by Joshua T. White, MD, Gifford Medical Center This past weekend, the first case of COVID-19 was discovered in Vermont. This was expected, and the only question was where it might pop up. I anticipate this number to jump substantially in the near future. Two weeks from now, there will likely be hundreds of identified cases in our communities. I want people to understand and expect this, such that it is not quite as alarming when it occurs.
A big reason for the jump in numbers will be testing.
Coronavirus is already out there, but we will soon be much better at identifying it. Remember that many individuals with COVID-19 are not very sick at all; perhaps a little cough or the sniffles. These people are not being tested, as there are simply not yet enough tests to go around.
Over the next week or so, we expect that manufacturers will catch up to demand. When this happens, the Department of Health will likely allow clinicians to test whomever they feel appropriate. This big increase in testing will translate to a big jump in the number of identified cases.
It is important to note that those cases were already out there. Nothing will have changed. We will just have identified them. Simultaneously, people that don’t feel sick will spread this around. The proverbial cat is out of the bag.
So what does that mean for all of us?
For most of us, it shouldn’t mean much more than another round of the news cycle. But there is a lot of panic going on, and my media feed is full of photos of empty shelves in grocery stores and wholesale retailers. This is important to think about, and leads to my message today.
Why are people panicking? Should we be panicking?
The rush on toilet paper illustrates my purpose nicely. You can find many photos of, and commentary about, people buying up months’ worth of toilet paper. I even noted a photo of two people in a tussle over a 24-pack of Charmin. Coronavirus doesn’t cause diarrhea and nobody is getting quarantined for more than a couple of weeks … so why buy up toilet paper? It’s nonsensical.
The answer is two-fold.
First, it is completely normal and appropriate to get anxious about something new or foreign, although our media that thrives on high emotion is not helping. When we don’t know what might happen, it’s common to develop a lot of angst about the possibilities. While it’s common to worry, what matters is how we respond to that fear. Being brave is not lack of fear … it’s what you do with that fear. For many people in the face of worry, it is comforting to do something … anything … even if that something isn’t clearly going to help. So we might just buy toilet paper.
brav·ery | \ ˈbrāv-rē , ˈbrā-və- \
Definition of bravery
1: the quality or state of having or showing mental or moral strength to face danger, fear, or difficulty: the quality or state of being brave: courage
Second, many of us have a poor appreciation of relative risk. Fear of flying is a great example. As of 2018, there was one death per 3 million plane flights. Your lifetime risk of dying in a traffic accident is roughly 1 in 77. So it makes no sense to fear flying when your ride to the airport is exponentially riskier. But the imagery of a plane crash is vivid and terrifying, and this is what we focus on, so the fear of flying is a common and understandable thing that we must work with people on.
Why am I dwelling on panic? Why does it matter?
It matters because when we, as a citizenry, fail to control our impulse to “just do something,” we can hurt each other. Many people have noted the surge of healthy people buying up and even stealing hospital supplies such as masks. Your basic mask will not stop you from getting coronavirus, and wearing them around in public, for this reason, does nothing but instill fear in your neighbors.
However, these masks are very useful for people who are already coughing. When you cough into a mask, those droplets get caught and stop other people from getting sick. If your fear leads you to wear masks around town, hospitals are going to have a very hard time limiting the spread of all respiratory viruses, not just coronavirus. You can make influenza worse in your community by doing this.
A second example: You may very well get the urge to go to your doctor or ER “just to get checked.” It’s understandable, as a negative test would be reassuring. But if you are under 65 and healthy, getting coronavirus is of little concern. There’s no medication for you, you don’t need to be admitted, and nothing really is going to happen.
Take a moment to imagine what will happen if you and all of your neighbors decide you need that reassurance and head to the ER “just to get checked.” It won’t take but a few dozen of you and your ER will get very congested. Wait times will skyrocket. And people won’t stop having other medical problems during this coronavirus scare, so someone with a heart attack could spend hours waiting to be seen while your ER staff is swamped with those that are worried but well.
To make a long story short: it is very, very possible for you to hurt your friends and neighbors by panicking. You, as a community member, can help or hurt with your behavior.
Before I go, I want to reassure you that we are preparing for this. We interact with the Centers for Disease Control (CDC) and the Vermont Department of Health on a regular basis. We have a strategy should this get into our nursing homes. We have a strategy should a large volume of our elderly citizens fall ill. We have a strategy should a lot of our own staff have to call in sick.
It will not be easy, and there will be surprises and unexpected challenges, but we will manage. This is what we do, and I can say with absolute certainty that we are dedicated to maintaining the health and safety of this community in everything we do. This is not different.
As in all things, this too shall pass.
Joshua T. White, MD, MBA, is Chief Medical Officer at Gifford Hospital in Randolph. March 9, 2020
Gifford is a community hospital in Randolph, Vt., with family health centers in Berlin, Bethel, Chelsea, Randolph, Rochester, and White River Junction; and specialty services throughout central Vermont. A Federally Qualified Health Center and a Top 100 Critical Access Hospital in the country, Gifford is a full-service hospital with a 24-hour emergency department and inpatient unit; many surgical services; a day care; two adult day programs; and the 30-bed Menig Nursing Home, which was named by U.S. News & World Report as one of the best 39 nursing homes in the country in 2012. The Birthing Center, established in 1977, was the first in Vermont to offer an alternative to traditional hospital-based deliveries, and continues to be a leader in midwifery and family-centered care. The hospital’s mission is to improve individuals’ and community health by providing and assuring access to affordable, high-quality health care in Gifford’s service area.