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COVID-19 Update: March 15, 2020, Discussion with Knowledgeable JRC Doctors

03/16/2020 01:25:43 PM


March 15, 2020

JRC is working to stay on top of the COVID-19 pandemic and its ever-changing implications for our community. To do so, we have a working group of staff and lay leaders talking on a daily basis with health professionals. JRC's board president Elliot Frolichstein-Appel recently had an opportunity to chat with Kim Grahl and Rob Feldman, two married doctors who are long-time JRC members. An edited transcript of that conversation is below.


Elliot: Thank you both for lending your expertise to JRC as we figure out how best to keep our congregation healthy. How is COVID-19 affecting your everyday work?

Kim: I am an internist at NorthShore University Health System, providing primary care in our Evanston office. In the outpatient setting, we are certainly fielding many questions from our patients regarding who should be tested, what they should do regarding travel plans, and what they need to do to stay safe. This past week has been an unbelievable whirlwind of putting procedures in place to identify and treat those people who do have COVID-19 while assuring that our staff are protected and that our offices are still up and running and remain safe places to keep coming to for routine medical care. We at NorthShore have started to identify and treat patients infected with COVID-19, and we are already seeing how severe this illness can be, especially in older people with chronic medical problems. And remember, we are still in the middle of a big outbreak of influenza, so one challenge has been to be sure that we are diagnosing and treating those patients, whose symptoms are for all practical purposes indistinguishable from the symptoms of COVID-19.

The week ahead is going to be a critical week; while we have not yet seen significant community transmission of the virus, we anticipate that we are at the inflection point in that regard. We all know from Evanston Mayor Hagerty's public announcement (below), of a patient with COVID-19 who had visited Evanston Unitarian Church before becoming symptomatic. The same thing could happen at JRC, so we all have to be very vigilant right now.


Rob: I am an ER doctor at Cook County Hospital and currently serve as the Director of Emergency Management for Cook County Health. I do disaster preparedness. (Kim has accused me for years of spending my time planning for "something that will hopefully never happen.” Well, here we are.) So I’m very involved in the county's crisis planning and response team. Cook County sees a large number of uninsured patients even when there is no pandemic, and we are planning in case we have a large influx of infected or potentially infected patients. As Kim mentioned, this year is a particularly bad flu season; there are multiple different strains of influenza circulating in the community. Many of the patients with suspicious symptoms have tested positive for one of these influenza strains and not for the novel coronavirus, but we know it's only a matter of time before that changes. While it is inevitable that there will be more cases of COVID-19 across the Chicago area, it is really critical that everyone work on preventive measures to keep transmissions down so our hospitals are not overwhelmed with sick patients. The graphs below (the "flatten the curve" graph) are illustrative of the impact those measures can have not just on individuals but on our public health system and the whole community.


Kim: One of the important pieces of this story is the limited access to testing for COVID-19: to get a handle on this, we need to know where the disease is and isn't. NorthShore's lab has developed its own test for the virus that just got FDA approval. That doesn't mean we have unlimited capacity, just that we can now test more patients and can shave off some of the time it takes to turn around test results because it's now being done locally. I want to be clear: we are ONLY testing patients who are sick, and we have protocols in place so that we utilize this testing capability in a way that prioritizes those patients at highest risk of having the virus. People need to understand that there is not a reason to get tested at this point if they are not ill.


Elliot: Is it accurate to say young people are less affected by the coronavirus? Does that mean our school age kids are at less risk?


Rob: One thing we are learning is that little kids can be completely asymptomatic while infected, but they can still be shedding a ton of the virus as they go through their day. That poses an enormous risk for their elderly grandma or their uncle getting chemotherapy for cancer who is immunocompromised. That is why the schools are closing, so existing infections don't get passed around between families by the school age kids coming into daily contact.


Kim: I worry a little bit about this message that ‘young people do fine with this’ and whether that might lead to a false sense of security. I worry about all of the college students who are now home, and about people in their 20’s and 30’s who might not be getting a clear message about how important it is to avoid gatherings of large numbers of people. That is one way that infections could start to spread more rapidly. Everyone needs to understand that catching this virus is not just about you; it’s about you becoming a vector for transmission to other people, some of whom could die of it.


We talk about "flattening the curve", which is so important to keep the hospitals from getting overwhelmed. But we also have to realize that we don’t just want to slow this pandemic down; we really want to minimize the number of people who ever get this infection. The idea that ‘we’re all going to get it at some point anyway’ is, in my mind, wrong and might lead to complacency.


Elliot: I have seen TV interviews of patients who have recovered from a COVID-19 infection. Do they build immunity, like with chicken pox? If I catch it and get through it, am I safe? Is my family safe?


Rob: Unfortunately, we really don't know yet. There have been some reports of possible reinfections, but there is not enough data yet on this question.


Kim: Yeah, we don't want to think about this like chicken pox and have people want to catch it on purpose just to build immunity. I don't know that that was such a brilliant idea before the chicken pox vaccine became widely available, but this coronavirus can be much more serious, and we simply don't know that much about it yet.


Elliot: Is this virus kind of like influenza? Many more people die of influenza every year than have died of COVD-19 so far. Are we overreacting just because it’s something new?


Kim: The idea that this is just like influenza needs to be debunked. This is not influenza. Yes, in its milder forms, the symptoms mimic influenza. And yes, it is transmitted via respiratory droplets and by getting it on your hands and touching your eyes/noes/mouth. But there are crucial differences. It appears to be much more contagious. Nobody on the planet has immunity to it. We have no treatment. We have no vaccine. We are just beginning to get the science on the virus- exactly how it gets into the body, how it causes the severe illness, etc.


Elliot: So this can feel a little paralyzing with everything we don't know here. Should we just hide under the covers for the next six months?


Rob: Well, it's going to spread, and we're going to have to treat the people who get sick. The key is to try to keep those numbers down, and particularly for people who are vulnerable. One of the biggest culprits helping the virus spread is travel. I'd say even at JRC, if you are having a bat mitzvah, invite your cousins who live in Glenview or Oak Park, but tell your aunt NOT to come in from New York. She shouldn't travel on a plane anyway during this pandemic, and flying from one part of the country to another and then immediately inserting oneself into a big gathering of people is one of the ways that this virus spreads rapidly.


Kim: Last week, I would have said that despite everything, we still need to be comfortable gathering in small groups and putting our arms around each other. There's not going to be a lot of virus hanging out on the back of my sweater, and if you put some there with your hands, it’s going to be hard for that virus to make its way into my mouth. But as we're seeing this thing spread, I do think that for now, physical distancing is essential. With what we've learned over the few days, I guess I’d prefer that nobody tests my back-of-my-sweater theory. Right now, anyone who is over 60 or who has chronic medical conditions including diabetes, heart disease, or high blood pressure ought to really stay at home. And yet, we all know that loneliness and social isolation are also toxic, and are already all too common especially for the elderly and we need to really address this as we encourage physical distancing. The risk to an older person of getting very ill with COVID-19 is real, and we’ve got to protect our most vulnerable members from exposure to this virus. At the same time, we’ve got to find ways to maintain connection and presence in each others’ lives in different ways. The “distancing” in social distancing needs only to be about not being in the same physical space at the same time.


Elliot: What was the CDC's Dr. Anthony Fauci talking about on CNN last night regarding having bottled water around?


Kim: I have no idea.


Rob: Yeah, let’s talk about that. He was really referring to preparation in general terms for disasters that might disrupt the infrastructure that delivers clean water to your home, or situations in which you might need to leave your home. If you are in Puerto Rico and a big earthquake hits, this might apply.


Kim: Truly, folks, Lake Michigan water will remain as potable as ever. Stop buying bottled water. Fill up a clean cup or reusable water bottle with tap water -- Rob and I use a Brita filter, but that is really not necessary -- and drink that to keep yourself hydrated.


Elliot: How about food? Food is one of my favorite parts of Jewish celebrations. And please don't tell me to diet -- my own doctor and family already do that!


Kim: The food thing is not so much about the food itself, it's about the risk of having 100 different people touching the handle of the same serving spoon or handling the same water pitcher or digging through the same bowl of clementines. If your caterer puts food on your plate, they are trained and sanitary, and they are the only person touching the utensils or the food except you. They can slice the challah in the kitchen and give you one slice, and then we avoid the tearing with all the hands. However, even with a catered meal, we all have to remain super vigilant and not sit too close to one another, so I wouldn't blame anyone if they canceled or postponed a celebratory meal.


Rob: But your doctor is right about that diet ...


Elliot: Thanks both for all you do! We hope to see you (virtually) around JRC, and we really appreciate your insight.


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