I hope you are staying well and out of harm’s way. I hope that you are safely getting a little sunshine on this beautiful day. Between meetings at work and talking with my colleagues I have spent a lot of time this week on the phone with many of you. I have heard good stories about how people are holding up, what they are doing to stay safe, and to stay sane. It is hard to socially isolate, and I am thankful that so many of you have loved ones in your home. I am thankful for the independent and resilient Mainer spirit in those of you who are going it alone or missing the companionship of a loved one. It has also been so good to hear about people delivering groceries, taking care of, and generally looking out for each other. These are difficult times, but times like these are precisely when we learn about human character. We are seeing the best of people lately, and for that I am so grateful.
Who is at risk?
It is however, still time to stay home. We are doing the best we can in Maine to flatten the curve, and avoid a surge of cases to our health systems. Most readers of MPDN news should consider themselves at high risk of severe illness in this pandemic (as defined by the CDC in Atlanta):
- aged 65 years and older
- people who live in a nursing home or long-term care facility
- people with other high-risk conditions, including chronic lung disease, moderate to severe asthma, serious heart conditions, immunocompromised (see footnote)
- people who have severe obesity (body mass index [BMI] >40)
- people with certain underlying medical conditions (particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk)
As for pregnancy, the CDC notes “people who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk.” I would note that they cannot say the same about related illnesses SARS and MERS. For that reason I would strongly advise pregnant people to consider themselves high risk.
Maine by the numbers
At his briefing today, Director of the Maine CDC Dr. Nirav Shah noted that there are 22 people hospitalized with COVID-19 in Maine. The number of those who have recovered and been released from isolation is now 16. We have confirmed 155 cases of COVID-19 in this state, 16 of whom are healthcare workers. Ages range from under 10 to over 90, and the average age is 55. Of note, yesterday the state received more of the reagent needed to run the test. As discussed previously, there is a national shortage of that critical substance. There have been 3,394 negative tests in the state thus far. As I discussed in my last post, the rate of growth of new confirmed cases is staying low in Maine over the last few days, and that is reason for cautious optimism. It is not a reason to let our guard down however. As I have mentioned several times, these numbers do not represent the likely total number of cases, but are limited to the very ill, the very high risk, or exposed healthcare workers. And, community spread has been confirmed in both Cumberland and York counties. To be clear, community spread is possible in all of them, and we should all act accordingly.
Our hospitals are holding up fairly well so far, but no health system is prepared for what might happen, and here in Maine we are concerned about the need for protective equipment. The Public Health Emergency Preparedness (PHEP) Team of the Maine CDC has distributed personal protective equipment (PPE) around the state to first responders, healthcare workers, tribal and law enforcement agencies. They received the second distribution from the U.S. Strategic National Stockpile about two days ago, and are determining what will will go where. Dr. Shah notes these distributions are a “good start, but they are not sufficient to meet the overall needs of the state.” Unfortunately, there has been some talk from the federal government that we might not receive more. Governor Mills has pushed hard to change that, noting we should not just focus on hardest hit states, but take a luck at “where the puck is going.” We are concerned that it could get a lot worse here.
If you have N95 masks or other medical protective supplies such as paper masks (with ties or elastic), paper protective gowns, protective glasses/goggles (can be previously used), or nitrile gloves, please donate them to your local hospital.
At present there are 86 available ICU beds in Maine out of a total of 151 in service, and 250 available ventilators out of a total of approximately 307. There are at least 88 respiratory therapists in the state. These are good numbers under normal circumstances. This is not one of them. We need to keep up the good work, and make sure those around us know how delicate this situation is.
“As a state, as a community, as an agency, the things that we thought were utterly inconceivable a month ago, now seem blindingly obvious… The question on my mind is, what will we be saying a month from now?…But we will get through this, and we will do so partly because our approach is informed not just by science, but by kindness, humanity, and compassion. We can, and must remain together, even though for now we may be apart.”
Dr. Nirav Shah, Director of the Maine CDC
The incubation period, the time from exposure to illness is between 2 and 14 days. Therefore, there may be many people in our state who do not yet know they are sick, yet are able to transmit disease. People who have been exposed to a COVID-19 case should quarantine for 14 days. And, as discussed multiple times here, there may be many asymptomatic carriers who may transmit disease also. We have also learned that some otherwise asymptomatic people may lose the sense of smell and/or taste with this viral infection. If someone you know has this, stay away from them, and tell them they should be in isolation for 14 days.
Social distancing
Since we cannot yet do the mass testing we need, the only reasonable strategy is social distancing. It has worked in other countries, such as South Korea, where the response was decisive and early. South Koreans were, and are very good at social distancing, but also tested a high percentage of the population, tracked down and isolated infected people. You should continue to stay home, stay at least six feet back from others, avoid sick people altogether. Also, wash your hands, don’t touch your face, and be COVID-aware. If people bring groceries to your home, have them set them outside the door and don’t pick them up until the delivery person is out of the six foot droplet range. Again, clean surfaces such as door handles, rails, anything that might be contaminated by virus. And wash any produce brought into your home. Wash your hands after putting groceries away.
If you do go to the store, please go alone at the best possible time, and please consolidate trips. Governor Mills urged stores to post times for seniors, to mark six foot distances on the floor at checkouts, to consider limiting the number of people in a store at one time. If you do not see this happening, ask a manager why. It is for public safety. By that logic, I have heard that Hannaford’s of Topsham has placed plexiglass shields between customers and checkout personnel. That is a great strategy for reducing droplet risk to store employees (and to customer for that matter).
Be prepared
If you have not had a pneumonia vaccine, and it is possible to have one safely (at your facility, or possibly at a pharmacy), it is a good idea to have one now. The reason is that while COVID-19 may cause pneumonia itself, it may also make you more vulnerable to bacterial pneumonia, another potentially deadly condition. In general, older people should also have an annual flu vaccine, unless there is a legitimate medical contraindication. Vaccines save lives. It is my deep hope that we will have a COVID-19 vaccine before this virus has a chance to come back-though I am certain we have not seen the peak of the current pandemic. Just look at the situation in our country and around the world: nearly a half million cases around the globe, and over a thousand deaths in the U.S. alone. The hardest hit state in our county is New York, where there are 37,258 cases (21,393 in New York City). Cases in Seattle and Washington state continue to climb.
You should have refills of all medications on hand. Make sure at minimum you always have a 14 day supply in case you are quarantined. Try to safely go outside a little bit every day. Get exercise, stay positive. Keep in touch with others by phone, text, email, Skype, whatever works. If you can stand far enough away from others in your neighborhood talk to them, ask how they are doing, and check on those that you worry might not be doing so well. We are all in this together.
FOOTNOTE
The CDC in Atlanta notes that many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
