the virus on delivery packages, but the real hazard is from touching door knobs or elevator buttons.”
- Fortunately, the novel coronavirus does not penetrate the skin. It enters through the nose or eyes when you touch your face, often without thinking about it. So wash your hands often so even if you mistakenly touch your face, you won’t be leaving viruses on it.
- “You’re more likely to get infected going to the grocery store and interacting with people than by touching things,” says Dr. Campen. Especially if you make a point of frequently disinfecting your hands.
- “Masks are a low-risk way to prevent transmission of the virus from people who don’t know they have it,” said Dr. Campen. “Beyond that, they help remind you not to touch your face.”
- At 2000 mg per day, Vitamin C does decrease virus replication. Zinc lozenges work too, as well as zinc taken orally. (But too much zinc will affect your sense of taste or smell.)
What to Do If You Have It
But what if you do have symptoms? Here’s Dr. Campen’s advice:
- If your symptoms are consistent with the virus (e.g., fever, fatigue, dry cough) but you aren’t short of breath, then stay at home and self-isolate. Don’t ask for a test, which involves inserting a strip up your nose. “Every time they put a test on you, they put themselves at risk. You’ll likely cough or gag or otherwise spew out virus particles,” points out Dr. Campen. Instead, just assume you have the virus. Save the testing for those for whom it will make a real difference: medical workers, first responders and nursing home clients and staff.
- Contrary to some assertions on the Internet, it’s perfectly safe to use Ibuprofen for headaches.
- On the issue of hydrooxychloroquine (HCQ), Dr. Campen advises caution. “Prolonged use can cause heart arrhythmia. Effective doses carry side effects. The safest application is by a doctor in a hospital setting.” In any case, seek first the advice of your personal physician, who knows best your medical condition, prescription drugs, etc.
- Campen points out that azithromycin is used in cases of pneumonia or bronchitis three to four days into the illness in order to fight bacterial infection. The coronavirus, in particular, “makes the body ramp up the production of white blood cells and use them up.” And so the patient is vulnerable to bacterial infection.
The Dilemma
Prevention and treatment are good as far as they go, but when will there be a cure? Dr. Campen estimates that a vaccine for the virus “is 12 to 14 months away.” One can only hope that we get it right the first time. “The Ebola vaccine got pulled from the market when it backfired,” she said. “Doctors discovered that it triggered an overwhelming immune response.” A successful coronavirus vaccine would be taken in addition to the flu virus annually; hopefully, the coronavirus would not mutate quite so readily as the flu virus.
Flu vaccines can be effective, with a due regard to their limitations. “Vaccines take two weeks to develop antibodies,” says Dr. Campen. “So if you wait too far into the flu season, then you may catch the flu before the vaccine can immunize you against it. Best to take the shot early in the season.” Moreover, Dr. Campen pointed out that UCLA had tested 3,600 people suspected of harboring the coronavirus. Only 10% tested positive; reminding us that there are still plenty of other respiratory viruses only too happy to make us miserable.
And so now we come face-to-face with our dilemma: What about those of us who have so far avoided the virus, perhaps by staying mostly at home, maintaining social distance and washing our hands more than Macbeth’s wife? Several cases come to mind:
- If we’re under 65 and healthy, chances are we’ll have a version of the cold from the virus, and that’s it. It’s even possible we already had the virus, had minimal symptoms and so we can go out into the world as before. We may even have been exposed to just trace amounts of the virus which, Dr. Campen points out, can also trigger the production of antibodies that way vaccines are meant to do. Massive testing for those with antibodies would be a good start; chances are they’d be safe, and the vaccine would arrive before the virus mutates into a new disease.
- If wer’re elderly and in a nursing home, chances are we’d be staying there anyway. The challenge is to keep the nursing home facility virus free until the vaccine arrives.
- If we’re younger but with any number of high risk factors (diabetes, prior lung damage, etc.) we may well decide to limit our exposure until a vaccine arrives. For many of us in this category, that’s easier said than done.
- If we’re over 65 and reasonably healthy, we’re still at an elevated risk, facing a morbidity of 5% or more. Before we take the risk and venture out into a coronavirus world, we’d want to know if we could receive antibody plasma or hospitalization if we needed it.
At this point, we need to start factoring in the deaths that may result from a wrecked economy as well as those that result from a ravaging disease. Perhaps we can think of a compromised economy as a kind of “side effect “ of the “medicine” of our semi-quarantine.
Minimizing total deaths from both disease and cure must become the new goal. Hospitals like St. Joseph’s, which have prepared for sudden contingencies and heavy caseloads, make it far easier to the rest of us find workable solutions.
To learn more about the coronavirus and how to fight it, visit Angelique Campen on facebook or visit glamerdoc on Instagram.
