I'm an ER Doctor and Here's Why You Should Fear COVID
In light of President Trump tweeting "Don't be afraid of COVID" while hospitalized with COVID, we asked doctors what they made of the Commander-in-Chief's advice. Read on to see how Darren P. Mareiniss, MD, FACEP, reacted, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.
It's a Dangerous Public Health Message
I am an Emergency Medicine doctor who has both treated many COVID patients and been hospitalized with the disease. The current COVID-19 pandemic has been a worst-case scenario for physicians and public health officials. It is a highly transmissible virus with a significant mortality. In addition, it spreads actively while patients are asymptomatic.
Currently, we have some limited medications for treating infected patients. Remdesivir is an IV anti-viral agent that has been shown to significantly decrease the duration of illness. In addition, Dexamethasone appears to have mortality benefit for ventilated COVID patients. As of today, over 7 million Americans have been infected and over 200,000 have died. The United States has the largest number of infections and deaths of any country in the world.
In light of our limited tools to fight the virus and the current lack of a vaccine, we have urged the public to socially distance, wear masks and perform hand hygiene to limit the spread of the disease. This is important because the US healthcare system simply does not have enough resources (such as ventilators, ICU beds and non-invasive ventilation equipment) to care for massive volumes of patients if the virus's spread is not checked.
A recent study in Nature showed that such restrictions prevented millions of infections in the U.S. Further, a study by Markel et al. in the Journal of the American Medical Association in 2007 previously showed that nonpharmaceutical interventions as social distancing and school closures significantly decreased death rates in 1918 during the great influenza pandemic. Cities that delayed enacting these social distancing interventions had significantly increased disease and death rates compared to more proactive cities.
Mixed Messages Have Made Matters Worse
During the COVID-19 pandemic, efforts to limit the spread of the virus have been hampered by an administration that has provided mixed messages, downplayed the dangers of the virus and failed to fully support public health measures. The CDC has been limited in its ability to communicate important public health interventions and advice about reopening.
Recently, the President was infected with COVID-19 and although we do not know much about his clinical condition, we know he was admitted to Walter Reed National Military Medical Center on Friday and was treated with multiple medications including Remdesivir, Dexamethasone and an experimental antibody mix by Regeneron. This cocktail of medications is not a standard treatment regimen.
With respect to Remdesivir, this drug is typically only used for COVID patients who are hypoxic and require supplemental oxygen. There is a limited supply of the drug and my hospital specifically allocates it. The anti-viral drug acts to inhibit viral replication and may have benefited the President by impeding the progression of the disease course.
If he was truly only symptomatic as of Thursday, he would have received the drug on day two of symptoms. This early intervention could speed the President's recovery. With respect to Dexamethasone, it is given to COVID patients who are intubated or require supplemental oxygen.
We Must be Appropriately Fearful of this Virus
Today, the President tweeted that he would be leaving Walter Reed at 6:30 pm. He stated that he was "Feeling really good! Don't be afraid of COVID. Don't let it dominate your life. We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!"
These statements by the President are extremely troubling from a public health perspective. As an Emergency Medicine doctor who was admitted to the ICU with COVID pneumonia and has treated dying patients with the disease, I disagree with the message. We must be appropriately fearful of this virus and respect the damage it causes.
The President's statement is essentially messaging to the public that they should not be afraid and nor modify their lives due to the virus, i.e., they should not observe the social distancing and non-pharmaceutical interventions we need to prevent further spread, deaths and strain on limited hospital resources. This is the exact opposite of what the public needs to understand. Winter is coming and so is the second wave of the disease. In the 1918 pandemic, the winter wave was the most destructive and deadly. Now more than ever, we need people to follow guidelines for social distancing, mask wearing and hand washing. If not, we may have a massive surge of disease and death in the winter months ahead.
With respect to the President himself, he still remains infected and if he is to return to the White House, he should be quarantined from staff and family members to avoid further spread. It is not clear if he will continue a five-day course of IV Remdesivir at the White House (the drug typically is only given in hospitals). Beyond this, if he is still early in his course, his symptoms could become worse. Often, patients can become sicker on day 5-10 of symptoms. If the President first became symptomatic on October 1, his symptoms could still progress over the next week. Only time will tell. As for yourself: To get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.