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PSA: It’s time to play offense on COVID-19

 

About 9 weeks ago I had written how in the middle of the tsunami of the first wave, the safest assumption (with the relative little information we had) at the time was that one should come to the ER only if they had a life and limb threatening emergency and to minimize any unnecessary exposure to, or spread of, COVID-19 for the sake of saving as many lives as possible. The goal was to keep everyone who was otherwise healthy or could improve on their own, out of what was the equivalent of being drowned unnecessarily in flooded buildings filled with sick patients.

Now that the floods have subsided and patient volumes continue to decrease across ERs in NYC (thanks to you and our communities working together!), I have time now to ruminate over what exactly just happened in the past 2 months: the overwhelming number of patients, rampant cross-contamination, fear for personal safety, afflicted friends, hyper-coagulation, cytokine storms, sudden deaths, and burying my grandfather.

They are now giving one of my nightmares a name: Silent Hypoxia. To this day I can still see it all too clearly — Patients that appear well one minute, suddenly collapsing into respiratory failure and cardiac arrest in the next. Simply put: patients who seemed to get better but then died. Patients like my grandfather.

Therefore during our temporary ceasefire we should not only prepare ourselves for a possible next surge, let alone an even more challenging flu season under the shadow of COVID-19, but also switch gears in making sure we don’t present too late to the ER: Instead of acquiescing to a new harbinger of inevitable sudden death, how do we now prevent it? 

When circumstances begin to change, so must our dance: Sometimes we need to freestyle, sometimes we need to tango. 


If You Are to Ever Contract or Are High Risk for COVID-19:

If you or anyone you know will ever be diagnosed with COVID-19 but still feel well enough to stay home (as to not spread the virus to others), I suggest to become more aggressive with the following:

1) Engage in safe physical activity (such walking around the house, proning yourself on your stomach) to help prevent possible clot formation and help you breathe better.

2) Coordinate closely with a primary care doctor via TeleHealth/Skype/Zoom/FaceTime (messaging another doctor via casual social media like myself DOES NOT COUNT).

3) Monitor symptoms with a verified pulse oximeter (“pulse ox”) device, whether mailed over by an online purchase, the primary doctor, a local healthcare facility, and even some ERs (For the record, smart phone apps are not as good as they measure only one waveform, not multiple, and thus may add another unnecessary risk).

You can then check your oxygen levels by placing the pulse ox preferably on the middle or index finger of your dominant hand. If you have COVID-19 and your fingers do not have any known circulation problems, are not cold, not sporting nail polish, and the device shows a legit SpO2% value less than 88-92% (the exact threshold depends on your history and the doctor you chose to coordinate with) consistently for more than 5 minutes, call your doctor. You may have to go to the ER immediately for supplemental oxygen to prevent silent hypoxia from manifesting. 

Therefore, in tackling BOTH the challenges in avoiding the virus’ contagiousness and yet also preventing the newly observed phenomenon of silent hypoxia, our tango demands that we neither act too early nor too late.

 

If You Don’t Have COVID-19: When Can We Go Out/Travel Again?

IF YOU ARE WELL / STILL DO NOT have COVID-19 or symptoms: I suggest that you not worry about silent hypoxia just yet. Instead, it may be more productive to fortify your baseline mental health and take control of your life again.

Watch the numbers in your area when things start opening up — if they stay consistently low after 2-3 weeks (the average incubation time it takes from exposure to symptoms), then that could be your cue to take the next step towards restarting your life depending on your risk tolerance and personal circumstances. And if you do decide to take a step outside, continue to proceed with caution: Maintain elevated hygiene standards (wash your hands with soap & water, cover your mouth, etc.), be aware of touching others, keep clear of crowds, and avoid small tightly packed interiors with minimal air flow. In other words: always look out for the safety of yourself and others.

But if numbers spike up after 2-3 weeks, then you know we’re not yet in the clear, that the virus does not care about the weather, and you had a 2-3 week head start with staying inside and safe from exposure.

 

If You Never Ever Had Symptoms or COVID-19: The Antibodies Test

If you are NOT a frontline health care worker and NEVER ever had symptoms, risking going outside during a pandemic for an antibodies test to determine if you ever were exposed to the virus may be less useful for you personally than it would be for local public health efforts to track and control the spread of COVID-19 in your area.

I leave such a decision up to you, your ethics, and your risk tolerance.

(To clarify: the PCR nasal swab is for presently active infections only, while the blood draw for antibodies are ideally done 2-3 weeks after a highly suspected or known infection occurs and/or resolves) 

 

Perspectives

This all might seem like a lot of moving parts, but remember (especially with new disease processes) medicine is more of an art than science. Our knowledge of this virus is ever evolving, and everyone’s specific care may differ depending on genetics, access, resources, housing, and risk tolerance. And yet whatever your circumstances are, cherish the autonomy you still have to choose what the best care is for you: The people who survive the apocalypse are not the smartest or the strongest, but the most adaptable. And therefore we must all adapt both individually and collectively to the perennially changing circumstances expected from a worldwide pandemic.

If we do this right we can ensure our ERs still can care for the right patients, encourage people who do need the ER won’t be too scared to come, soften the impact of the next surge, decrease the chances for a next wave, and be better able to handle the next flu season.

Good luck. Keep your head up. You are not alone.

Photo credit: Kareem Black

Thank you Diana Klatt (of Global Caveat), Dr. Sharon Li, Mel Jeng, and Dr. Linus Sun for feedback, suggestions, and addressing some blind spots to make this PSA possible.

For further immediate, live updates on the ground, follow the stories posted on my Instagram: https://www.instagram.com/monsoondiaries/

For more information on silent hypoxia and the simple things we can do to prevent it: https://www.nytimes.com/2020/05/10/opinion/coronavirus-elderly-pulse-oximeter.html

 

- At time of posting in NYC, it was 11 °C - Humidity: 33% | Wind Speed: 5km/hr | Cloud Cover: partly cloudy