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Covid-19 Quarantine: are we afraid of going back?

It is 2 weeks since Governor Brad Little of Idaho issued a statewide "stay at home" order and about 3 weeks since my little town has been staying at home because of an earlier mayor's order. The whole US has been increasingly moving toward self quarantining. People throughout the world are being asked to avoid sharing space and sharing germs with others. Buying and selling and traveling aren't happening much. There is very little going to school, receiving non-essential services, partying, touching or breathing on people outside of our immediate biological or chosen families.

Some people are getting bored. Many are feeling challenged by having to do things that aren't normal for them, things like cooking, cleaning, childcare. Many of the things that filled our days are just not happening. There is a whole lot of quiet.

The creativity that is happening in the absence of whatever it was we used to do is pretty stupendous. People are writing for each other and makin…
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Covid-19 and death rates--doctors know why numbers of people who have died are wrong

This morning the total number of deaths in the US from Covid-19 was said to be 994. That sounds kind of low, since influenza has already killed 30,000 this season. In the places where coronavirus has hit hard, it's much worse than the flu, in New York and New Orleans for instance. People are much sicker and the whole healthcare system, including emergency medical services, is stressed to breaking. We know that coronavirus is more severe and more contagious and more deadly than the flu by at least a factor of 10. Why are the numbers of deaths presently so low?

The thing that nobody is talking about with regard to Covid deaths is that our data about who has died is going to lag by weeks, months or even years and will probably fail to represent all of the deaths for which Covid is responsible. Why is this?

People are dying at home of Covid. How do I know this? Because 25% of people die in their own homes. People with symptoms of coronavirus are being encouraged to stay at home so som…
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Sex in the time of Covid-19

When we are all trying to avoid deadly spread of coronavirus infections, can we still have sex?

This is a GREAT question. Luckily the New York City department of health has answered this and many more questions you may hesitate to ask in their very complete and unabashed 2 page primer on the subject. Please follow the link. It is a brilliant document leaving just enough to the imagination.
The most controversial and absolutely true statement they make is that "You are your safest sex partner."
Sex is the most physically intimate activity that most people engage in. Coronavirus is transmitted when virus from one person's respiratory tract (usually lungs, mouth or nose) finds its way to another person's respiratory tract where it infects vulnerable cells. Not all cells are vulnerable. Coronavirus is found in certain other body fluids but it is less practical for the viruses in, say, stool or tears to be involved in transmitting infection. But sex between humans just a…
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Things everybody should know about Covid-19. Plus some ideas.

Idaho has 42 cases of Covid-19 as of this morning. It feels like nothing, but that's because very few people are being tested and we are on the leading edge of the exponential growth curve. Some of us feel bad for feeling happy because these are serious times, some people feel sad in expectation of feeling sad in the future and others are just scared. It feels a little like a snow day, though, and we are knee deep in possibilities. Young people who never cook are learning to cook. People are doing crafts and hunkering down. I've heard from friends who I'd lost touch with. Much of my day is eaten up by learning more of what's known and what's known today may be wrong tomorrow.

Things you should know which are likely to be true:

The coronavirus has a median incubation period of just over 5 days and nearly everyone who gets it will get it within 12 days of exposure. This is from China's data, reported in the Annals of Internal Medicine. Symptoms can be variable: m…
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PPE--personal protective equipment. How we can have enough in the era of Covid-19.

We doctors are worrying about shortages of personal protective equipment. PPE is what we call it. When we see a patient with a disease that could be transmitted to others, we wear things that cover our bodies that can either be washed or thrown away. Infections can be spread by contact, by droplets or aerosols. We have different precautions for each type and within these categories, what we do depends on precisely which kind of infection we are worried about. We also, since the advent of HIV, use "universal precautions" to protect ourselves and our patients from bloodborne pathogens that we may have no reason to suspect but might be present anyway.

Universal precautions include wearing gloves for any procedure that involves contact with a patient's blood or body fluids or presents a significant risk for that, such as drawing blood or cleaning wounds.

Diseases such as influenza or certain pneumonias are transmitted by droplets. For those infections we need to use a mask …
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Covid-19 why does it seem like nothing is happening? #mycoviddiary

In and around town there are people who are looking at all of the rest of us who are hand sanitizing and social distancing like we are crazy. I feel for them. They are simply trusting their own experience. They don't see people dropping like flies. Nobody they know even has a cough. Restaurants are closing and it looks like everyone is needlessly panicking. What gives? Why are they wrong?

The reason it seems like nothing is happening while governors and doctors are predicting huge numbers of people who will be sick and dying is something called exponential growth. That means that the number of cases of this disease are increasing faster each day.  In a time of exponential growth things seem really mellow at first, as the number of cases goes from 2 to 4 in one doubling time, just 2 more cases, what's the big deal? Then the next doubling time the 4 cases become 8, but that's not so bad, just 4 more cases. Days go by... when you get to the tenth doubling period with 1024 cas…
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Covid19--can we really just drop everything? #mycoviddiary

Still vigorously healthy, thank you. I sneezed once yesterday afternoon and my voice was just a wee bit gravelly. Today my nose runs when I'm out in the cold. It always does that. No exposures that I'm aware of.

My clinic is functioning as well as it can, consistent with keeping almost everyone out of our waiting room. We have agreed to keep meetings to no more than 10 people with everyone at least 6 feet apart. We have all been instructed to self screen every morning for new significant cough, sore throat, shortness of breath or fever over 100. Most of my patients have been phone visits rather than in person but I saw a few. I do a better job in person, but spending a good amount of time with someone on the phone is not without its benefits. The counselors and psychiatric nurse practitioners will be working from home until this is over. They had one day to figure out how to do this. Their patients are kind of reeling. Nobody had typical coronavirus symptoms. Things are kind …
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