From: Andrea Settje, MD
NEBRASKA INTERNAL MEDICINE
I am terrified, we are about to all get slammed with a tsunami. As a physician, I feel my duty to speak out what this looks like from my perspective. Actually, I really don’t worry too much about myself or loved ones dying from this illness, as 80% of COVID19 is a mild disease. But I know our healthcare infrastructure can not withstand this sudden surge. I know my geriatric and chronically ill patients are most at risk of dying.
COVID19 is much more infectious and lethal than the flu, a percent more or less may not seem like much, but when multiplied into community numbers, that is when is gets scary. The reproductive number – the number of secondary infections generated from one infected individual – is reported to be between 2-3.2, the flu is 1.3. The fatality rate for COVID19 is 2-3.5%, the flu is <0.1%. Additionally, COVID19 hospitalizations are lasting days longer than flu hospitalizations.
Population of Lincoln 287,500
community attack rate 10%= 28,750 sick
Cases requiring hospitalization 10%=2,875
cases requiring ICU 1%=287
case fatality 3.5%= 1,006
Guess how many hospital beds Lincoln has? 1,100. Not even close to the low estimate of 2,875. Plus those bed are already occupied by sick patients. It very likely will be 3X this number!!!Other countries are seeing over 30% community attack rate. We cannot handle this surge!
China was extremely aggressive about testing and isolating in Wuhan and providing healthcare providers with the proper masks, gowns, etc. We are way under diagnosed due to narrow indications for testing and very limited supply of tests. I am worried our numbers will be worse than China.
Healthcare workers do not have the supplies needed: N95 masks, surgical masks, gowns, face shields. What happens when a dialysis nurse works with mild symptoms, and later is diagnosed. She may have exposed 2-3 days of dialysis patients, so 20-30 dialysis patients suddenly need quarantine and continue to receive dialysis. Where will the heart attack patient go who needs the ICU? Who will care for my patient admitted with a hip fracture?
If my staff gets sick (remember our lack of N95 masks) who will care for my high risk elderly patients?
The stories from physicians in China and Italy are terrifying and heart breaking.
What can we do? We don’t have a treatment or a vaccine. I need the public to act quickly. We need to slow the rate of transmission so we don’t have a quick peak in cases. If we can ‘flatten the curve’, our infrastructure maybe able to handle this crisis. The only way is public health measures... stay home. Cancel the basketball games, concerts, group gatherings. Follow social isolation, limit travel. Absolutely follow any quarantine. Wash your hands. Push our government to get more testing and masks, right now! If we can’t mitigate the cases and slow the surge, in one month we will need the National Guard setting up temporary hospital beds in Pershing.