Covid-19 perspective from ICU Doctor Dave Price

I just listened to a Covid-19 talk with Dr. Dave Price.  He’s an ICU doctor at a hospital in New York.  Their hospital is seeing 25% of the patients who need hospitalization in New York City right now.  His job is to decide which patients need ventilators and how long they need to stay on them.  He did a 1-hour podcast that can be accessed via this link (https://vimeo.com/399733860), discussing what people need to do to protect their family in this Covid-19 era.  Since most people don’t have the time to listen to an hour long podcast, I’m summarizing my notes from this talk.  There is a wealth of up-to-date information from someone on the front line of treating this crisis.

Just a caveat - this is one doctor’s option.  I have not fact-checked or altered his statements.   Please take this information in that context.

Notes from the talk:

How do we get Covid?

• We get it almost exclusively from our hands to our face – it enters through our eyes, nose, or mouth.
• To get it from the air, we need prolonged, sustained contact with an infected person without a mask in an enclosed room.  This is typically more than 15-30 minutes.  An infected person is someone who has the disease or is about to get it.  We start shedding the virus and can be contagious 1-2 days before the fever or other symptoms develop.
• The majority of the time, we get it from physically touching an infected person and then touching our face.

Symptoms of the disease:

• Fever, cough, sore throat, and body aches.
• 80% of the people just don’t feel good and maybe have a cough.
• The disease lasts usually 5-7 or up to 14 days, depending on the severity.
• In 20% of the people, the disease progresses to the lungs.

For all of us, regardless of where we are living, we can assume that Covid is in our community.

There are 4 steps/rules we should do to prevent getting sick.

1. Become a hand-Nazi.  Always know where your hands are.  Wash your hands or use Purell after touching anything that might be suspect.  If you keep your hands clean, you likely won’t get it.  Most cases come from sustained contact with someone who has it.  So it’s not likely to come from touching a surface that a Covid-19 infected person has touched.  But with an abundance of caution, clean your hands all the time just in case.
2. Stop touching your face.  Work with unhooking the connection between your hands and your face.  Start wearing a mask, not to prevent exposure to the disease, but to help break you of the habit of touching your face.  Become aware whenever you touch your face.  Bottom line – if you keep your hands clean and don’t touch your face, it’s unlikely you’ll get it.
3. You don’t need an N95 medical mask.  The masks aren’t preventing you from getting the disease – it’s washing your hands and not touching your face that will prevent you from getting the disease.  The N95 masks should be saved for doctors in the hospital.
4. Distance yourself.  Stay away from people. You don’t need to be scared of the outside world or of your neighbor if you follow those 4 steps.  Socially – shrink your social circle to just 2-3 people or immediate family.  Find your isolation group/family and set boundaries to keep that bubble.  People who are getting the disease typically are people who have larger circles.

What do you do if you get this disease?

• The fast majority of transmission of the disease is through the family.
• If you develop a fever, but are otherwise fine, isolate yourself from your family.
• Follow the rules of hands and face.
• If you’re able, isolate the person in a separate bedroom and bathroom.
• Have the infected person wear a mask if they have to interact with the family.
• Avoid sustained contact with someone who has the disease.
• You can start interacting again with your family as you feel better and the fever is gone.  Still wear a mask when you interact and be vigilant with hand washing.

What do I do if I have a mild cold?

• For a mild cold, take precautions like you would if you had Covid-19.  If you don’t develop flu-like symptoms or a fever after 1-2 days, then you don’t have Covid and are probably fine.
• Exceptions to this is if you have a vulnerable person in your home (someone who is older or in the high risk group).  For that, be completely rigorous to isolate them from the person who is sick.  It’s all about touching the person and touching your face.

When do you go to the hospital?

• If you feel shortness of breath with sitting or walking, go to the hospital.
• You don’t go if you only have fever, body aches, etc.
• Only 10% of Covid people need to go to the hospital.  Of those in the hospital, only 1-2% will need a ventilator.  Typically people are on a ventilator for 7-10 days and then they recover.

Should I get tested if I have the disease?

• If you have flu symptoms, it’s likely you have Covid-19.  Nothing would change as a result of having the test result.  If there is a lot of testing available, this information could be useful, but if there aren’t many tests available, don’t take them away from people who need them.

How does the virus affect newborns and infants?

• Kids younger than 14 are not significantly affected by Covid.  They aren’t getting critically ill or dying.  They may only have mild symptoms.

Do I need a mask?

• The vast majority of transmission is from droplets that go on our hands or on a surface and then our hands touch our face.
• The only time someone would NEED an N95 mask is if they’re doing something where the patient would spit (i.e. an aerosolizing procedure in a hospital).  Even in hospitals, nurses usually are only wearing regular surgical masks for their routine The N95 masks are being used by the doctors who are doing procedures that would involve saliva.
• The healthcare workers who have gotten sick are typically the ones on the front line who’ve had extensive contact with patients without precautions.
• Hospitals are not taking home-made masks.  The main role of home-made masks is for you to use.  Give the N-95 masks to hospitals and doctors.

Miscellaneous

• It’s okay to go on a walk outside.  Follow the rules.  Don’t get sloppy.  Wear a mask to train yourself not to touch your face.  Wearing a bandana is fine.  It’s not about prevent you from getting the disease.  It’s about preventing you from touching your face.
• The coronavirus is a wimp.  It dies any time you disinfect it.
• Regarding groceries – it’s probably not necessary to wipe them down.  For deliveries that are left outside the door, you could use gloves to open the outer package.  Ultimately, it’s about following the rules and washing your hands.
• The incubation period of the disease depends on the amount of exposure.  The maximum is 14 days.  If you have casual contact with someone with Covid, 14 days should be sufficient to confirm you don’t have it.

Why are patients in their 30’s-50’s dying?

• This disease affects EVERYONE older than 14.  Younger people are going to the hospital and needing ventilators.  It’s not just older people who are being infected.
• The disease is more common in men.
• All of us need to follow the rules.
• Younger people are less likely to get the disease, but they are still getting it.  The risk for infection goes up the older you are.

What about ibuprophin?

• Hospitals in New York are no longer using I There is some data from Germany that it may be linked to worse outcomes with the disease.  So if you have a fever, take Tylenol, not Ibuprophin.

What is the experience like in the hospital?

• Everyone there has a cough and a fever.  They are there because they have shortness of breath.  The shortness of breath may get worse after 1-3 days.  If it gets bad enough that the person can’t walk to the bathroom, they are put on a ventilator.  The breathing settles out after a day or so.  They stay off the ventilator for 7-10 days.  If there are no complications, they are able to get off the ventilator.

What are the long-term projections for the disease?

• He projects that social distancing will last for several months to a year, based on the experience from Asia.
• The intention of social distancing is to flatten the curve so hospitals don’t get overwhelmed.
• As people get more relaxed with social distancing protocols, often see a second smaller spike.
• He sees social distancing as a way of life for a while.  Follow the rules.
• As the virus becomes controlled over the next 3-6 months, may be able to relax more around it.
• Learning and following the rules can be empowering – can live life with less fear.

Asymptomatic spread

• We can shed and spread the virus 1-2 days before the fever shows up.
• So if you develop and have a fever, let the people you interacted with in the previous 2-3 days know.
• Have them self-quarantine.  After 2-4 days if they don’t have symptoms, they probably won’t get the disease.

 Do we have immunity after we recover?

• Yes – the vast majority develop immunity to the disease after we recover.
• Rebound symptoms probably mean the person hasn’t fully recovered from their first episode of the disease yet.
• From 1-2 days prior to having the fever to 14 days into it, you’re spreading the disease into the environment.
• Some people who’ve had nasal swabs show that they’re not shedding the disease after 14 days, but on day 16 are.  He doesn’t think it’s because they’ve relapsed in the disease, but rather that they’re slowly coming down from it and the test is still picking up a little bit.
• The vast majority recover with antibodies that prevent them from getting the disease again.
• At some point, the disease will enter general circulation the same way the common cold or flu does.  As it mutates, it will get more mild.  In 5 years, when we get it, it will feel like a cold.

What about herd immunity?

• This will ultimately happen.  He disagrees with the UK’s approach because it would overwhelm the medical system.  You don’t want to expose everyone at one.  Have people get exposed over time.  Eventually, herd immunity will develop.

That concludes the notes from his talk.  In response to his statements, I have a couple points to clarify.  Here are a few other perspectives:

• There are plenty of other people online (including other doctors) who recommend wiping down groceries.
• Here’s is the CDC’s guidance about the method of transmission of the virus: How does COVID-19 spread? The virus that causes COVID-19 probably emerged from an animal source, but is now spreading from person to person. The virus is thought to spread mainly between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs or sneezes. It also may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. Learn what is known about the spread of newly emerged coronaviruses at https://www.cdc.gov/ coronavirus/2019-ncov/about/transmission.html.
• Some hospitals are welcoming home-made masks. There is a central repository in Seattle that is collecting home-made masks for hospitals around the country who have filled out a form with them indicating their needs.
• At least one baby has died as a result of the virus.