California: Open Wide
As California begins to open its shuttered stores, restaurants, bars, salons, factories, parks and beaches, there are some important lessons from the first phase of the Covid Pandemic that can help keep us all safer.
While ‘the curve’ has been effectively flattened, the Covid-19 data continue to show that the virus is not going away. New infections continue to be detected, and Covid related deaths that are being reported today are typically coming from patients who first contracted the virus some weeks ago.
All of this is to be expected.
Remember, it does not matter how many people will get Covid but which people get Covid. Some 50% of patients with Covid infections never knew they were infected in the first place. 80% of the other half have very mild symptoms. An additional 15% experience Covid as a bad flu with an attitude. Some 5% of that same half will have a severe flu like illness and less than 1% will end up in a hospital.
When you add up all of these numbers, 99.8%-99.9% of Covid patients survive and most will require zero or minimal medical attention to get better.
There remains an important exception to these encouraging numbers and that is the impact of Covid on the elderly and those with other medical problems. For these patients, Covid remains a very serious, potentially life-threatening illness. And, so while California prepares to reopen for business, these two sets of people must maintain more restrictive social distancing protocols in order to remain safe.
Recently developed information suggests that, for the majority of the population (including the elderly and the vulnerable), staying home may be more risky than venturing out. Last week, New York’s Governor Cuomo reported on the findings of a survey that his office commissioned which found that 67% of all those hospitalized with Covid-19 had been sheltering at home. Many had not left their residences for weeks, yet they still became infected. The same New York survey found that those essential workers who were going to work daily and interacting with the public (like grocery store employees) were much safer and less likely to become hospitalized with Covid-19 compared with those who never left their homes.
How is that possible: that converting your home into a Covid Bunker was less safe than going to work and interacting with other people?
In Medicine, we know that proximity breeds contagion. For example, high school seniors are not at any special increased risk of meningitis. However, once these same students graduate high school and go to college, their risk for meningitis rises significantly, so much so that all colleges require entering freshman to receive a meningitis vaccine before arriving on campus. These college freshmen are only a few months older than they were at their high school graduations, but their risk is so much greater of contracting meningitis because of the nature of campus dorms. College dormitories pack students into tiny rooms and crowded public spaces that can more easily spread diseases like meningitis that are all but unknown on high school campuses.
So, when the public is mandated to sequester at home, en mass, the risk of spreading diseases like Covid goes up, not down. Even if you stay at home, you still need food and supplies to be brought to your door. And in that food and on those supplies may be the very Covid virus that you are hiding from, left unintentionally on or in your delivery. Furthermore, without sunshine, fresh air, and exercise, the homebound also get increasingly more unhealthy which also makes shut-ins more likely to become a Covid victim. ‘Stay at Home’ may have some pandemic mitigating benefits early on, but then this strategy seems to become a risk in and of itself.
If it’s no longer ‘Home Safe Home,’ then what is an effective anti-Covid strategy?
My successful experience on the frontline of this pandemic has taught me that an effective anti-Covid strategy is multidimensional and overlapping, including: (1) Sanitization; (2) Creating Hardened Human Targets; (3) Early testing and treatment for new Covid cases; (4) and Air Scrubbers.
You do not get Covid from walking behind someone in a store or passing them on a sidewalk. Outside of sharing a residence or prolonged exposure in a small, unventilated space, nearly all cases of Covid transmission are the result of self-contamination: your 10, unwittingly contaminated fingers touching your face or your food without having just been thoroughly cleansed. I understand that it is uncomfortable to accept this reality. I understand the desire to blame others for spreading the disease. And while it is true that there may be some contagion in the air, if it is not directly coughed or sneezed onto your face, chances are overwhelmingly small that you can catch this virus just by walking around others who are not actively sick.
So, I am in favor of masking those who are currently infectious, in order that their large respiratory droplets from coughs and sneezes be contained as much as possible. But understand this: cloth and basic surgical masks will not stop Covid viruses. Imagine that a single Covid virus is the size of a cell phone and that the holes in the weave of a mask are the size of a high school gymnasium. When you breath, cough or sneeze, those Covid viruses are sailing right through the weave of a mask. It’s like trying to keep ticks out of your yard with a chain-link fence. It’s nonsensical. The only reason to mask everyone is because those who are sick may not know they are ill or be willing to acknowledge that they are, and their unprotected coughs and sneezes can then spread the large respiratory droplets that are highly infectious.
If the virus really was spread through the air, then those workers who venture out everyday would be at more risk of disease than those who stayed at home. But the exact opposite is true. Sometimes science is such an inconvenient counter to our incorrect assumptions.
To stay safe, America needs to take a deep breath…and wash its hands.
When it comes to infections like Covid, my practice is dedicated to teaching patients how to go from a fearful victim to a hardened target. In the ‘Library’ section of my website, you can learn about the simple, but important lifestyle changes that can reduce your chances of contracting Covid. These are the choices that you can make right now to best resist and recover from a Covid illness.
Having successfully navigated my patients through the first wave of the Covid Pandemic, I know these techniques work because they have just been successfully battle-tested. My office door was not locked during the epidemic, but was opened to all Covid victims who needed our care. Everyone of our Covid patients made a successful recovery. No ventilators. No advanced medical care. And not one of my staff contracted Covid from working in my office.
I do not share this to impress you, but to impress upon you that prevention works.
Still don’t believe in ‘kitchen cures’? At the beginning of the Covid pandemic, my family and I were in Greece studying their lifestyle and herbal traditions. While the pandemic was punishing Italy to the North, the Greeks had no collective fear of Covid. There may not be a doctor in every Greek family, but there is at least one Greek Grandma who knows a thing or two about viruses and how to beat them. As of this writing, Greece has lost a total of 150 citizens to Covid since the inception of the pandemic. For comparison, New York was losing this same number of residents every 30 minutes at the peak of its pandemic.
If you say it’s a myth, I say that’s Greek to me.
So, as we start to collectively venture outside, it is time to turn your home from being a Covid Bunker into a Boot Camp for your immune system. Everything you need to know is available on my website. Or just call the office, and we will walk you through it personally. As you re-enter the world, these important lifestyle lessons will keep you from being a hapless victim and forge you into a hardened target.
As it has been said: ‘Those who say it cannot be done, should get out of the way of those who are already doing it.’
Don’t Wait: Early Testing, Early Treatment
One of the most important lessons learned from the first wave of the Covid pandemic is that timing is very important. The earlier we begin appropriate treatment the less likely patients are to get terribly sickened with Covid. For most patients, the first five days of Covid are typically experienced as a very mild common cold: fatigue, slight sore throat, drippy nose, cough, general achiness, and headache. With these symptoms, you may think to yourself, ‘Maybe it’s not Covid, maybe it’s allergies?’ But you could be dead wrong. In days 6 – 8, the Covid symptoms can get bad very fast, causing shortness of breath, chest pressure, painful cough, and severe body aches. These symptoms typically mean that Covid has reached your lungs, and this is where the infection is most dangerous.
I encourage all of my patients to get tested at the first sign of any cold, flu, or allergy-like symptom. My office offers a comprehensive Covid testing menu: nasal swabs, saliva sampling, FDA-approved ‘5-minute’ antibody testing (IgM, IgG), and serum IgG testing. Most of these are also available as ‘drive-thru’ tests so you never have to leave your car.
Early testing means early treatment which can dramatically reduce your chances of catching Covid in your lungs and blood vessels. If you let Covid go from a minor cold to a major systemic infection, you risk inadvertently passing the point where you can be kept out of the hospital, ICU… or worse.
Having treated many Covid patients of all ages and health, I know that this effort is much like the proper handling of a small kitchen fire. When the fire just starts to break out, a fire extinguisher can be a very effective tool to knock out the fire early and prevent any serious damage to your home. But once the fire has spread to the adjoining dining room, you are going to need a fire hose…and some serious home repairs.
Effectively treating Covid in my office works on the same principles: early action ensures best outcomes.
An Air Scrubber is like an air filter on steroids. These powerful machines suck every particle of dirt, pollen and contagion out of the room and pump out fresh, purified air. Just before the pandemic hit hard in Los Angeles, I installed Air Scrubbers in every room in my office, and they run 24/7/365, constantly ensuring the safety of my office space.
As discussed above, 99% of Covid cases come from patients self-contaminating by touching their face or food with the invisible contagion that is on their fingers. So, that does leave a 1% risk of getting Covid from airborne viruses that somebody inadvertently coughed, sneezed or breathed into the air. Well positioned and maintained Air Scrubbers can effectively reduce this residual risk, and this will be necessary for businesses that require patrons to not wear their masks, including restaurants, bars, gyms, dental offices, and the like.
These businesses will also need to get body temperature scans off of the foreheads of all their patrons before entry. Screening for fever and the use of Air Scrubbers should provide the safety and confidence the public requires to trust these venues. Currently, many people clutch their ineffective masks like a toddler clings to a ‘blankie,’ fearful that they will immediately get Covid without a cloth facial covering. And letting go of this false talisman is critical to the rest of the economy fully reopening. This transition to unmasked spaces is very important, and Air Scrubbers backed by venue health screenings will make this possible.
Just as our government asked companies to retool for ventilator production, that same manufacturing capacity needs to start making the millions of Air Scrubbers that can safely accelerate access to the remaining venues in which the public needs to confidently ‘open wide.’
Michael Hirt, MD