I visited NYC for Asia Week (largest Asian Art fair in galleries and museums) 2½ weeks ago as I had the past four years. Just as chaos was erupting heralded by the closure of major museums and Broadway. Susan and I dropped into empty art galleries, one opened just for us after my call – the owner wore a mask. On Saturday night, Broadway was unprecedently deserted, we along in usually full restaurant and one of a handful at an off-Broadway whodunit. We took the emerging CoVID concern seriously but not fastidiously seriously. For example, we elbow bumped instead of hugged, but didn’t distance or mask even though not yet recommended. Ben called me repeatedly, “Dad you’ve got to get out of NYC, it will the next epicenter!” (before it became so) and shared articles (on community acquisition) as well as his frontline experience. Somewhat reluctantly, I shortened my stay and returned to a less exposed Middleton, Midwest. A few days later Susan alerted me that our mutual friends both tested positive, and that she had spent four hours with them before onset of symptoms and that I had been secondarily exposed. I then went into self-quarantine for 2 weeks. Fortunately, both of us … remained healthy. We dodged a bazooka.
What did I learn? Despite burdensome anticipation from an indirect CoVID contact, I was relieved to be alive, and well. I indeed had not fully pondered the early on risk. Were it not for Ben, I would not have altered plans. He acted pointedly like a parent for which I am truly grateful and thank-full. I am concomitantly humbled as parent and physician.
Like you at home, I’ve had a chance to speak with numerous family and friends in the US and Canada. I have read many articles, heard presentations, spoken to my retired from CDC classmate, listened to overwhelmed front-line (including Ben) physicians, and carefully followed my two CoVID + friends. After an interminable two weeks of fever, cough, shortness of breath, low oxygen levels, their course finally turned. Like all of you, I still worry for others.
A few numbers and observations I wanted to share. Some may be helpful.
1) Infectivity, compared to influenza. While a single case of influenza (which I had this spring) is estimated to potentially infect 400 others over a 2-month period, a single case of CoVID could similarly infect 100,000! Like a California wildfire, it only takes one (ironically even at a funeral) to ignite a whole city. And, CoVID is 20X more likely to cause mortality than flu.
2) Spread by whom. No longer just travelers and the obviously infected, it is in the community even spread by the asymptomatic (except for loss of taste and smell) infected persons. It is running silently and ubiquitously in our communities. And, in the absence of herd (previous) immunity it can run rampant, via direct cough droplets, via indirect surfaces (20 hours), in the air (3 hours) and possibly stool.
3) Who. Although 80% of cases are mild or moderate, 20% require hospitalization and 5% need ventilators and are at a significant risk of dying. Serious cases appear to require almost a month in the ICU (much longer than usual) and overwhelms critical care and supplies. Besides the chronic disease risk factors (especially hypertension due to ACE2 receptor?), it has a predilection for males (70% fatalities) especially over 80 years. Yet in is not only the elderly as 40% of NYC in-patients are < 50 years. What is causing deaths not the virus so much as the body’s immune overresponse (cytokine storm = systemic inflammatory response syndrome SIRS) leading to adult respiratory distress syndrome and multisystem organ failure. And, who wins, and more importantly, who loses ventilator lottery?
4) Social isolation and distancing. The countries where they have stopped CoVID cold, including Taiwan, Singapore, and in South Korea, have done so early self-distancing and isolation and by extensive testing, tracking all contacts of positives, and quarantining. We don’t have that capability. However, this flattened curve doesn’t mean you won’t eventually acquire CoVID but avoiding a CoVID mushroom cloud will relieve an overladened medical system and provide a better chance for survival later on.
5) Medications. Hydrochloroquine antimalarials do show promise in trials (controlled study from Wuhan), but it may be even better when coupled with azithromycin (Z-pack). Remedesivir a failed IV anti-Ebola agent shows promise and is currently in trials here. Tocilizumab an IV anti-inflammatory agent in one case report calmed the cytokine storm. A vaccine is at least a year away.
So friends and family, take care and be safe. Follow the guidelines especially washing your hands anytime your go out or return with regular soap and water for 20 sec up to your wrists. And, if you should get symptomatic – fever, cough, shortness of breath, muscle aches, headaches + loss of taste, diarrhea – please get tested if available and self-isolate.
Equinox unseen
under Corona glare
daffodils arise 
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