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Viral in Seattle

March 24, 2020

[Posted also on Facebook.]

Dear Friends.  As you know, turns out I’m living in the city where we first learned that America was joining the World Viral Alliance.  Since the Seattle Experience is still a preview of coming detractions for much of the country, I’ll offer a few local thoughts.

First:  Everybody stay well!  Do what it takes, including social distancing. (At about 9 last night I was making my regular promenade in my very normal neighborhood.  Nobody else out, no cars passing by.  A man walking his dog approached.  We were closing at about 3 ft/sec.  At 20 ft he swung way out into the street.)

In my isolation, I’ve been rereading Camus’s The Plague (actually this time, La Peste, reading out loud to myself, as part of my study of French).  A few days ago, at the end of Part I, the mayor issued the order to close the city (“Fermez la ville”).  Seattle is still open; but in many ways living with the virus here (unless Trump cancels social distancing to try to save his assets) is noticeably like life in Oran.  So it occurred to me that you might find it interesting to get an occasional report from this ville.

Vastly unlike Camus’s narrator, I have no expertise; and rather than being at the center of things, I live near the southern periphery of Seattle; and while Dr. Rieux is out and around, risking his life to aid his concitoyens, I’m aiding my community by keeping to myself and just trying to stay alive.  I do have a family friend, G, an anesthesiologist and medical ethicist, who is in the thick of things.  Yesterday we asked (by text) how she’s doing.  Reply:  

“Lots of admin stuff as we get ready to surge in about 2 weeks. WA is doing much better than New York. But we are doubling about every 5 days in deaths and cases (over 2200 cases today and totally of 110 deaths) to put in perspective, in 2 weeks that would translate to 17,000 cases and about 900 deaths and about 3500 hospitalized in WA alone if we don’t slow down. Damn how I wish the [navy hospital] ship was coming to us instead of LA. The virus is still moving too fast. But at least we’re not NY. New York alone now has 22,000 cases, more than France or South Korea, and 157 deaths (up 38% from yesterday).”

I’ll post more, soon, about family and city.

3/25 This will help understand the response Heidi got re. her serious symptoms:  On March 20 our friend G (anesthesiologist, medical ethicist) shared this letter, about Seattle health care resources:

The hospital situation is concerning.  We are not in a panic yet.   Here is the somewhat sobering message I sent to Todd yesterday, which is worth repeating.  Bold text shows where I am updating it for today:

“Seriously, no need to panic, but social isolation is important, not just to prevent YOU from getting the illness and spreading it or dying from it (and here’s the bad news–the latest wave of statistics say that younger people (20-60) are the biggest risk for requiring hospitalization and/or critical care than any other group.  Over 60 is most likely to die if they become critically ill, but serious infections seem to be very high in your age group), but also to slow the epidemic.  Texas by the way, is one of about a half a dozen States that have done the LEAST amount of appropriate measures and restrictions.  so hang on to your hat, Texas. 

Why is social distancing important?  let me give you an example using Washington State (my numbers come from yesterday, by the way, and are already outdated, but here goes);

Let’s suppose that ultimately Washington state alone develops around 30,000 cases (it will be at least that–we are at about 1400 (this is increasing by about 50% every 24 hours at this time—yesterday was 1200 at end of day) confirmed cases and 74 (was high 60’s yesterday) deaths as of last night).  From China, which did a slightly delayed, but excellent job of lock down, the rate of serious infection needing hospitalization was about 15% (many if not most requiring intensive care), and death rate about 2.5 percent (I’m averaging a lot of reports).  Those numbers appear to be holding true for us, too.  That would mean in Washington state alone, there would be 4500 hospitalizations and 700 deaths.  How many ICU beds are there in Washington state?  Less than 1500 total.  (total hospital beds in Washington state are 10,231 as of this year) i.e. there will be no way we can take care of even 1/3 of serious cases if the epidemic “dumps” those cases all at once or over a short period of time–which it will do and in just a couple of weeks from now if we don’t move quickly–it may already be too late.  Since recovery time is about 3 weeks for hospitalized patients (and that is just an average–some take 6 weeks and months of rehab) then we cannot afford to see more new cases than “recoveries” come in over that period of time or hospital beds will be completely overwhelmed.  And that is presuming that no one else needs or gets a hospital bed for a non-corona related cause (god forbid you have a heart attack or cancer during the pandemic).  That would translate to maybe only about 3 new cases per day per ICU MAXIMUM.  Guess how many patients we have at my hospital and affiliate 2 hospitals in Seattle right now with COVID?  about 40, around a dozen in the ICUs.  Most of those arrived in the last 3 days.  And this is very early days of the appropriate measures.  The engine is just starting to rev, and soon it will roar.  Starting to get the picture?  We are already running out of protective equipment at the very beginning of the epidemic.  People are stealing masks from hospitals that they can’t even use.  We have had 2 doctors critically ill in ICUs in the Seattle area.  One of our most famous epidemiologists died Wednesday of COVID.  (he was retired however, and got it in the community).  

So we need to slow things down primarily so that the cases come in don’t flood the hospital beds (we’re at near capacity now), and don’t deplete us of needed medical supplies and protective equipment (we are running short now).  The pandemic, if we take our lessons from China, will continue apace for another 3-3.5 months, and then if we are diligent and do appropriate lock downs now (hey Texas, get with the program–there’s a pandemic going on), we may be able to ease restrictions in about 4 months.  (I know the media and the government are reporting a much shorter period, but trust me, it will be longer.  Inslee has already extended our lock down times for several weeks and he will have to do so again.  At the moment, our hospital is projecting a peak ((hopefully)) in about 3-4 weeks, after which we will be looking at minimum of 3-4 weeks for those cases to recover and new less serious cases will still come in for a while.

If.  

What measures are we taking in our hospitals?  We are screening every person who walks through our doors.  We don’t allow visitors in.  Period.  If your relative gets sick you will have to say goodbye at the door.  We are cancelling ALL elective surgery and procedures, ALL, which means all patients get screened to see if their care can be postponed.  We went from 80 cases per day here to 17 starting last Monday.  We are self-isolating exposures, testing, and home quarantining anyone who is positive.  We are donning expensive and very limited supplies of protective equipment when we have to take care of a COVID positive patient.  This includes full showers for the anesthesia staff after anesthesia or airway care in infected patients.  This all takes time, and resources.  And yes, it is exhausting.  

We are looking at methods to change visits to Telehealth.  Which requires education of our providers and installation of equipment that permits visual contact with patients.  That will take time.  We are looking at whether with reduced surgeries, if ICU cases continue to surge, anesthesiologists can be cross-used as intensivists and empty ORs used as extra ICU beds.  The Washington State Dept of Health in conjunction with the Wash State medical societies is outlining a plan for rationing of care in the event of an overwhelming need. Meaning not everyone will get extensive medical care if they are not expected to survive.  The President has just today enacted emergency powers to command that manufacturers divert resources to produce protective equipment (masks, gowns, etc) and sell them to the government for emergency dispersement to hospitals.

And just to be clear.  No chloroquine was not just released by the FDA, it was released years ago.  And no, studies are not very promising that it will treat COVID.  But it is early.  There are some triple antiviral therapies that actually have shown some promising results, but those drugs are pretty toxic in some people and we need more info.

All while Fox News announcers have it a hoax, our congressional representatives have been using inside information from their security briefings to avoid losses on the stock market, and idiot preachers decide it is there “right’ to have large gatherings, thus generating new cases and accelerating spread.  I will have a serious ethical problem on my hands if any one of these guys and gals presents to me and asks me to risk my life to take care of his/her COVID infection.  Maybe they should be allowed to compete instead for a Darwin Award.

Here’s the good news.  98% of us will be fine.  The problem is that the other 2% represents about 6 million people for the United States.

The skies are turning blue in Wuhan, for the first time in decades

The dolphins swim in Venetian waters again.

As I said before, Mother Nature loves the COVID virus, even if we don’t. ”

Thanks, G!! As of this morn, of 2469/123 confirmed WA cases/deaths, 1277/94 are Seattle metro area.  I’ll add that COVID-19 is one of the “10,000 things.” [2 b cont]

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