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The New Norm

Gloves

He sat in his car waiting for me. John was a 38 year old male with a history of diabetes. He looked slightly overweight and out of breath. He was sitting there for a good twenty minutes. The medical assistant said that he had a fever of 100.4F and had an oxygen saturation of 93%. The window was rolled up with AC running. John called the clinic, concerned about his fever. He was evidently in a panic about the situation after he started developing body aches and a cough. The staff informed him to pull up to the parking lot and call back.

I was in full gear - gloves, gown, mask, face shield. It was a typical sunny day in Florida. When people were typically out on the beach enjoying the weather, I was sweating it up in this suit, about to knock on John's window. This was the new norm. The world we live in has been turned inside out and we're trying to keep up with these changes. 

With the pandemonium surrounding the COVID-19 infection, everything has changed. We are dealing with multiple crises all at once. It isn't just a public health crisis. It's the economic crisis that came as a result, the existential crisis of our freedoms being compromised, the crisis of misinformation that had left many confused about what to believe. Finally, there is the crisis of two generations of people at odds with how to approach it (millennials and boomers).

To shed some clarity on what and how to handle the public health crisis, I wanted to give some basic information about what this virus is and how it should be approached from the perspective of a patient. COVID-19 is a new strain of the coronavirus. Coronavirus has been around for quite a long time, and is actually one of the viruses that's responsible for the common cold, but this is a new version that no human has ever seen until now. They believe this virus jumped from a species of animal to humans.

Why is this important? Since no human has ever been exposed to it, there is no herd immunity.  Herd immunity is typically created by the production of a vaccine but it can also be produced if enough people are exposed to the specific infection which will then produce immunity. If enough immunity is produced in the community, or the herd, then the risk of transmission to the entire population becomes greatly reduced and limited.

Without herd immunity, this infection will spread with very few obstacles. To give you some idea of how extensive it can be, the flu infects over 25 million people on average, just within the United States. It kills about 20 to 30 thousand annually. These numbers are with herd immunity. Without it, an infection that is highly contagious can explode exponentially.  With this particular virus, you can anticipate upwards of a hundreds of millions of people getting infected and more than a million people dying from this if nothing is done to mitigate it.

In addition to this, they discovered that half the patients that will have this illness will be asymptomatic carriers of it. In other words, a person can potentially exhibit no symptoms but still manage to infect a large number of people that may be prone to the full force of the infection. These people may be the largest group involved in spreading the infection.

Once the hospitals are overwhelmed by the number of people infected with this illness, the non infected stroke and heart attack patients may be waiting longer than they should and potentially die from their affliction. And while their death won't be included in the tally, rest assured that the overall mortality rate in this country will go up. 

As of now, there is no treatment and there is obviously no vaccine in the foreseeable future, so how do we manage this crisis? The first and most important step is to test. We should test as many people as possible, not just the ones with symptoms, but the asymptomatic ones as well so that we can identify the asymptomatic carriers and isolate them as well. Unfortunately, however, as of writing this, there are not enough testing kits around. The CDC is only giving guidance to physicians to test people that have prior confirmed exposure to COVID-19, anyone over 65 with comorbidities, and anyone with a history of international travel. So, if you're 35 with a fever and cough, you're out of luck, or should I say we're out of luck at this time. Hopefully this will change very soon.

At this early time, social distancing is the only tool we can use to try to limit its spread. Social distancing is trying to remain 4 to 6 feet away from the next closest person. The reason for this is that a cough can travel as far as 6 feet beyond your mouth. Limiting how much you touch your face and consistently washing your hands are also important in reducing your risk. Surgical masks will not protect you from infection and furthermore, using a surgical mask repeatedly will potentially cause more infections, so stop stealing them from your local hospitals and doctor's offices, please.

The state mandated quarantines are important in trying to limit the number of infections at any given time. Understand that this is first of several possible quarantines that the state may mandate depending on how the virus will spread. We all have to adjust to this new way of life, where we work from home, we homeschool our kids, and we avoid shaking hands and hugging our loved ones as a precaution. 

As I shoved the nasal probe into John's nose, he winced, almost triggering a sneeze. As I pulled the swabs out, he coughed. I breathed a sigh of relief, knowing that I was fully prepared for the occasion. I told him to self quarantine for 2 weeks and to call us if his symptoms progress. This situation that we are currently in isn't going anywhere anytime soon. If we are going to get through this as a people, we are going to need to pull together and do the right thing not just for ourselves, but for our fellow people. 

Author
Dr. Juan P. Borja Juan P. Borja, DO Board-certified family physician Juan Borja, DO, brings more than a decade of experience to Delray Medical & Dental, serving adults in Delray Beach and it's surrounding communities. Dr. Borja was born in the Philippines and raised in New Jersey. He began his professional pursuits at Rutgers University in New Brunswick, New Jersey where he earned his Bachelor of Arts in English. Following graduation, Dr. Borja decided to pursue a career in medicine and enrolled at Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, California. Professionally, Dr. Borja has special interests in sports medicine and loves using nutrition and fitness to help his patients lower their risk of chronic disease.

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