Suffering From Cabin Fever?

Life in the Time of Coronavirus - Brought to you by Dr. MZ

All of us, especially those who live in California, have been pretty much confined to our homes now for more than two weeks. Cabin fever has set in and we are dreaming about what we would like to do if we weren’t imprisoned in our homes by this invisible enemy. The temptation is great to go out, to see our friends, to check on our extended families, to go to church, to abandon our masks and the 6-foot rule, and to return to life as we knew it.

Here’s why we can’t do this, why we need to suck it up and persevere in our confinement:

 Our armamentarium against this virus is sorely limited: no antidote, no vaccine, and no proven treatment. The current mortality in the US is 2.7%. with much higher mortality rates among those older than 65 years of age. It is highly likely that these figures will change over time, both because deaths may be found that were not previously attributed to SARS CoV-2 (numerator - raising the mortality) and because with more testing, more mild and asymptomatic cases will be found (denominator - lowering the mortality). Our only available and proven weapon is social distancing, or more correctly, physical distancing. We need to distance ourselves physically from each other but continue to connect socially via means that don’t allow virus transmission (phone, social media, email, texting, video conferencing, FaceTime, Skype). So let’s call it physical distancing from here on out.

Physical distancing is proven to work if we are patient and apply it long enough. Physical distancing has been sufficiently effective in Washington State that the state is returning 400 ventilators to the Strategic National Stockpile (for use in other states as needed) because the predictions are that the ventilators will not be needed. Physical distancing has been "bending the curve" in California.  That does not mean that we should throw a huge party and celebrate. The threat to all of us is by no means over.

The goal of physical distancing is mitigation. That means slowing the transmission of the virus in the hope that hospitals and healthcare staffs will not be overwhelmed, that supplies of personal protective equipment (PPE) will not run out, that there will be enough ventilators for all who need them, that fewer deaths will occur both in the general public and among the healthcare providers upon whom we are depending. Successful mitigation would allow a return to full scale and effective containment. Full-scale containment means that individual cases are identified, tracked, and isolated, that contacts of those cases are traced and quarantined, and that clusters of COVID-19 are stamped out as they occur. Full-scale containment requires robust public health infrastructure and staffs, both of which are currently lacking due to many years of meager funding. If and when containment is successful, this virus might at least be temporarily controlled.

The good news with containment is that fewer people will die. The bad news with containment is that many people will remain who are susceptible and not immune. Many respiratory viruses are seasonal in occurrence. It is possible that SARS CoV-2 will also turn out to be seasonal. At this point, no one knows. The good news is that it might remit as the weather warms. The not so good news might be that it returns in the fall or winter to infect those who were not infected and therefore remain susceptible. This resurgence might be as deadly as the first phase or might be slightly milder. Again, no one knows. It is possible that physical distancing could be eased a bit if mitigation is successful and we are able to return to full-scale containment. That remains to be seen. No one should count on physical distancing being lifted anytime soon.

Lifting the physical distancing requirements too soon would mean that we lose all the ground we have gained against this virus. Viral transmission would surge. In addition, we would then have sorely depleted our healthcare resources of all sorts: hospital beds, ventilators, PPE, physicians, nurses, and other healthcare providers, testing kits, public health personnel, only to find a resurgence of the disease with us being all the weaker in our response.

Gaining some ground on this virus allows time for many good things: for the manufacture of more PPE and more ventilators, for a modest rest for our greatly overtaxed and exhausted healthcare providers, for collection of immune globulin (antibodies) from those who have been infected and survived, for scientific clarification of potentially useful therapies, and most important, for formulation and study of various vaccine candidates to assure their efficacy and safety (not to mention planning the huge task of deploying a chosen vaccine to the entire American population).

 This week Thad and I had to spend a number of hours in a major medical center in downtown Los Angeles dealing with an urgent but non-coronavirus health problem. The pervasive mood throughout the medical center was somber and determined. No one looked happy but no one was failing to do his or her job. I would describe it as an atmosphere of well-controlled terror. Additionally, my sister, also a retired physician, texted yesterday from New York City to check-in. She reported that two NYC hospital residents had just died of COVID-19. These young physicians are our most valuable seed corn; their loss is a loss to medicine and healthcare for many years to come, to say nothing of a profound personal tragedy for their family and friends.

 So please keep up the physical distancing and resist the temptation to break out and do something that might transmit this virus. We are all in this together and we all have to do our part.

Feel free to send questions and concerns about COVID-19 and this pandemic to healthcare [at] lwv-pa.org" target="">healthcare [at] lwv-pa.org. They will be collated and addressed in future columns; individual answers to individual questioners will not be provided. Stay safe and don’t forget to wash your hands, stay 6 feet away from others, wear your mask in public, and, as much as humanly possible, don’t touch your face.

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Dr. Margan Zajdowicz is the Co-Chair of the League of Women Voters-Pasadena Area Healthcare Committee and a retired infectious disease physician who spent many years in clinical practice and emergency preparedness and pandemic planning for the US Navy. She holds a Doctor of Medicine degree from the University of Maryland School Of Medicine and a Master of Public Health degree from Old Dominion University/Eastern Virginia School of Medicine.