Updated on: September 10, 2020

COVID-19 déjà vu

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Original story posted on: September 9, 2020

This has been a humbling six months to be an American and an emergency physician. It seems like we have gone from one crisis to the next, with COVID-19 persistently in the background, ready to ignite when too many people ignore it or get sloppy about prevention because of fatigue.

Today’s U.S. numbers stand at greater than 6 million cases – and greater than 185,000 dead. There is one American death from COVID-19 every 77 seconds. Just think about that.

Rhode Island had some of the earliest cases, aggressively and successfully controlled it, and is now seeing increasing numbers, so much so that its neighboring U.S. states have just placed travel restrictions on Rhode Islanders. What is going on now reminds me of a quote by Yogi Berra, the former New York Yankees catcher and Baseball Hall of Fame great: “it’s like déjà vu all over again.”

From a Rhode Island perspective, are schools really going to reopen again, in less than one month? Please keep in mind that 46 percent of all teachers in Providence, the state capital, are greater than 50 years of age. Will there even be enough teachers…?

COVID-19 looks like migrating brushfires that can easily (and do easily) get out of control. The Northeast in the spring, the South and Southwest at the start of fall, now spikes around the Midwest, and perhaps an impending return to the Northeast – much sooner than the experts expected.

So, what can we do about it? First, follow the basic public health rules: wear face masks, maintain physical distancing, and wash your hands. We also need better testing. A test with delayed results is like no test at all. And we need to trace contacts and isolate those who test positive or are symptomatic. It is impossible to trace contacts without rapid test results.

So, what are the symptoms of COVID-19? The three classic symptoms are fever, cough, and shortness of breath, with a cough being the most common one. According to the Centers for Disease Control and Prevention (CDC), only 45 percent of symptomatic patients have all three of those symptoms, but most patients do not present with classic symptoms. Others may present with a loss of smell or taste, or they may have fatigue, or GI symptoms like nausea or vomiting or diarrhea.

Although patients are generally symptomatic between day 2 and 14, post-exposure, with an average of five days, they can still transmit the disease a few days before the onset of any symptoms. And here is the real shocker: up to 40 percent of all COVID-19 patients never develop any symptoms at all, yet still can pass this virus on to others.

That was the challenge for first responders like myself, treating COVID-19 patients during the initial flareup in the Northeast. I saw sprained ankles with COVID, bad motorcycle accidents wherein the rider also tested positive for COVID, strokes and heart attacks and G.I. bleeds in patients who also were COVID-19-positive, in addition to other severe illnesses on ER presentation. After a while, we viewed every patient as at least COVID-possible. We then began to view even each other that way.

And now once more, there are so many unknowns. Is it about to restart in the Northeast? Are we ready to view all our patients as COVID-possible again? Will physicians and nurses burn out? Will American citizens be able to tolerate another round so soon? Can we handle another shutdown?

Most importantly, are we willing to understand that individual liberty is not possible if we are too selfish to consider wearing face masks and maintaining at least six feet of physical and social distancing? It is collectively up to all of us. If we fail, it will be “like déjà vu all over again” – and again.

John Foggle, MD

Dr. John Foggle is an emergency physician with 31 years of clinical experience. He is formerly a professor and clinician at Brown University and Rhode Island Hospital. Dr. Foggle was also consultant with the World Health Organization in Fiji and Tonga during the COVID-19 pandemic designing guidance and training and continues to provide COVID-19 education across the world.

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