In case I haven’t been explicit in recent posts to MPDN, I have suspended the normal format to give public health notices and generally respond to the COVID-19 Pandemic. This is because the most vulnerable are older people, and those with chronic conditions. Most people with PD fall into both of those categories and would be at high risk of serious illness or death if they caught the virus that causes COVID-19. I am very worried about that because I am still hearing from some of you who are not staying home or are not taking on board the seriousness of this situation. I am still seeing high risk older individuals chatting with other people at the grocery store and ignoring the droplet range distance of six feet, even though it is now common knowledge that infected people may spread the virus while asymptomatic, maybe while just chatting.
Perhaps the pandemic doesn’t seem real to you, or it doesn’t seem as bad as people keep saying. Maybe to you it seems unreasonable to cancel everything and close so many businesses. Maybe to you it seems unreasonable to ask well people to stay at home. It is the best we can do right now because this virus is new, not so well-understood, and dangerous. There is also no vaccine, and no proven treatment.
In an ideal situation when something new like this virus came along we would rapidly test everyone, health workers would have adequate equipment, we would have a strong public health initiative from day one, and we would have leaders who understand that we need to bolster, not reduce the Centers for Disease Control and Prevention (CDC). That is not the situation we find ourselves in. We came into this crisis less prepared than we should have, and we are all risk because of it.
We have nowhere near the number of tests we need to find out who is sick and who isn’t. We therefore cannot selectively isolate sick people and carriers. Instead, we have shut down all “non-essential” services and ask everyone else to stay home and to practice social distancing. If all of us did this, the virus would stop spreading. Yet, some people are not getting it right. There needs to be a mindset change. My advice to everyone who thinks that they are well is that we act as though any person might be infected, including ourselves. If we do that, if we limit trips out of the house, stay at least six feet away from other people, and don’t spread germs, we will be doing our part.
Also, for the same reason, I would strongly advise all of us to keep our living spaces as a sanctuary, no visitors. As I discussed earlier this month, clean surfaces, wash your hands, cover coughs and sneezes, and don’t touch your face. List of CDC recommendations to protect yourself.
You should also know that as the number of infected people goes up, your chance of catching the disease does too. If you go out of your living space you are more likely to encounter a sick person, and more likely to encounter droplets left on surfaces such as doorknobs or rails. This is important because we are talking about something that is invisible to the eye but may infect you long after the sick person has departed. A correspondence to New England Journal of Medicine on March 17, 2020 showed that this virus may stay in the air indoors for up to three hours after a cough or sneeze, all the while remaining viable. The same authors reported viable virus on copper for up to four hours, cardboard for 24 hours, and plastic or stainless steel for up to three days.
Some people think the numbers of infected people are not that bad, that their risk is low. In the U.S. every state has cases, and the numbers are growing. Today the World Health Organization estimated over 300,000 cases worldwide. Recall that the virus was only reported to WHO by Chinese officials on 12/31/19. The virus has spread rapidly and continues to do so. It is overwhelming healthcare systems in Italy and Spain. There is no doubt that the numbers are bad.
If you already realize that this is the worst pandemic in modern history, and is occurring on a truly unprecedented scale, but have a cavalier attitude about your own mortality, consider the fact that if you get sick you will probably spread the virus to other people. That is the nature of infectious disease: it jumps from one host to another. While you might survive, someone else down the line from you might not.
The numbers today
The state of Maine has 70 confirmed cases of COVID-19 as of today, 3/21/20, and these are only the people who have been tested (a limited number of sick people and others who meet very narrow criteria for testing). The majority of cases are in Cumberland County, and following in order of cases are the counties of York, Kennebec, Lincoln, Oxford, Androscoggin, “unknown,” Penobscot, and Sagadahoc. Ten percent of confirmed cases in Maine are under the age of 30, 45% are between 30 and 59 years old, and 45% are 60-years-old or greater. We have no idea how many cases have not been tested. In Maine we have had cases caused by travel, cases with community spread (catching it from someone else who tested positive), and cases in which there is no explanation (likely exposure to an unknown sick contact, droplets on a surface, or seemingly least likely, contaminated air). Numbers vary from state-to-state in New England. Massachusetts has 328 cases. New Hampshire has 65 cases. Vermont has 49 cases.
As I noted previously, serious illness and death as a result of COVID-19 is more likely with increasing age. To get more of a sense of that problem, let’s look at the numbers from the state of Washington today: 1793 confirmed cases (up over 500 cases in just a few days), and 94 deaths so far. Deaths have occurred as follows by age and (percentage): 0-39 (0%), 40-49 (2%), 50-59 (5%), 60-69 (10%), 70-79 (23%), 80 and up (60%). Washington was the first state known to have COVID-19. However, it is not the worst. New York has 10,356 cases as of today (over 6,000 cases in New York City alone).
The CDC in Atlanta reported as of yesterday that there were 15,219 cases in the U.S.
We in Maine are in a serious situation. Remember that per capita we are the oldest state in the nation. We are trying to flatten the curve of cases so that we don’t overwhelm health care systems. If a surge of cases comes to the hospital, there may not be a way to care for all of them.
What I’m asking
Stay home as much as possible for now. It is still early days and we are behind. We don’t have enough tests to learn the true scope of the problem, and the best thing you can do is not to become a part of it. We might not be able to help you if the rate of infection continues to increase. If the rate of infection levels off in Maine and around the country we may be able to “catch up” with test kits and other supplies we need. We may be able to wait long enough to find out if certain drugs are effective against the virus. We may be able to develop a vaccine.
Ask younger family members, friends, associates to take this seriously too. They could be spreading disease and not know it. They need to think about the community around them and how they might spread disease within it. And, while the death rate is low for younger people, they may also become seriously ill. They should also limit trips out of the house, and when they do leave, wouldn’t it make sense to limit the number of people going into stores? I keep seeing families and groups of friends together in the grocery store. The more people present, the more likely someone will become ill.
If you have clean N95 masks, give them to a local hospital. We are running out fast, and standard surgical masks will not work. I know that people in the community have boxes of them because they were cleaned out of hardware stores and medical supply outlets, and I see people wearing them at the grocery store. If doctors, nurses, and emergency personnel don’t have adequate protection we will become ill and be unable to care for you. This is what is happening in Italy.
Be very careful about news sources. There is a great deal of misinformation out there from politicians, news anchors, and other non-medical sources. The CDC in Atlanta is the best source for information.
Finally, remember that what we do matters. I believe this is a pivotal moment in our history. Let’s try to lead it somewhere good. Let’s learn from this and not make the same mistakes in the future.
That’s all for now. Stay well, keep your head on straight, and as I like to say at the end of visits, stay out of trouble.
