Two weeks have passed since my last post. We are now squarely in the throes of this crisis, and the situation has changed for the worse as we all expected. COVID19 continues its devastating march across the world, but one country has been hit especially hard – The United States. America now has the most confirmed cases at 311,000. We now stand at 8,400 deaths and rising fast. For comparison, we had 25,000 cases and under one thousand deaths just two weeks ago. Yesterday we recorded over 34,000 cases and 1,300 deaths in 24 hours – again, the most recorded in the world. Since our testing is uneven and haphazard, there are likely many more cases in the community that are unrecorded. Unfortunately, our situation will still get worse before it gets better.
The New York City metro area is hardest hit, and conditions at many of their hospitals are dire. I trained at Lincoln Hospital in the Bronx and worked as a faculty member at Mount Sinai in Manhattan and Elmhurst Hospital in Queens, so I feel for the health care workers at those locations in particular. (See for example: https://www.nytimes.com/…/ny…/nyc-coronavirus-hospitals.html)
I have spoken with some of my colleagues
at the New York hospitals and have read their accounts. They describe a
– Huge lines of very sick patients waiting to be seen, all coughing and febrile
– A painful and miserable course for patients lasting weeks, including persistent shortness of breath and severe weakness
– Multiple “Code Blue” (cardiac arrest) announcements throughout the day
– Emotionally and physically exhausted staff who are afraid for their lives but continue to persevere
– Several doctors and nurses who have fallen sick and a few who have lost their lives
– Lack of PPE (personal protective equipment) and supplies such as masks, drugs, and ventilators
– Dead bodies being loaded into refrigerated trucks because there is no space in the morgue
The Governor of New York and their Mayor continue to plead for help, and the help they are receiving does not seem to be enough to meet demand, possibly because other hot spots have emerged across the country, such as Detroit and New Orleans.
We must use all available means to prevent this from happening in Arizona. Currently, we continue to see large increases in cases here. Today, April 5, we have 2,269 cases and 64 deaths – compared to the 100 cases and one death that I mentioned in my last post. Unfortunately, these numbers will continue to rise. Compared to New York, our growth rate is lower, with cases doubling about every five days instead of every three.
Despite the increase in cases, the good news is that the *growth rate* is actually slowing across America – meaning that even if we are on the upslope, the curve is starting to flatten. We believe that this is a result of our ever-stricter social distancing. Let’s keep it up. This is crucial for the sake of our individual safety and for those on the front lines. From all of us health care workers out there, we really appreciate how the vast majority of the public has acted with great responsibility and sacrifice, as well as offers of help.
Meanwhile, I have reached out to many of my physician colleagues to understand how our health system is coping. So far, our Arizona hospitals are not yet saturated with cases. Emergency departments are seeing fewer patients overall. Patients that do present are more often truly ill or injured. We are freeing up resources appropriately, and I’m grateful that the public is responding to our messages to come to the hospital only when appropriate. With regard to sicker patients, several Arizona hospitals have ICUs that are partially full with COVID19 patients, and one (in Flagstaff) is reported to have a full ICU. But most hospitals still have capacity, and the Governor’s order to increase beds in every hospital by 50% will certainly help.
Meanwhile, our hospitals continue to see an increased demand for PPE and are keeping up at this point, even as the situation is tenuous. I have been personally working to connect our hospitals and the Arizona Department of Health Services (ADHS) with suppliers. While manufacturing has ramped up and more supplies are available for sale, we have also received reports of a chaotic and difficult marketplace. Hospitals, state governments, the Federal government (by way of FEMA) and foreign countries are vying for the same precious resources. Just today, however, we received welcome news that Honeywell will manufacture millions of masks here in Arizona for our use.
Testing continues to expand. The US has tested over 1.7 million people. This number continues to increase rapidly with more tests entering the market due to expedited FDA approval. Yet Arizona is still behind. We have run over 27,000 tests, but there are concerning bottlenecks, including availability of swabs and testing reagents. Currently, we can only test those who are ill or with whom we have higher suspicion of contagion. With increased availability, we hope to broaden testing criteria. (I discussed the individual and public health benefits of testing in my prior posts.) Also, researchers in Colorado have developed an antibody test to determine who has already recovered from the virus. This will take months to formulate, but if successful may help many people return to normal life.
Throughout these two weeks, our Governor has taken more steps to maintain social distancing. We’ve pared down the list of essential businesses, allowed for emergency refills of chronic medications, and allowed the use of telemedicine for a number of occupations including physical therapists and veterinarians. Schools are closed for the rest of the year. This will continue to reduce human interactions and therefore viral spread. The CDC has not yet issued a national recommendation that everyone wear a mask in public, but I believe it would be helpful.
Meanwhile, the economy continues to be in free fall, and the pain is real. This week, Arizona saw 88,000 unemployment claims, compared to the few thousand we usually see. The US had over 6.5 million, compared to the usual few hundred thousand. These figures are unprecedented since the Great Depression of the 1930s. Importantly, the supply of food, financial services, and other necessities remains very stable. We are continuing to provide for the basic needs of our people.
These past two weeks, I have heard from so many tenants who have had difficulty with rent, small business owners who are afraid that they will have to permanently shut down, and unemployed people facing uncertainty. We are working to connect every constituent to resources to help them through this difficult time. To highlight, we have increased unemployment benefits, made Small Business Loans much more accessible, and placed a temporary halt on evictions, among other initiatives. Please visit my website at www.AmishForArizona.com/Covid for a complete list.
Finally, I want to address a few questions that I have been asked frequently in recent days.
How are we doing? Is our public response adequate? Since the beginning of this crisis, I have continued to support all of our elected officials who continue to act in good faith to serve the American people. This is not a time for politics and backbiting, but rather a time of national unity and good governance. We are certain to learn some important lessons, and once this is over, I hope that we will never forget nor let this happen again. Our human toll and the economic hardship cannot be in vain.
In the longer term, we will have to take specific actions to protect humankind. The origin of the current virus appears to be a food market in China with wild animals and unsanitary conditions, and the international community will have to insist that these types of markets be closed or heavily regulated to stop the emergence of such diseases. We will have to spend more money on research into the development of vaccines for known, predictable threats. Most importantly, we will have to ensure that the national preparedness plan is not just a dusty document on a shelf but a reminder of a real danger to our existence.
Have any drugs been proven effective in treating COVID-19? As for medications, we have had mixed news. Chloroquine has been touted as a promising drug, and one small controlled trial demonstrated some efficacy, but another showed no effect. Larger studies are still ongoing. Another drug, Kaletra, was not found to be useful in one trial. But researchers continue to investigate dozens of other drugs that either block viral entry into our cells or stop its replication. Vaccine development is also promising as more than one research lab has identified a real candidate, but these will take several months of development before we can demonstrate true efficacy and safety in humans.
When will this end, and how can we end it? The timing is very difficult to predict, but it will take at least several weeks before cases start to decline. Once we are certain that the decline is stable, we will want to end the crisis by progressively clearing areas and declaring them virus-free and safe for resumption of normal life.
But to get there, we will need a systemic public health effort to track and trace the virus. This piece of the puzzle has been glaringly absent so far. Such an effort would begin with rigorous quarantine of all positive cases. Then, we would find all of their recent contacts and test/isolate them if positive. We would rinse and repeat until very few positives occur. Several Asian countries enacted such a strategy, and it is akin to using a fine scalpel to cut out the disease from society. It would be a win-win scenario, because once we have only a few positives, whole communities that are free of disease can re-open and restart the economy.
Unfortunately, we do not have a “scalpel” available to us yet. That takes preparation and effort. All we have instead is the “hammer,” meaning massive lockdowns that disrupt much of society. The hammer is blunt and causes collateral damage. My hope is that our hammer buys us enough time to develop a scalpel soon. (For more, see: https://medium.com/…/coronavirus-the-hammer-and-the-dance-b…)
I know that the days ahead are dark, especially the next few weeks. I wish I had better and more uplifting news for you, but my intent here is to give you a real look at what our people are now facing. If this is not affecting your immediate circle, it likely will soon, and I want you to be safe and prepared. I feel the melancholy of our national mood, but find real strength in the knowledge that all of you are striving to make your contribution to our great country every day. For some of you, this means providing essential services like staffing grocery stores and maintaining the food supply despite personal risk. Others are navigating the stress of family obligations while working at home. Some of you are just isolating and making TikTok dance-challenge videos. While social distancing may not feel always like contributing, it’s the most patriotic and community-minded action we can take.
I promise that one day this will end. We have seen other countries get past their terrible peaks and we will, too. Until then, let’s continue to give it our best fight every day, like so many proud generations of Americans have before us during the most difficult of times.
Thank you, and please continue to reach out.
Dr. Amish Shah is an emergency room physician and an Arizona state representative from Legislative District 24 in central Phoenix.