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As an ER doc trying to treat patients who may have COVID-19, I can't underscore enough how much harder the lack of testing is making our job. Yes we're used to making life-or-death decisions with limited information, daily. But this scenario is very different. Here’s why: (1/12)
For us data is everything. Board Certified Emergency Physicians (ER docs) are trained in pattern recognition & rely on research to know when the preponderance of evidence directs us toward one or another path of treatment that could significantly help or harm our patients. (2/12)
With COVID-19, we doctors have very little evidence-based data on the basic science of transmissibility, incubation period or even what measures would be taken to protect patients (& providers). Our best evidence? What has occurred in China, South Korea & Italy thus far... (3/12)
But the difference with these other countries with COVID-19 is that at the earliest point possible, a huge testing regime was used to determine the extent of the virus in the hospitalized “very sick” population & the "walking well” less-sick population. We don't have that. (4/12)
Because this novel #coronavirus causes such minimal symptoms in so many young people (including children) -- as well as in older people at the onset of disease -- we're not able to determine cases based on symptoms. This is how we managed the SARS outbreak of 2002-2003. (5/12)
SARS had a case-fatality rate of 10%, but the ability to ID cases early & isolate them significantly, limited its spread and kept fatalities relatively low. By contrast, COVID-19 cases are difficult to ID early above the background level of other respiratory viruses. (6/12)
During the H1N1 influenza pandemic of 2009, the case-fatality rate was 0.1%, slightly higher than seasonal flu. That's also ~50% less contagious than COVID-19. The point? With a highly contagious virus that's difficult to diagnose clinically, early testing is critical. (7/12)
Here's the kicker: WHO had a test that worked, but it was rejected by the U.S. in January. Then, initial attempts to make our own test failed. As a result, as an ER doc I can't get most patients tested. And it's now known that the virus has been here for several weeks. (8/12)
To get a patient tested, they have to have traveled to certain countries, had direct contact with a COVID19+ patient, or be ill enough to be hospitalized & have no other diagnosis. There's no way around it: Tests are being rationed due to the Administration's mismanagement.(9/12)
Right now we're not truly defining the extent of the virus in communities. Short of a complete lockdown,we're dependent on everyone exercising caution when they have even minor symptoms, to avoid infecting those most at risk of dying (elderly & those with chronic disease).(10/12)
The only path forward is a massive testing regime ID’ing relatively healthy individuals who are infected.Only then can containment stop the spread in communities. And perhaps the more "walking well" positives we get, the more we can convince people that the threat is real.(11/12)
To be blunt: Our ability to fight this virus has been seriously hurt by right-wing pundits & the President, who convinced people it's “just a cold” and will go away “like that.” For us ER docs to do our job, those comments need to stop. And massive testing needs to start. /END.
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