As we swiftly surpass 100,000 cases and 4,000 deaths globally, every one of us is understandably rattled and may be asking, will I be next? Will I get infected with COVID-19? Will I end up in the hospital? Will it kill me, my family or friends?
While many of us may get infected with SARS-CoV-2, the virus that causes COVID-19, we can be reassured that the vast majority of us won’t die as a result of it. Sadly, the same cannot be said of our elderly population or those with underlying illnesses, for whom there is little doubt COVID-19 is dangerous. In Italy, which has one of the world’s oldest populations, the vast majority of its deaths have been in the elderly. In Washington state, 14 deaths were linked to a nursing home. For those who don’t die, many of them will require long hospitalizations and life support in intensive care units.
The other — and perhaps more concerning group at risk — are the workers staffing our hospitals. In Wuhan, China, they were hit hard with thousands of infections and a dozen deaths. These individuals put their own health at risk to provide the care these patients need.
There currently are no cures or vaccines for COVID-19, so improving outcomes hinges on preventing infections in the community as well as providing supportive care in hospitals. It is these priority populations — our elders and those who will take care of them — that we must protect and prevent from getting sick.
Imagine for a moment that your grandmother isn’t feeling well. She’s been coughing and running a fever for a few days, so you take her to the local emergency department. Unfortunately, when you get there the waiting room is full of worried people with flu-like symptoms. SARS-CoV-2 has started circulating in the community, and everyone wants to be tested. After waiting for hours, your grandma is finally seen. But it will take more hours for her to be admitted and get the care she needs. The nurse finally tells you that hospital beds are full so they are looking for another facility to transfer her to. We all have or had grandparents we love, and we all have friends with cancer or diabetes: This is a spot we never want them to be in.
So then how do we ensure those who need care will get it?
Although much remains to be learned from the epidemic of COVID-19 in Wuhan, it appears sensible today to keep infected people with mild symptoms under self-isolation at home. As we ramp up our testing capacity and are able to test more sick folks, more and more cases will be identified. But having every sick person visit the emergency department to be tested and having all positive cases hospitalized — including those who would likely get better on their own — will quickly overwhelm our health-care system and risk its collapse. It will undoubtedly lead to diverting care away from patients who will be most at risk to develop severe forms of disease. This will no doubt lead to worse patient outcomes, additional work for hospitals and increased risk for health-care workers.
Testing is no doubt a critical part of the response, but it is not the answer — reducing new infections is.
And that is achieved by keeping sick people away from healthy people. Asking people to go to emergency rooms that are often busy and full of at-risk individuals is not a good idea. But having access to these tests, like we do at the University of Washington, allows us to identify infection in those at risk of disease progression, such as those over age 60 or people with heart disease. Staying home when you are doing well and have little risk for disease progression is the right thing to do. As well, leveraging tools like telehealth can also help to support people to remain at home while also still having access to their health-care providers at any time.
Staying home also helps ensure that we won’t unnecessarily run out of the already stretched-thin reserves of personal protective equipment like masks, eye shields, gowns and gloves. It guarantees that health-care workers can continue to safely care for our sick. It ensures that hospital staff do not, as was the case in Wuhan, become so exhausted that inadvertent breaches in infection prevention control protocols are made, resulting in infections and decreased staff availability.
Everyone knows keeping health-care workers safe ultimately leads to good patient outcomes.
This epidemic is a chance for Washington state to change an approach that has not worked to one that can truly mitigate the impact of the disease on our citizens. It is also what we must do to alleviate the tremendous strain that will undoubtedly be put on our hospitals and health workers.
But it is only possible by asking the health-care sector, public health and our leaders in government to work together to provide a unified voice that agrees on goals and resource allocation, and to ask our communities to stay home when ill and to seek care only when needed. Those of us in clinics and hospitals are preparing and ready to make this happen.
This is the time for the people of Washington state to stand united — and by our actions, collectively commit to support our most vulnerable members of society and our most essential workers.
And remember, this is a virus like many others that infect us. We have the tools and the intellect to dramatically mitigate the impact it has on us. Let’s use those to make good, science-based choices, and we will make it through this challenge.
Now is the time.