We have entered a new and eerily unfamiliar era in medicine with the Covid-19 pandemic spreading across the United States and into Massachusetts. And we are worried. As infectious disease physicians on the front lines of an unsettling scourge, united in our sense of urgency to take action, we are concerned that the community response to this pandemic feels too cavalier and casual, misaligned with that of the medical community and public health officials.
In Boston’s health care organizations, the number of Covid-19 patients is escalating, as is the need for imminent and acute care. Hospitals are busy testing patients who meet the criteria of the Centers for Disease Control and Prevention, planning for a surge in patients, restricting visitors and trying to conserve N95 masks and other vital supplies. Physicians who specialize in understanding, diagnosing, treating, and preventing infectious diseases cannot keep up with the desperate phone calls seeking guidance about testing, exposures, and symptoms. More and more hospital employees who may have been exposed to someone with Covid-19 are requiring furloughs. Indeed, the medical community is in full disaster mode.
In the greater community, however, the response has been more tempered, more measured. While it is true that many schools and businesses have closed and numerous activities, sporting events, and conferences have been canceled, there is still an undercurrent of denial and skepticism about the warnings. The fact is we are no longer at a point where containment is an option. Rather, our focus must be on mitigating the spread and impact of the coronavirus as much as possible. This can happen only if our communities and our nation heed the clear and horrifying warnings coming out of China, Italy, and Iran — we must act fast and now to prevent the same kind of catastrophic scenario from happening here.
We have three important requests that may help us get through the weeks ahead.
Testing capacity is still woefully lacking, and we therefore must conserve Covid-19 testing for those most in need.
Early evidence suggests that 80 percent of patients have mild disease and do not require medical care. SARS-CoV-2 is a new pathogen and we are still learning about it, yet we do know that its symptoms are somewhat similar to those of influenza — the flu — with fever, cough, and shortness of breath.
When patients self-diagnose with the flu, most are able to stay home and manage the symptoms. With that in mind, we recommend that people who have upper respiratory symptoms and fever should self-isolate, rest, and recover at home, calling your physician for guidance if your symptoms worsen. A test will not change your medical care, may divert resources from others who need them, and may put health care workers and other vulnerable patients at risk. Improved access to testing in the future may help to understand and control the epidemic in the United States, but the reality is that we do not have that accessibility now.
The community must begin social distancing immediately.
“Social distancing,” or minimizing the unnecessary interaction among people who might or might not be infected, may be a perceived hardship, but it is a well-established mitigation strategy to protect you and your loved ones from getting sick. Over 75 percent of transmission in China was driven by family clusters. Our community should take seriously its civic responsibility to minimize unnecessary interaction among people, staying away from crowds and congested places. Fortunately, with Covid-19, children fare well, most often with mild or no symptoms. It appears that the risk of children gathering in classrooms or other locations is not necessarily as great as the risk of congregating, for example, in houses of worship, senior centers, nursing homes, and other places that bring together elderly or medically compromised adults.
The public should help in conserving vital medical resources, such as health care provider time and personal protective equipment, such as masks and gloves.
While the situation is dynamic, with many unknowns, we are taking bold steps in each of our medical centers to respond in what we believe is the most prudent manner. We are all moving toward reducing the level of elective clinical care to free up our facilities and staff to care for the likely surge of patients with Covid-19.
Simultaneously, we recognize the need to continue to meet the urgent needs of the patients who are seriously ill with other diseases. Prioritizing those in greatest need will reduce the potential that patients or caregivers are incidentally infected. We are also working hard to preserve our own use of protective equipment — including video communications and streamlining care — so we are safe and well-equipped to provide care to those in most need.
During this looming public health crisis, we at Boston’s biomedical epicenter are collaborating with each other and our colleagues nationwide to ensure swift implementation of best practices and lessons learned. We are foot soldiers in the war against a relentless foe, and we implore you to help in the battle.
Dr. Tamar Foster Barlam is chief of Section of Infectious Diseases at Boston Medical Center. Dr. Helen W. Boucher is chief of the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center. Dr. Daniel Kuritzkes is chief of Infectious Diseases at Brigham and Women’s Hospital. Dr. Matthew R. Leibowitz is chief of Infectious Diseases at Newton-Wellesley Hospital. Dr. Rochelle P. Walensky is chief of Infectious Diseases at Massachusetts General Hospital. Dr. Peter F. Weller is chief of Infectious Diseases at Beth Israel Deaconess Medical Center. Dr. Kenneth M. Wener is chair of the Division of Infectious Diseases at Lahey Hospital and Medical Center.
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