Newsletter
Note from Dr COhen
The aim of this newsletter is to present short ACCURATE information on topical issues.
Again, this is especially important at this time, with the Corona epidemic at present. A perfect example of this is the story around the “Cure” for the corona virus. The message going out there is that by taking plasmaquine and/ or one of the anti retrovirals, you can be cured.
This is NOT true and NOT verifiable as yet.(28 March 2020)
The newsletter will be continually be updated during this crisis and I will not bombard you with even more information.
Rational Approach to the Pandemic
Cape Town anaesthesiologist Dr Anthony Allwood has written a letter to friends and family setting out what it is like to be on the frontlines of a global pandemic and how we can work together to flatten the curve of infections.
“We are at the start of a Covid-19 pandemic and just heard an excellent speech from our president. His decisions are sound and there are many good decisions and actions that are being made by our authorities. I have confidence in plans that I know about. There are some brilliant people around, and we need to listen to what they are saying and advising. “
But there is also a deluge of information coming from all directions and people are struggling to make sense of it. I have had many requests for insights and what to do.
So here is what I personally am thinking and doing:
The exponential speed of what is happening is difficult to comprehend. First world countries who thought they were prepared are finding that the speed and numbers of sick people are rapidly overwhelming their healthcare systems.
The statistics that are being reported are frightening. What we are seeing is a global pandemic of a highly infectious new virus to which we have no immunity. We know that Covid-19 is very easily transmitted.
We know that once infected, the virus attacks the respiratory tract and causes a cough and sustained fever, and later may progress to severe pneumonia. We know that the incubation period before you show symptoms is about 5-14 days. We know you can make a complete recovery and will probably gain immunity unless it mutates into another type. Like influenza.
We don’t know when a treatment or vaccine is likely.
We know of many false rumours about the virus going around.
What makes Covid-19 tricky is that even before you feel unwell, you can start infecting others. This can happen as soon as 24 hours after becoming exposed. The other difference is that we now know that the virus can survive outside the body on some surfaces up to 72 hours.
This is making it very difficult to control. We believe that transmission is via droplet spread, but there is a lot we don’t know about the transmission, infection and effects.
Research papers and reports are coming out on our medical airwaves thick and fast. They are all showing similar data: That about 80% of infections will be mild, and you will make a complete and rapid recovery at home; 15% of infections are more severe and will require medical help at a hospital or clinic; 5% will be so severely hit with pneumonia that they require critical care and possibly ventilation.
At present, we see the current mortality at about 2%. Older patients, and those with underlying chronic health issues will have a higher incidence of severe infection and poor outcome, but Covid-19 is not restricted to the elderly. It is a misconception that younger healthy people are hardly affected. Certainly children seem to be spared bad infections, but as a younger healthy adult, you can still get severely ill.
Why the virus causes severe illness in some and not in others is not yet known. Covid-19 is going to go around the world possibly more than once until such time that there is a natural immunity, or a vaccine. 60% of us must get it before we benefit from what’s called herd immunity – which is where enough people in a population are immune that the virus fails to transmit effectively. Like influenza.
This past week, we have had discussions and meetings to try and strategise our preparations. The hospital management has been working for weeks on preparation.
As doctors, we are part of the machine. I am monitoring the figures and stats very closely. We have seen from our colleagues in European hospitals what to expect. Sadly, no amount of preparation is going to be enough. We do not have enough resources to offer every critical patient the same care. Neither does Italy, the US, or the UK.
As frontline doctors, we are fearful. We are fearful for our own safety, that of our families and that of our future patients.
All of us at the hospital will be exposed to many critically ill Covid-19 patients over the next few months. The hospitals are all trying desperately to re-organise and plan resources and how best we can cope.
This is happening at speed at local, regional and national level. SA is lagging a few weeks behind the rest of the world in time-line, but the trajectory of expected caseload will be roughly the same. We are fortunate to be able to learn from the rest of the world and prepare better. We have a few weeks to do it.
The only thing we as a population can do is to try and slow down the spread in order to try not to overwhelm our hospitals. Forced quarantine at home of entire populations is one option, but disciplined social distancing and contact precautions are more effective. (See links below). This spreads out the number of very sick patients over time and allows us to offer our expert resources to more people.
In the Western Cape, we have less than 800 ICU beds available, but based on European data, we expect that out of every 10,000 infections 500 patients will need intensive care. You can see that there is a big problem there. It will reach a time that the ICU doctors will have to decide which patients are going to be helped and which not. A terrible situation to be in.
So my advice to you all is the following – and this is what we are doing in our home:
- Explain to your kids what is going on in the world. They will pick up your anxiety if you don’t.
- Strict social distancing: Prepare and plan to stay at home as much as possible. We are not allowing our family to go to any more social or public gatherings. No parties or braais.
- No close physical contact within 2-3m outside the home. We’ll go for walks in the open or the beach. Then we’ll go home. Period.
- We will consider every surface and object outside the home a potential source of Covid-19.
- We will all wash our hands thoroughly with soap and water many times a day at home.
- We will not touch our eyes, mouth and nose – the only time we’ll use alcohol hand rub is when we cannot wash our hands, like in the car, or after touching anything foreign, like trolleys, lift buttons, banisters, tea cups, etc. outside the home. We’ll wipe down anything bought off the shelves, or delivered, with an alcohol cloth/soap and water.
- We want to minimise trips into crowded shops and so are slowly building a supply of basic essentials to cater for two to three weeks at home in the case of forced home quarantine. Stockpiling masses of stuff will only put others at risk. These might be friends, or those less fortunate. There is time enough not to panic. When there are cases reported in our hospital, then we will avoid the shops as much as possible.
- We want to make sure our friends and neighbours, and domestic workers are also taken care of. We plan to tell our maid to stay at her home and pay her something as usual. Their community is going to be hardest hit, and I want to support her and advise her.
- If you have a person in your home that is at risk, that has a chronic illness, or is elderly, then you need to prevent them from getting the virus. Take extra care. Make sure that you have enough medication for them.
- We are expecting this to go on for months. I would think 4-6 months before we see the infection rates start to go down. But I’m not an epidemiologist. I may be wrong. This does not mean you need to stock up for that whole time. It simply means that we are in for a very rough time over winter.
- There are a lot of people going to die. Some healthy people too and possibly someone we know. But let’s not forget that if you get the virus, there is an excellent chance you will just get better. We will most likely all be exposed to it at some point in the future. Like influenza.
- We really need to be there for each other and the poor. Especially the poor. The burden is on us as an affluent society to limit the spread as much as possible and try to flatten the curve. We need to step up to the plate, take responsibility, be brave, do not panic, and to religiously follow the advice given to us by our NICD, WHO, our government and local leaders. There are no exceptions.
- Please don’t panic. It will make it all worse. We have time to prepare.
- If you are worried, please phone your own doctor. You can visit DR Cohen’s website for guidance and advise Or call the NICD hotline 0800 029 999. Or go to the mediclinic portal (link below). Do not rush out to the GP or the local casualty. You will only put them under more pressure. If a state of emergency is declared, all health facilities will be forced to treat all patients presenting for treatment. Private or not. Resources are so precious. We cannot waste them unnecessarily early on.
If you have a sustained high temperature, with a continuous hacking dry cough, with or without a positive contact or recent travel, then you need to get tested and advised. Go to the Mediclinic Casualty first, where they will advise or admit you if necessary, and arrange for testing.
Test kits are limited and unnecessary negative tests will mean someone else won’t get one. Please take time to browse the following websites and arm yourself with correct information. Try not to google or YouTube randomly.
So, arm yourself with the correct information and stay safe. Stay safe, stay apart, wash your hands, work as a team, help your neighbours. DM
Useful resources:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.cdc.gov/coronavirus/2019-nCoV/index.html
http://www.nicd.ac.za/media/videos/
https://www.nhs.uk/conditions/coronavirus-covid-19/
https://www.worldometers.info/coronavirus/
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
https://twitter.com/westerncapegov/status/1239117782417125376?s=12
https://www.mediclinic.co.za/en/corporate/corona-virus.html
https://www.epi-win.com/advice-and-information/myth-busters
published with great appreciation to Dr Anthony Allwood – Anaesthesia and ICU,
Blaine and Associates, Vergelegen Mediclinic, Somerset West.
How long does the virus last on different surfaces
