Thread by @DrBayani

An open letter from a friend on the front lines of hospital response to COVID19...
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Dear family and friends,
I am writing to share with you what my experience has been on the front lines of COVID and to make a plea...

"I work at our county hospital in - and also on faculty at - so I am privy to their hospital responses. All county patients with COVID-19 from the SARS-CoV-2 virus will come to the service staffed by me and my colleagues primarily until they escalate to needing ICU level care."

"For months since we learned about this pandemic hitting the US in January, our hospital has been preparing, even if the federal government has been suppressing data and impeding public health initiatives."

"Despite our thoughtful and swift preparations, and as a direct result of the US federal government's decision to decline the WHO tests in favor of a bugled attempt to develop their own, we lack the critically important capacity to test."

"This is imperiling patients and staff. Despite what Trump, Pence and his administration say, we have VERY limited capacity to test people and are drastically underestimating the degree of community spread."

"At my public hospital, we are limited to the tests made available by the CDC via the Department of Public Health, which is enough tests for 20 people a day for ALL of - (some expanded testing is on the horizon via private labs)."

"Symptomatic physicians and nurses cannot even get tested! We are wasting our dwindling supply of protective equipment waiting for suspected patients to be tested."

"I hear this experience echoed across the country via my professional networks, and many hospitals are also already out of masks to protect health care workers."

"While 80% of people who contract COVID-19 will just feel like they have a cold or the flu and will recover, 14% will need hospitalization, 5% will need ICU level care. Of those who need ICU level care, 49 - 81% will die."

"For those infected, the mortality jumps at age 60. People with comorbidities or immunosuppression are at higher risk. Children generally do not get critically ill but can transmit it."

"Limited data on pregnant women seem to show mom and baby are okay. Many people are asymptomatic but infectious and can spread disease and we won't know it because we cannot test them."

"COVID 19 is spread via droplets in the air and on surfaces with detectability in the air up to 4 hours, on surfaces such as plastic up to 72 hours. It also may be spread with fecal-oral transmission, including viral shedding from stool of infected asymptomatic children."

"If this continues to spread via community transmission at the rate we are seeing, we will overwhelm the health system. By the numbers, we are 10 days behind Italy where they are rationing vents and not even offering vents to people over 65 because they don't have enough."

"People with non-COVID 19 emergencies cannot access essential hospital-based care and are also experiencing increased mortality for routine conditions (eg pregnant women with birth complications, people with heart attack and stroke)."

"As you can imagine this is morally distressing to all health care workers, 20% of whom contract COVID-19 in the course of caring for infected patients, some of whom have died. The US is more poorly positioned to respond than Italy."

"Our hospitals already operate at max capacity."

"We have about fewer per capita physicians and hospital beds than Italy has, and.."

"...our fractured health system is more vulnerable due to lack of universal healthcare, individual reluctance to seek healthcare due to cost, ICE raids on immigrant communities that make them avoid seeking care, American's ideological commitment to social liberties which..."

"...make them less likely to adhere to social distancing recommendations."

"As a health system, we have limited capacity to accommodate the surge and levels of patients we'll see in coming months so it is imperative that we "flatten the curve" to spread out infections over time...."

"Our individual risk may be minimal, but our collective risk of systemic collapse is very high."

"What this means is that every one of us, in an act of compassion for others who are vulnerable to this disease and for the health care workers who will be on the front lines and are at risk, should do the following immediately..."

"Social distancing! Avoid any unnecessary trips into the community. Cancel/avoid all large gatherings (church, concerts, sporting events, parties, weddings, funerals, conferences, gyms, etc). Avoid all sick people. This may be necessary for months."

"Avoid unnecessary contact with people over 60 or those with compromised immune systems as you may be an asymptomatic carrier. I plan on not seeing anyone over 60 (including my parents) until this settles down and we can all be tested and I am sure I am not carrying it."

"While social distancing, be sure to check on elderly or at-risk family members and neighbors from a distance to see if you can grocery shop for them so they can maintain their social isolation."

"Consider a grocery delivery app so you can avoid the stores. Given surface survivability, consider letting groceries sit up to 72 hours to minimize the possibility of surface contact, or wipe them down with disinfecting wipe, or be sure to wash your hands after handling."

"Wash your hands! This is critical in preventing fecal-oral and droplet oral/mucosal transmission (via mouth, eyes, nose). Wash for 20 seconds front, back, between fingers. Wash like you just cut chili peppers and are about to take out your contacts."

"Don't touch your face! Cover your cough with your elbow. Then wash your hands. Wear a mask if you are sick. Disinfect high touch surfaces often (phone, doorknobs, handles, etc). Avoid food prepared by others."

Invent new ways to greet people that don't involve hugging or shaking hands. If you have symptoms including a cough (68-81%) or a fever (50-90%), assume you are positive and quarantine. Up to 10% have nausea/vomiting/diarrhea."

"Some people never get a fever, others develop this later in the course. Call your doctor before going anywhere to see if they have the capacity to test you (they likely don't)."

"Go to an emergency room if you have trouble breathing, chest pain, dizziness or are feeling faint or having trouble staying hydrated. In the meantime, you should avoid contact with everyone and assume you are infected."

"Support paid sick leave, freezing mortgage/rent payments, basic income, relief for low wage workers, loan forgiveness, food provisions children who depend on schools to eat, ceasing ICE raids, student loan forgiveness..."

"Support each other! Support artists, art teachers, and servers whose income will be disrupted by social distancing. Develop a socially distanced exercise routine, meditation practice, music practice to calm the nerves and occupy the mind."

"...Reach out to family and friends. Support Chinese owned businesses who are suffering a lot right now because of racism. You are not more likely to get the virus from Chinese Americans or immigrants. The Chinese grocery stores are often well-stocked too if you need essentials."

"Wash your hands!"

"Many are dismissing this COVID-19 a hoax or criticizing those sounding the alarm as irrational extremists. In a pandemic, all preparation seems extreme and unnecessary until the pandemic takes root, then all preparations seem retrospectively inadequate."

"The response of the federal government was and continues to be inadequate and counter to expert recommendations. We are all in this together. Please let's do our part to stop the spread!

Stay safe out there!"

Love,
------------, M.D.