What We Need To Do To Flatten The COVID-19 Curve, According To A Medical Doctor On The Frontlines
To fight this pandemic, we need to work together now more than ever.
cottonbro via @pexels As a physician, I have seen the medical community prepare for the onset of the novel Coronavirus.
My colleagues around the country have focused their energy on preparing for the potential of a wave of patients needing emergency care.
But is our community and our country focused on the right bigger-picture strategies to defeat this virus and get our lives and our economy back on track?
How do we flatten the curve of the Coronavirus?
As we look around the world there are two models in combating COVID-19 infection.
We can study the Coronavirus and each nation's response to it in order to find answers as to how we can work together in order to flatten the curve.
China provides a blueprint for how this virus can be contained; they have been so successful that new cases of the virus in their country have virtually stopped and their economy is well on its way to recovery.
In fact, even as Apple recently closed all of its stores in other countries, they excluded their recently-reopened stores in China.
Even China’s stock market is doing well again.
Italy, on the other hand, should be a cautionary tale for us as we look towards the next critical phase of this crisis.
The Italians allowed pervasive spread and now has the world’s worst epidemic, an overwhelmed medical system, and an economy that is at a complete standstill.
And although we have taken some recent attempts at social distancing and business disruption, unfortunately, the United States is currently on a path that is more like Italy’s.
As of the date from this article, we are only two weeks behind them in the spread of this fast-moving disease.
As a physician, I understand the logic of trying to “flatten the curve”.
We need to slow the pace of this virus — giving our testing system and emergency rooms time to better prepare for what is to come.
But this strategy, as successful as it could be in slowing the virus, is a poison pill for our national economy.
I fear that a prolonged stoppage of our way of life in Central Florida.
The United States could cause such a financial catastrophe — with unintended consequences — that could exceed even the loss of life from the spread of the virus.
So, what do we need to do to combat COVID-19?
Neither long term quarantines nor the so-called “Herd Immunity” will work by themselves.
We need a different solution, and we need it STAT.
To beat this virus we need to focus on three key areas:
- We must rapidly test everyone appropriately
- We must immediately quarantine those who test positively
- We must treat victims with antiviral therapies...many of which must be rushed to market in record time
Testing for COVID-19
First, we must rapidly test people on a mass scale.
As a primary care provider, I am currently unable to straight-line an order to have my patients tested without having to either go through the local Emergency Room or the local Florida Department of Health.
Any physician suspecting someone having a COVID-19 infection must be able to initiate an order at any laboratory facility and receive viral PCR results the same day.
The faster this occurs the sooner we can locate, quarantine and treat individuals — greatly reducing the number of additional people they can infect.
At the same time, we need to make sure we focus testing resources on the people most likely to be infected so we do not overwhelm the medical system and limit its ability to care for people in high-risk groups.
Routing people appropriately is also critical. The more sick people who visit their doctor or show up at the emergency room will only spread the virus to more people.
Why it's important to Quarantine during the COVID-19 pandemic
We must isolate individuals who test positively for the COVID-19 virus.
We can do this by setting up locations for treatment and sequestering that will prevent the spread.
Since time is of the essence, it may make sense to commandeer hotels and cruise ships – many of which are currently idle anyway.
There are also many empty retail stores, malls and even warehouses that could quickly be modified as well.
The Chinese did something we are not having an honest discussion about — they did not let people “self-quarantine” when they tested positive.
They quickly learned that 70% or more of the spread was happening between family members.
We are not being honest about the ineffective nature of home quarantines.
We are not properly projecting the amount this virus will spread within families unless we provide alternative options.
Treatment for the Coronavirus
Third, since time is of the essence, we should start mass-producing promising antiviral drugs.
New drugs like Remdesivir have shown promise in trials, and it is now completing a Phase 3 test in China.
While originally developed for Ebola, it has illustrated to be effective in in-vitro testing against the COVID-19 virus when administered to individuals with a positive test in a non-clinical trial application.
China has been conducting randomized placebo-controlled trials in patients with COVID-19 infection.
Its mode of action is that it is a nucleotide analogue, which means it inhibits an enzyme called reverse transcriptase, crucial to replicating the virus in host cells.
In layman's terms, this drug slows the impact on the infected person’s lungs and could give us hope to lower the impact on those most critically effected.
The Trump administration could partner with a drug’s maker, Gilead Sciences, to start mass production now without waiting for FDA approval…saving critical time in getting the drug to a patient that needs it.
This would dramatically reduce the duration, severity and spread of COVID-19 in people who get it.
We cannot allow the normal bureaucratic approval process to delay close-in, low-risk solutions.
Why Italy was such a terrible model on how to handle the Coronavirus pandemic
The U.S. is currently following Italy’s path and is only two weeks behind them in infections.
The actions already taken have set us on a path of economic collapse; with many corporate bankruptcies and the loss of tens of millions of jobs.
Even in our “rich” country, a high percentage of Americans live paycheck-to-paycheck and, once unemployed, will quickly be unable to pay their rents or mortgages.
We will see catastrophic increases in homelessness, divorce, alcoholism, drug use, mental health problems, suicides, and stress-related illnesses.
And most of these victims will be people who otherwise could have had additional decades of happy, healthy, productive lives.
The path the Italians have chosen will actually do far more harm than good, and the United States is currently following the same path.
To beat this virus and save the American economy we must rapidly test everyone suspected of having the disease.
Those who suspect that they are infected must immediately quarantine.
Those who test positively need to be treated with antiviral therapies.
We are in a race against time and failure is not an option. We MUST do these things right now.
Dr. Littleton serves as the Chair of Family Medicine at Orlando Regional Medical Center and CEO/Founder of Littleton Concierge Medicine serving patients in the Orlando area.