March 1 2020
I’ve been back from my Thailand/Cambodia holiday two weeks now. Opened up my work email to find a number of emails related to my hospital’s preparedness for the novel coronavirus, SARS-CoV-2 and COVID-19. Reassuring. Jumped right back into a busy clinical service. Checked my temperature daily and avoided the gym (more so out of laziness, but I told myself it’s the right thing to do). Life is carrying on as usual all around me, and I try to assimilate.
I join an international group of friends for a movie night. I find it ironic that I have not been to the movies since 2018, and here I am, “trying to be normal”. Luckily, the theatre is tiny and I make sure to use my hand sanitiser. The bar we go to eat and socialise in though is a different matter. Large and packed to the brim. Oh well. Several of the group are Italian. I ask how their families are back home. Despite the cases of COVID-19 rising in Italy, it apparently isn’t a big deal. Soon we are back to socialising and having a good time.
In the WhatsApp groups I am in that are predominated by Africans, there are questions and jokes about why COVID-19 isn’t on our continent. Trevor Noah, a South African, had said on The Daily Show about a month ago that Ebola would be waiting at the airport if “Corona” showed up so it is scared.
A forward is going around that Africans are protected from acquiring the novel coronavirus because of either suffering from malaria itself or from extensive use of chloroquine and other antimalarials. Chloroquine, the anti-malarial created in the 1940s, but no longer used in many parts of Africa because of high levels of drug resistance and thus treatment failures.
Another forward says Africans are naturally protected because of our genetics. One says it’s our tropical heat keeping us safe. Other forwards contain untested cures and treatments. One from Nigeria is a voice message telling people that chloroquine is the cure and suggesting a treatment regimen that is of a higher dosage and longer course than would otherwise be prescribed for malaria. Dangerous! Rumours. Myths. Misinformation. Social media is rife!
The misinformed theories do not account for the lack of testing, the poor infrastructure that limits how fast the virus can spread, and the youthful populations of many African countries. I’m still worried about the continent.
A debate flares over the decision of several African governments to not repatriate their citizens who are students in Chinese universities and who feel stranded due to the shutdown. Ghana said their students should stay put in China, stay safe and they would send them “shito, gari, and kenkey”. I find myself in agreement. Eventually, some like South Africa decide to evacuate their students.
But the social media panic is not limited to Whatsapp. I can tell who of my colleagues are on medical Twitter or on several of the physician COVID-19 groups on Facebook. They seem to be either very worried or panicked. The non-social media doctors, on the other hand, seem nonchalant.
March 3 2020
I’m supposed to give an informal talk to a private practice about COVID-19 preparedness. It ends up being an unsatisfactory “well we can’t do anything about it, so it is what it is” response. I feel helpless.
Meanwhile, at the hospital, I find out meetings on COVID-19 preparedness have been ongoing (and frequent). I am not involved. But when I simulate a patient with risk factors for having COVID-19 walking up to the ED, having to be admitted, having to be upgraded to the ICU, being found to indeed have COVID-19 at any stage of their admission, needing some kind of experimental treatment due to failure of supportive care, the reassurance I had previously that we were prepared falters. We are not prepared.
It doesn’t help that official CDC screening requirements are changing daily and that we are all supposed to be calling our state health department for permission to test patients for SARS-CoV-2. Testing is limited. Personal protective equipment is limited. No-one knows what they are supposed to be doing. And I’m eating Cadbury Mini Eggs chocolates by the bagful even though I have given up chocolate for Lent.
March 5 2020
I’m out for dinner with my hospital’s infectious disease epidemiologist whose ear I am happy to have when we find out that 3 cases of COVID-19 have been confirmed in our state. The governor in announcing this news immediately declares a state of emergency. Even though the three cases were imported from overseas, it’s clear that the turning point has arrived. We will now need to be extra-vigilant. It is only a matter of time.
March 9 2020
I am on ER call this week for infectious disease. I’m nervous but it is business as usual. I’ve gone back to the private practice to provide guidelines for triaging phone calls, appointments, and sick visits now that the threat of COVID-19 is very real. I tell them to not have sick patients present to the waiting room but perhaps to field sick calls over the phone. But this would be detrimental to the business’ bottom line. Telemedicine isn’t quite a thing here.
March 16 2020
I have survived my week of call and have been in contact with infectious disease colleagues around the country. I have learnt a few things. First, my klutz continues. If anyone is going to inadvertently infect themselves when doffing off personal protective equipment, it’s going to be me. I’m riding on the high likelihood that this is a droplet + contact borne illness rather than an airborne + contact one. As for not touching my face, this is going to have to be a skill taught in toddler-hood. I just cannot not touch my face.
Second, a reminder that a disease doesn’t always read the textbook. This is what makes the practice of medicine an art, a skill honed by experience. With COVID-19 being around less than three months, we don’t have much science to rely on, just lots of extrapolations from similar diseases and many case reports. Anecdotes. And you know what they say. the plural of anecdotes is NOT data.
What we have learnt to be the overriding symptoms of COVID-19 – fever, cough, shortness of breath – are nonspecific, meaning that so many other illnesses present themselves this way. Add in that we are still dealing with a rather bad influenza season and an early onset of spring-time allergies.
But then you are face to face with a patient who presents with none of the above but instead with abdominal pain or diarrhoea or fatigue or lethargy. By the time they develop a cough several days into their hospitalisation, several tens of healthcare workers have been exposed. You go back to read the fine print of the case reports out of China and there indeed it sits (NEJM).
Okay, you say. I have not seen enough of these cases to sharpen my clinical acumen. I am just going to be more open-minded and more liberal in whom I send SARS-CoV-2 testing in. And there lies the next problem. Where are the tests? So we are rationing. Then for those we manage to test it takes forever to a result. Extended opportunity for unknown exposure. It’s rather stressful and a lot more difficult than I imagined. I do not want to experience the high COVID-19 patient volumes that Chinese, Iranian, Italian doctors are dealing with. No thanks. Absolutely, let us flatten the curve.
Leave a Reply