5th April 202, Dr Chee L Khoo
I have been meaning to write something about Covid-19 for weeks but as you can imagine, life have been chaotic over the last few weeks in more ways than one. First, all my travel plans were completely uprooted. I was supposed to be in Paris this weekend for the Paris Marathon, my first overseas marathon. As they say, the rest is history. With the whole country in (kind of) shutdown, I couldn’t even run the Canberra Marathon scheduled for the same day. We are all encouraged to stay at home which is what I will be doing for the next week for my “holidays”. Hence, the opportunity to write to you now.
The number of Covid-19 cases will continue to escalate with or without social isolation or social distancing in place. It generally takes 3-4 weeks after a lock down to see the effects of the lock down. It’s a bit premature to claim that thanks to community efforts this week, we are seeing the rate of increase slowing down. One day of lower rates and we are celebrating? Don’t be alarmed though, if we keep seeing the rates rising and rising. I expect it to. Even if this pretend lock down works, it will be 3-4 weeks of ongoing increase in the numbers. It doesn’t mean it’s not working. It’s all to do with the incubating process of Covid-19 which is not that much different from any other viral infection.
So far, the overall mortality of Covid-19 in most first world countries (USA doesn’t count) is about 1% and about 3% in the less developed countries. We are doing well in Australia. Our numbers are more like <0.5% and so far, most (but not all) are in older Australians including many from nursing homes. For the average Australian who are well, the mortality risk is more like 0.1% which means out of 1000 well people who gets Covid-19, one will die in Australia. But these are early days yet. Our hospital systems are not overwhelmed yet but the numbers might go up if we are.
One of the many reasons why we have been caught with our pants down with things that have been done the last few weeks have been done reactively rather planned, I suspect, is that many in the government did not think that Covid-19 was anymore than a flu until now.
Is it just a little more than a flu? In influenza, the dreaded complication is pneumonia, a bacterial complication that kills thousands every year. We can normally treat the bacteria infection with antibiotics. Sometimes, the infection is too severe and too overwhelming that we lose the patient but overwhelmingly, most of the time we succeed and patients leave hospital alive.
With Covid-19, the dreaded complication is also pneumonia but it’s usually NOT a bacterial pneumonia. It’s an inflammatory pneumonia (so called viral pneumonia). Inflammatory means there is a lot of fibrosis (scarring) everywhere starting in the lungs, the liver, the heart and sometimes the kidneys. The lungs don’t work and cannot exchange oxygen. Some patients will need to be intubated and ventilated. The frustrating part is that we are powerless to stop the fibrosis. We don’t have effective drugs to stop or even slow down this fibrosis. All the doctors can do is to support the lungs, the heart and the kidneys and patiently wait for the fibrosis to settle which can take 2-4 weeks to happen. Not uncommonly, in older patients (not exclusively), we lose them during those weeks. So, Covid-19 is not just a flu!
So, what can we do while waiting for the pandemic to settle (and it will and it will not take 18 months)?
Social isolation
Don’t get me wrong. Social distancing works. The less you socialise with anyone, the less the chance of you coming into contact with the virus. Some of us have to physically go to work and we meet people and that can’t be helped but we don’t want to visit anyone – not your parents, not your brother or sister, not your neighbours or your mate. Zero. Zilch. Keep social contact as close to zero as possible.
I know we all have to go out and buy food and once again, that can’t be avoided but please keep that as short and infrequent as possible. Buy what you need for the week and go home.
Protective masks
There is still debate as to whether wearing a mask in a healthy asymptomatic person is helpful or not. It probably isn’t helpful if the numbers of Covid-19 in the community is low but as the numbers in Australia continue to rise, in the next week or so, wearing a mask would be advisable. Disposable masks are a one use only item and you will be needing a lot of masks over the next 6-8 weeks. Start making your own masks from disused fabric. Here is one of the many links. Using disposable surgical masks will deprive front line medical staff in our times of severe mask shortage.
Hand washing or sanitising
Covid-19 cannot be transmitted through the skin. It’s the transmission from the hands to the rest of the body, the clothes and the rest of the house which then ends up on the food that we eat that transmit the disease. So, we don’t need to incessantly wash or sanitise our hands after we touch everything. We just have to wash or sanitise when we finish the task before we eat. Better still, let’s keep our clothes and our body clean as much as possible (see below).
Isolate your home
It’s almost impossible to keep germs away from your home. But we need to try. Leave your shoes outside your house. You really don’t know where those shoes have been. You need to makes sure you clean your hands before you get into your car, before you touch your door knob and before you touch anything else at home. If you have been out then I would suggest that your change your clothes when you get home and shower before you sit on your sofa and contaminate your home from the germs of the outside world. It all makes sense to some but sounds a bit excessive to others. Wearing gloves when you are out may give you a sense of complacency. You may keep your hands clean but you invariably will be touching everything else with your contaminated gloves. Just clean your hands after you finish your tasks.
It’s not just about us and our liberties. By keeping safe and virus free, we keep everyone around us virus free too. If everyone do their part, then the community we live in will be safer. The younger and fitter amongst us might get away lightly if they get Covid-19 but what about the family members they may infect? Or their colleagues who has older relatives? Or the medical staff that care for them? Do you want to be the one that was responsible for someone else demise? Let’s all do our little bit during this difficult time. Let’s behave as a community.