Medical Discussion of Coronavirus

[Hatton]

Great question, which I have thought a lot about. I’m 61, though healthy with no other risk factors. I personally know more than 20 people with COVID-19, including 4 patients in my practice. There are a lot of cases in my area. I would like to live to a ripe old age, so my goal is a risk of as close to zero as possible. I am a psychiatrist doing primarily psychotherapy with some psychopharm, and all of my patients, mostly stable long term relationships, are continuing to see me through telemedicine. I get food delivered and have no need to go out. I live in the outer reaches of NY metro but my house borders a large beautiful forest where I hike daily.
If it were up to me, I would opt to stay home under these perfectly acceptable conditions until there is a vaccine or a highly effective therapeutic strategy.

Only one glitch. At some point, and I expect it will be long before there are very low risk options, the schools will reopen. I have a child in 11th grade. Refusing to allow her to return to school does not seem like an option. So I will not be able to remain isolated for the duration. I would if I could though. No question.

I am 62 and recently retired. I live in a medium sized city in the South. My county has only 199 cases with 4 deaths. One person in my neighborhood has COVID after visiting NYC. I guess I could live isolated forever or until a vaccine is available. I am continuing to exercise. I have continued to go to the grocery store and to Target. I recently went to a garden center to buy hanging baskets. I wear a N95 mask and gloves when I do this. I am continuing to walk my dog outside as well. I quit wearing a mask on walks. I simply walk away when I pass people. I miss the exercise classes and other social gatherings but I see the need for now. I know I am taking some risks but in this area it seems reasonable.

[White.Beard.Doc]

I am 62 and recently retired. I live in a medium sized city in the South. My county has only 199 cases with 4 deaths. One person in my neighborhood has COVID after visiting NYC. I guess I could live isolated forever or until a vaccine is available. I am continuing to exercise. I have continued to go to the grocery store and to Target. I recently went to a garden center to buy hanging baskets. I wear a N95 mask and gloves when I do this. I am continuing to walk my dog outside as well. I quit wearing a mask on walks. I simply walk away when I pass people. I miss the exercise classes and other social gatherings but I see the need for now. I know I am taking some risks but in this area it seems reasonable.

That all sounds reasonable for where you are.

The circumstances here are different, but somehow I am still healthy. I am not sure why. We have over one hundred deaths from Covid in my hospital alone.

The area you are in makes a big difference. Your high quality mask and clean hands are quite effective at protecting you in the circumstances you describe.

[ENT Doc]

Anyone else seeing new spikes (presuming from Easter)? I thought we had it under good control and then 2-3 days now of the worst days we've had, even in my county where testing has been relatively fast (meaning that I would not attribute the new spikes to batches of testing coming back faster now leading to new spikes).

[CordMcNally]

Anyone else seeing new spikes (presuming from Easter)? I thought we had it under good control and then 2-3 days now of the worst days we've had, even in my county where testing has been relatively fast (meaning that I would not attribute the new spikes to batches of testing coming back faster now leading to new spikes).

Our numbers of those hospitalized, ventilated, and presenting to the ED as a PUI have still steadily been trending down. Our area is past the peak according to models and that's what we've been seeing although you could say those hospitalized and ventilated is somewhat of a lagging indicator.

I've seen more people outside exercising than I ever have over the last month so I'm hoping that change is here to stay.

[StarTrekDoc]

We've had just a slight bump last week that was supposed to be our surge and plateaued this week.

I wouldn't expect an Easter spike of symptom calls until this week and hospitalizstion next 1-3 weeks depending on comirbidities. The south side is much more densely concentrated cases so will be most suspect.

[Tim]

I think there are some serious limitations on the ability of our populations to isolate. Many serious scientists think one year for vaccines is very optimistic. I don’t see becoming a recluse for a year as feasible for > 60 population segment. There is a segment of “Boomers” that will slip into “Reclusers” or the “Hermit Generation”. Isolated and disconnected. Takes a walk in the forest and never comes back to society. Lives isolated behind closed doors.
Howard Hughes was isolated as a child to protect from polio.

http://content.time.com/time/specials/packages/article/0,28804,1902376_1902378_1902405,00.html

[HikingDO]

I think there are some serious limitations on the ability of our populations to isolate. Many serious scientists think one year for vaccines is very optimistic. I don’t see becoming a recluse for a year as feasible for > 60 population segment. There is a segment of “Boomers” that will slip into “Reclusers” or the “Hermit Generation”. Isolated and disconnected. Takes a walk in the forest and never comes back to society. Lives isolated behind closed doors.
Howard Hughes was isolated as a child to protect from polio.

http://content.time.com/time/specials/packages/article/0,28804,1902376_1902378_1902405,00.html

I agree. I know that short term social distancing is necessary, but I too am concerned about the long term effects that this will have on society. We're not robots, we can't turn it off and on.. To stay isolated for a year or longer until we have a vaccine is not psychologically healthy.

[ENT Doc]

I agree. I know that short term social distancing is necessary, but I too am concerned about the long term effects that this will have on society. We're not robots, we can't turn it off and on.. To stay isolated for a year or longer until we have a vaccine is not psychologically healthy.

Though I think this whole social distancing and the behavior change COVID induces will end up having some positive effects. For example, if people are more careful during cold and flu season we could see a significant decrease in morbidity/mortality/healthcare utilization/hurt productivity as a result. Those marginal flu benefits are not only beneficial for the elderly but for pregnant women and kids, who are largely spared from COVID - for possibly years to come.

[artemis]

Though I think this whole social distancing and the behavior change COVID induces will end up having some positive effects. For example, if people are more careful during cold and flu season we could see a significant decrease in morbidity/mortality/healthcare utilization/hurt productivity as a result. Those marginal flu benefits are not only beneficial for the elderly but for pregnant women and kids, who are largely spared from COVID - for possibly years to come.

That's the one good thing I can see coming out of this epidemic. If "wear a mask when out in public (especially if you know you are sick)" and "wash your hands/use hand sanitizer frequently" stick around for future respiratory virus seasons, we could see a big decline in mortality and morbidity from all respiratory viruses for years to come. And neither are that hard to do, so fingers crossed those behavioral changes stick!

My area may have peaked, as we are seeing a significant decline in admissions - but just a few hours west of my city, COVID-19 is hitting smaller towns hard (largely because workers got infected at meat processing plants). So we're not out of the woods yet!

[Tim]

Is the hypothesis that washing hands, wearing masks, safe spacing will move the needle on life expectancies?
Sure there are benefits, but there seems to be some extrapolation going on.
Taking the mask off for 3 cheeseburgers, fries, apple pie and a supersized drink might be prohibited as well. Keeping that mask on seems to be more beneficial to prevent eating. Even in tight spaces. Absolutely no data and I doubt we could get enough people to run a study. Just saying speculating on life expectancy is questionable.
Criteria is how many people die and at what age.
Doubtful these steps will move the needle in the long term. Maybe cutting the the fries and apple pie should be put in place. Just food for thought.

[Max Power]

I think there are some serious limitations on the ability of our populations to isolate. Many serious scientists think one year for vaccines is very optimistic. I don’t see becoming a recluse for a year as feasible for > 60 population segment. There is a segment of “Boomers” that will slip into “Reclusers” or the “Hermit Generation”. Isolated and disconnected. Takes a walk in the forest and never comes back to society. Lives isolated behind closed doors....

Isolation and solitude can be a wonderful thing. Thoreau and many of the best literary, scientific, engineering, etc minds in American history did their best works during relative solitude via (voluntary) retreats. You can tap into the infinitude of the private man and consume or create projects and literature undisturbed; it is very good... for awhile. Longer term, yes, any solo human goes certifiably crazy, even if they make up deities to talk with or socialization tools a la Wilson in Cast Away. We are tribal animals, though and through, and we start to shut down and become dysfunctional or even self-mutilate just like rodents, primates, dogs, etc when in a cage or totally closed off from socialization.

Enter YouTube, FaceTime, non-stop news updates, Netflix, Call of Duty, etc! While it's true that the vast majority of people are co-dependent and that even the strong can only be isolated for so long without mental health deterioration, digital media and communication can fill that gap (consuming consciousness, 'leveling up,' feeling connected) well enough for a shelter-at-home situation. It is not ideal, and they will be minimally productive, but it can be done. For those more motivated and self-reliant, even a basic novel or companion or two has proved functional enough for stoic and imaginative astronauts, expeditions, prisoners, sailors, etc to sustain for years. Relative isolation with cancelled sports and limited entertainment or social option for whole cities or territories has happened for years during many regional and world wars. It is all in how you deal with the free time.

The true problem is that most contemporary people 60+ can't go that long without assistance in terms of medical Rx/therapy/procedures/diagnostics, govt assist monies, non-medical services (housekeeper, repairmen, transportation, etc), food services, etc etc. Humans do not naturally live anywhere near as long as we currently help them to. The old survive by eating off the table of the young and thrive off the sweat of the young in any society. Does that mean the old don't have a right to live? Nope, but there is nothing to eat if the young can't go out to do the farming and hunting and pay the taxes (and they also need long term carrots-on-the-sticks of learning, enjoying, earning, etc). That is the long term problem: lack of incentive for the provider age groups, and I sure hope it doesn't get neglected for the sake of cutting the death tolls by a fraction of a percent simply because this happens to be a national election year. We can't just print money and neglect education and production forever. It will be interesting, esp with summer starting soon in northern US, to see how long people - old and young - continue to go along with the isolation and limited travel and required bandanas and blah blah.

[childay]

Enter YouTube, FaceTime, non-stop news updates, Netflix, Call of Duty, etc! While it's true that the vast majority of people are co-dependent and that even the strong can only be isolated for so long without mental health deterioration, digital media and communication can fill that gap (consuming consciousness, 'leveling up,' feeling connected) well enough for a shelter-at-home situation. It is not ideal, and they will be minimally productive, but it can be done. For those more motivated and self-reliant, even a basic novel or companion or two has proved functional enough for stoic and imaginative astronauts, expeditions, prisoners, sailors, etc to sustain for years. Relative isolation with cancelled sports and limited entertainment or social option for whole cities or territories has happened for years during many regional and world wars. It is all in how you deal with the free time.

If only we had a chiral network..

[StarTrekDoc]

That's the one good thing I can see coming out of this epidemic. If "wear a mask when out in public (especially if you know you are sick)" and "wash your hands/use hand sanitizer frequently" stick around for future respiratory virus seasons, we could see a big decline in mortality and morbidity from all respiratory viruses for years to come. And neither are that hard to do, so fingers crossed those behavioral changes stick!

My area may have peaked, as we are seeing a significant decline in admissions - but just a few hours west of my city, COVID-19 is hitting smaller towns hard (largely because workers got infected at meat processing plants). So we're not out of the woods yet!

Iowa got smacked hard with Smith workers out -- this is what lack of social distancing at the workplace will cause despite a relatively low prevalence rate.

Same thing happened in Singapore -- largely avoided surge but 2nd wave hitting the migrant worker dorms -- spreading like wildfire. Same on the Teddy - spread fast and furiously quickly.

Distance is needed .

So, during this weekend - saw a return of something haven't seen in a LONG time -- Drive-In. Parked car, got food in parking lot and able to eat right there. A+W/Sonic all over again! Nexxt -- Night Drive-Through movies return. Gotta love to see that happen -- use the current stadium parking lots --- perfect IMHO.

[Tim]

StarTrekDoc
Drive In Movies! No need to leave the driveway. Just use your phone and WiFi at home. The concession stand is a short walk away during intermission, commonly called the kitchen.

https://images.app.goo.gl/SeRTasLMBMDHmvM8A

If nostalgia is appealing, get some speakers.
Might even hang a sheet on the garage door- Name of this week’s movie and the time. Admission is by the vehicle, pet friendly.

[StarTrekDoc]

StarTrekDoc
Drive In Movies! No need to leave the driveway. Just use your phone and WiFi at home. The concession stand is a short walk away during intermission, commonly called the kitchen.

https://images.app.goo.gl/SeRTasLMBMDHmvM8A

If nostalgia is appealing, get some speakers.
Might even hang a sheet on the garage door- Name of this week’s movie and the time. Admission is by the vehicle, pet friendly.

But NOT new releases -- would love to have that come back and SAFELY reopen movie releases