The following is a short repost from social media.
Well, call me triggered.
I’m a Family Medicine Physician, and every day for the past 3 months I’ve seen patients for COVID-19. Every day for 3 months, I’ve told every patient I’ve diagnosed with COVID-19, with the exception of the few I’ve sent directly to the hospital because of the severity of their symptoms, the same three things:
1. Don’t be afraid of COVID-19.
I say this to my patients for a few reasons. First, because I am mostly seeing patients in the outpatient setting, my patients and I have the privilege of emphasizing this point. Second, for many patients who have a mild to moderate severity course of COVID-19, anxiety is a very real issue, and I want to make sure that while they are recovering they are not sitting at home wondering when the virus is going to get them. Most people who get COVID-19 don’t end up in the hospital (as we have been saying since the beginning of the pandemic), even fewer end up in the ICU or die from the virus (as we have been saying since the beginning of the pandemic). The virus is very, very dangerous, but our brains are bad at statistics; just because this is the most dangerous viral pandemic since the Spanish Flu of 1918 doesn’t me that your individual chances of dying are high or that getting deathly ill is a foregone conclusion. If I were mainly seeing very sick patients in the hospital or ICU I wouldn’t be saying this as much; we would be talking more about treatment and response than about the patient’s anxiety about getting sicker, though the latter certainly deserves our time and attention in any clinical setting. When a patient is struggling to breathe, “don’t be afraid” is a theological statement rather than a clinically valid reassurance, and it typically gives way to “I am with you; I am here and I am going to do my absolute best for you.” But in the outpatient setting, talking with patients who are worried about how COVID-19 will affect them and their children and their friends, “don’t be afraid” is an extremely important part of the conversation.
2. If you have the following symptoms, go to the hospital.
As important as “don’t be afraid” is, it is equally as important to talk about what we call emergency and return precautions. Yes, for most people COVID-19 is not deadly; but it is for some, for many in fact, and we do not have any perfect way of predicting who will have a more severe course. For my healthy patients in their 20’s and 30’s, the chances of ending up severely ill are extremely low; yet people who are medically just like them- same age, same paucity of risk factors- have died from the virus. The same for parents who are worried about their children; children are at extremely low risk from COVID-19, yet some children have died from the virus. I can look my young, healthy patient in the eye and honestly tell them I expect them to be fine; but I cannot promise them that they will be, and that’s a vital distinction. So with each and every patient, in addition to reassurance, we talk about what to look out for. Shortness of breath. Chest pain. Severe malaise and fatigue, even syncope; passing out or almost passing out from the toll the virus is taking on your body. We talk about oxygen levels if they happen to have a pulse oximeter at home, and signs of hypoxia if they don’t. We discuss both the reasons they would come back to see me in clinic and the reasons they would skip my clinic and go directly to the Emergency Department instead. With my older patients or patients who have known risk factors (most Americans, in fact, including myself, considering that risk factors for a more severe course of COVID-19 include hypertension, diabetes, obesity, chronic lung disease and other very common ailments), this discussion is even more important, because even though the odds are still in their favor, their ending up in the hospital or dying from COVID-19 is not nearly as unlikely. I want my patients to be free from fear; but I also want them to be equipped with the knowledge they need to make sound choices if their symptoms do worsen.
3. Please keep the virus from spreading to others.
This piece of guidance is no less important than the previous two. If you are healthy and young and your chances of dying from COVID-19 are very low, that’s really wonderful; but self-isolation during your illness is still the responsible, kind, and charitable decision because not everyone is as lucky as you. The case fatality rate of COVID-19 is much higher than even very deadly illnesses like the flu, and it is very, very contagious. With each and every patient I discuss the precautions they can take to keep the virus from spreading to their own family, and of course the responsible social decisions like sheltering at home during their contagious window and alerting their close contacts so they can self quarantine. It’s one thing to tell yourself that you’ve only exposed other people at similarly low risk to yourself, but once you have spread the virus to someone else you have no control of whose grandmother, whose father in poor health, or whose immunocompromised child it spreads to from there. I said before that we are bad at intuitively comprehending statistics; the COVID-19 virus, like most illnesses, is unlikely to cause death to any given individual regardless of risk factors, but is extremely deadly in aggregate; containment is still our best strategy for keeping the 210,000 deaths in our country from doubling or tripling by the end of this pandemic. The reality is that most people get this; most people I talk to understand the need and are concerned about keeping their families and communities safe. But there is a counter-narrative being promoted by some that rejoices in defying all calls for caution, sober mindedness, or charity when it comes to COVID-19, and so the reminder from me, the doctor actually seeing the patient face to face in clinic, becomes that much more important in case my patient has been lured by these cruel and irresponsible ideas.
These are the three pieces of advice, the three categories of discussion that I have with each and every patient. It is time consuming; it appropriately turns what might be a 5-8 minute visit into a 10 or 15 minute visit. It requires careful explanation of statistical and clinical concepts that might be challenging. It is worth it, because the proper way to approach a diagnosis of COVID-19 is with caution on behalf of others and preparedness rather than fear for yourself and your family, and it’s my job as a Physician to equip my patients with the knowledge and tools they need to approach the virus this way, even in the face of anxiety and rampant misinformation.
So when I see someone with a platform like President Trump’s endorse the first point of not being afraid of the virus, follow the second point of going to the hospital when his symptoms escalated and he experienced hypoxia and shortness of breath, and finally utterly disregard and contradict the third point of taking precautions on behalf of others, I am, I think very understandably, upset. Because when a doctor or a nurse survives COVID-19 (and many haven’t), contracted by putting themselves in harm’s way every day and despite taking maximum precautions to keep themselves and those around them safe, they rejoice that they are now able to dive back into the fray, fighting the virus with no less caution but somewhat less stress and anxiety for their own health, knowing that reinfection is very likely a rare occurrence. But when the president contracts COVID-19 by ignoring all precautions and survives it with the help of state of the art high-level hospital care, expensive and experimental treatments, and a private team of doctors and nurses, his first statement after leaving the hospital is one that builds upon his long-standing guidance and example of not taking precautions or acting to protect those around you, despite neither you nor your family and community having anything like the medical access that helped him.
Please keep yourself and others safe. Don’t be afraid of the virus, but please act in charity to those around you by taking reasonable and proven precautions like wearing a mask, maintaining physical distancing, and engaging in sound epidemiological principles like getting tested if you are ill, self-quarantining if you are exposed, and honestly and proactively participating in contact tracing if you are diagnosed.
I will go ahead and anticipate a couple of objections to this post. First, some people are going to claim that the facts I’ve shared here are inaccurate; that the ‘CDC admitted’ that only 6% of the deaths were actually from COVID-19, or that the fatality rate is actually lower than the flu, or some such nonsense. For people who still believe these pieces of COVID-19 misinformation, there is no shortage of good explanations and rebuttals available on the internet and I suggest finding and reading one. For people who don’t mind a long and mediocre rebuttal over a good one, I’ve written a few myself over at tjwebbmd.com.
Second, some people are going to look at this tweet from the president and say, “but TJ, he isn’t discouraging caution or telling people to take COVID-19 less seriously! He just said don’t let it dominate your life, that could mean lots of things!” To those people I will say, along with Doctor Archibald from Veggie Tales, “Stop being so silly!”
When I tell my patient “don’t be afraid” after reviewing their vital signs, asking about their symptoms, carefully examining them and listening to their heart and lungs, and carefully talking through emergency precautions and transmission control measures, they are absolutely not confused about what I mean. And nobody in America is confused about what the president means when, after months of promoting misinformation, minimizing the pandemic, shirking transmission control guidelines even to the point of endangering his secret service and staff during his own illness, refusing to wear a mask (and then only wearing one intermittently and with a wink at mask truthers when he does), he then says to ‘not let it dominate your life’. And nobody will be surprised when the ongoing unwillingness of our national leadership to take the pandemic seriously, and encouraging others to do likewise, results in more cases, more severe illnesses (and associated suffering and medical debt), and more deaths.
On the same day that I posted a short essay titled “Don’t Be Afraid of COVID-19”, Dr. Emily Smith, Your Friendly Neighborhood Epidemiologist, posted a short essay saying that Yes, We Should Be Afraid of It. Now, Dr. Smith is so much smarter than me that this would normally be enough to make me immediately delete my post; but thankfully, it turns out we are saying essentially the same thing, despite the seemingly contradictory essay titles. To understand what Dr. Smith and I mean when we say you should/shouldn’t be afraid of COVID-19, go and read her essay where she discusses the difference between unhealthy fear and wisdom, the latter being something our national response to this very deadly and dangerous virus has been sorely lacking.
𝐒𝐨, 𝐰𝐡𝐲 𝐬𝐡𝐨𝐮𝐥𝐝 𝐰𝐞 𝐛𝐞 𝐚𝐟𝐫𝐚𝐢𝐝 𝐨𝐟 𝐂𝐎𝐕𝐈𝐃? 𝐁𝐞𝐜𝐚𝐮𝐬𝐞 𝐭𝐡𝐞 𝐬𝐜𝐢𝐞𝐧𝐜𝐞 𝐭𝐞𝐥𝐥𝐬 𝐮𝐬 𝐰𝐞 𝐬𝐡𝐨𝐮𝐥𝐝. 𝐋𝐞𝐭’𝐬 𝐝𝐞𝐟𝐢𝐧𝐞 𝐰𝐡𝐚𝐭 𝐭𝐡𝐚𝐭 𝐢𝐬 𝐟𝐢𝐫𝐬𝐭 𝐭𝐡𝐨𝐮𝐠𝐡. 𝐓𝐡𝐞𝐫𝐞 𝐢𝐬 𝐚 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐢𝐧 𝐰𝐢𝐬𝐞, 𝐡𝐞𝐚𝐥𝐭𝐡𝐲 𝐟𝐞𝐚𝐫 𝐚𝐧𝐝 𝐮𝐧𝐡𝐞𝐚𝐥𝐭𝐡𝐲, 𝐝𝐞𝐛𝐢𝐥𝐢𝐭𝐚𝐭𝐢𝐧𝐠 𝐟𝐞𝐚𝐫. 𝐓𝐡𝐞𝐫𝐞 𝐢𝐬 𝐚 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐢𝐧 𝐫𝐞𝐜𝐤𝐥𝐞𝐬𝐬 𝐛𝐞𝐡𝐚𝐯𝐢𝐨𝐫 𝐚𝐧𝐝 𝐜𝐚𝐮𝐭𝐢𝐨𝐮𝐬 𝐰𝐢𝐬𝐝𝐨𝐦. 𝐈𝐭’𝐬 𝐭𝐡𝐞 𝐫𝐞𝐚𝐬𝐨𝐧 𝐰𝐡𝐲 𝐰𝐞 𝐭𝐞𝐥𝐥 𝐨𝐮𝐫 𝐜𝐡𝐢𝐥𝐝𝐫𝐞𝐧 𝐧𝐨𝐭 𝐭𝐨 𝐭𝐨𝐮𝐜𝐡 𝐚 𝐡𝐨𝐭 𝐬𝐭𝐨𝐯𝐞 – 𝐭𝐡𝐚𝐭’𝐬 𝐧𝐨𝐭 𝐮𝐧𝐡𝐞𝐚𝐥𝐭𝐡𝐲 𝐟𝐞𝐚𝐫, 𝐢𝐭 𝐢𝐬 𝐰𝐢𝐬𝐝𝐨𝐦.Dr. Emily Smith, PhD, MSPH