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Dear Community,
I hope everyone who has the option to is hunkered down at home.
We have a new dispatch below from my brother, Dr. Jordan Shlain, so you can be as informed as possible during this pandemic.
Take care, stay at home, and remember we are all here for each other.
Tiffany + The Let it Ripple Film Team
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#StayHome. Dispatch #4 from the Front Lines.
by Dr. Jordan Shlain
The virus is moving fast, the news even faster. Please, please, please do not disseminate disinformation; it can be as virulent on our psychology as Covid-19 is to our physiology.
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Chicago Airport after new travel restrictions.
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First-order thinking is fast and easy. It happens when we look for something that only solves the immediate problem without considering the consequences. For example, you can think of this as I’m hungry so let’s eat a chocolate bar.
Second-order thinking is more deliberate. It is thinking in terms of interactions and time, understanding that despite our intentions, our interventions often cause harm. Second order thinkers ask themselves the question “And then what?” This means thinking about the consequences of repeatedly eating a chocolate bar when you are hungry and using that to inform your decision. If you do this you’re more likely to eat something healthy.
In the absence of national leadership, it is up to you and your local communities to ensure a) viral spread slows and b) you protect your front line medical providers who are at the highest risk.
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| Think Bigger Than Yourself
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The invisible hand describes the unintended social benefits of an individual’s self-interested actions, a concept that was first introduced by Adam Smith in The Theory of Moral Sentiments, written in 1759, invoking it in reference to income distribution.
Covid-19 is a viral invisible hand which is challenging the fundamental tenets of our civil liberties.
Limiting our movement and the size of human gatherings is a small price to pay in the short run; yet in order for this fist not to crush our economy, we need leadership.
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Updated Stats — that you all know
March 13th, 2020
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The last eleven days give us a statistically good model that we're going exponential.
Here’s what that looks like:
- March 18th the US passes 10k
- March 26th the US passes 100k
- April 4th the US passes 1 million cases
*The mortality rate is still a moving target that only time and data will help us understand.
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A March 9–10 survey done by the Covid-19 Expert Judgmental Forecast by Thomas McAndrew, University of Massachusetts Amherst predicts that only 13% of all Covid-19 infections were reported to the CDC as of Monday March 9th and that nationwide hospitalizations will peak in May. Full expert forecast here.
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We Need To Repurpose More Buildings Into Hospitals
In 2018, there were 5256 American Hospital Association registered community hospitals with a total of 534,964 acute hospital beds. The Society of Critical Care Medicine is trying to sort out the number of ICU beds in all the hospitals around the country. Remember, there are many different types of ICUs: cardiac, neonatal, medical-surgical, pediatric and other.
The number of actual ventilators is still being sorted out, but the number varies from 60K–160K from what I can find.
For anyone who is thinking of buying a ventilator at home, I strongly suggest you call your local hospital and see what equipment they need and buy it for them.
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A bright spot, I suppose.
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https://lab24.ilsole24ore.com/coronavirus/
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I just got a message from a doctor in Italy who states that the data show that approximately 12% of the ICU admissions are for people in the 19–50 age bracket and 80% are over 60 years old. See LinkedIn for full paper — in Italian.
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Meanwhile back at the ranch. New York City is starting to see a rise in cases and the ability to test is still very weak.
If there are any doctors in New York (or anywhere in the world) who work in hospitals, please find me on LinkedIn and I’ll invite you to doctors around the world chat group so we can share what we see.
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A brief respite of global entrepreneurial spirit
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On Testing
We need more testing to get smarter about who to quarantine and who is free to roam about the world. Testing is a critical piece to the overall strategy to flatten the curve.
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Here in San Francisco, the Department of Public Health has put out Instructions While Awaiting Results of Testing for Covid-19. While this is all a moving target, this is some very useful information.
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The Truth
There are no experts. There are only good people trying their best to sift through the raft of information coming in extremely fast. For those who “know it all,” I recommend reading Shane Snow’s article on intellectual humility.
Important to understand: Aside from some great updates from clinical researchers, most information is “best guesses” at this point, and if qualified experts say this is what they believe, we need to listen to them and share the learnings.
The bottom line is we need to look at Italy, Spain, France, China, and Japan and learn…quickly. They are shouting at us to take immediate action. Denial and hubris is a horrible strategy.
Action is the only solution.
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On Treatment
It’s important to understand that what we believe is killing people is not the virus itself, but our hyper-aggressive immune systems response, called a cytokine storm.
This is what ravages our own tissues. We are still all grasping for straws to learn quickly what works and what doesn’t.
Please do not hoard medicines that are purely speculative. It could harm people who actually need those medicines for their day to day lives.
There has been a lot of talk about medications that can be used. Chloroquine and hydroxychloroqine have been researched by a group of Korean physicians. However, with every benefit, there is also the risk that it could cause the coronavirus to mutate.
Gilead has a protocol for using remdesivir…so for those folks trying to get some — hope you never need it — here are the inclusion criteria and for simplicity — you need to be on a ventilator to get this medication.
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| Specific Actions You Can Take
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We are moving into the psychological realm and I urge everyone to take a deep breath and ask, “What can I do?” In addition to continuing to give to hospitals, food banks, and reputable organizations that help people…the most important thing to do is stop the spread and Flatten the Curve.
STAY HOME as much as possible, even if you have no symptoms, until you hear otherwise from health care officials. It may be in your community now or it may be soon. That means avoiding playdates (that means zero), sleepovers, bars, restaurants, parties, or houses of worship. Avoid all crowds.
I along with 15 other health care officials wrote an open letter to encourage everyone to stay at home. Please read and share far and wide to everyone in your life.
Information for families during COVID-19 school closures.
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Embody Social Distancing: You can still take walks outside, shop for essentials (be smart, use disposable gloves and sanitize things you think may have been touched), get take out food, and enjoy your online community of friends as long as you maintain a safe distance from them.
Minimize alcohol. Sorry to be the bearer of this news. Alcohol can impair your immune system.
Drink lots of water. As my father the surgeon used to say, “the solution to pollution is dilution.” So dilute!
For pot smokers, edibles only.
Quit smoking.
Avoid NSAIDS (Advil, Aleve, Motrin, etc.) Early data suggests that those with the virus should avoid them. Better safe than sorry.
This is a great time to optimize your existing medical conditions. The Lancet just came out with a study that suggested that people with cardiac disease, high blood, pressure and diabetes are at higher risk. Get a home blood pressure monitor and make sure your blood pressure is 120/80 or below. Get a home blood glucose kit and make sure your numbers are what your doctor recommends.
Exercise, meditate, read poetry. Tell jokes. Watch funny movies.
Take time away from screens.
Practice good clean hand washing.
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To State and Local Leaders
- Prioritize the most vulnerable in your community: the elderly, the sick, and those living in close quarters.
- Temporarily close bars and restaurants when there is evidence of rising community transmission.
- Work with Congress to provide continued economic support for your constituents most urgently affected by the pandemic’s financial blow.
- Consider temporary suspension of all commercial air and rail travel.
- Ensure the safety and resources needed for your health care workforce. Health care and critical infrastructure workers should have the highest priority for personal protective equipment.
- Make rapid expansion of COVID-19 testing a top priority. Open drive-through testing stations and at-home care.
- Make prescription drug supply and other necessities in your community a priority.
- Provide immediate training for all medical providers to join the effort wherever they can be most useful.
- Honor cross-state medical licensing for all healthcare providers until the pandemic is over.
- Prepare large spaces (stadiums, hotels) to become quarantine residences, as needed.
- Coordinate with the National Guard to provide surge ICU capacity for communities in need.
- Create fever clinics for triage.
- Re-evaluate any regulations that impede the above (or below).
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To My Fellow Healthcare Colleagues
We know you are in uncharted waters and are standing on the front lines. If you have not yet joined this fight, please contact your local hospital and find out how you can enlist. Be safe and understand we also need to get our sleep, eat well, exercise and spend time with family.
- Contact telemedicine platforms and offer your services.
- Stop all elective surgical and medical procedures.
- Send people home if it’s safest for them to be at home.
- Reinforce the benefit of staying home and getting tested.
Help the people on the front lines do their jobs. Focused and united, we can avoid the worst possibilities. It’s up to all of us. As a country, we can overcome this together.
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I’ve put this 40-minute documentary about the Spanish Flu epidemic for historical context in my last post, but now that you have more time at home, it’s worth a watch.
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In Closing
If you’ve been infected and recovered already, you are highly likely to be immune (there are a few caveats that we do not yet fully know how long you can be shedding virus). I am looking all around for testing that shows who has been exposed via IgM IgG antibiody testing. If there is strong evidence that you’re on the other side and not contagious, you can serve your community in public spaces where others can’t. #CovidClub.
Like any story teller knows, all stories have a beginning, a middle and an end. We have left the beginning and are entering the middle. This is going to hurt. Stay strong, stay home, keep your wits and we will collectively get through the fog of this pandemic.
If you’re going to spread anything, spread help, compassion, and humor.
Above all, do not panic. Remember: Like all outbreaks, this too will eventually end.
South Korea just finally reported more Coronavirus recoveries than new cases for the first time since the outbreak began.
It’s rare we are all united as humans across the globe.
Let’s do this.
Jordan
Dr. Jordan Shlain is a practicing internist who manages a team of doctors and nurses in SF, Silicon Valley, NYC, and LA. Follow him on LinkedIn and Twitter. This whole dispatch is also on Tincture and you can sign up for updates directly from Dr. Shlain there.
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