At the end of March, we asked our medical experts what they wished the public knew about SARS-CoV-2 and COVID-19. The answers were insightful. Now, as we move into May and the pandemic evolves, we ask them again.
Pandemics, by their nature, do not sit still. Since our first “ask the experts” article, the global number of confirmed cases of COVID-19 has more than doubled, as has the number of deaths.
With the situation shifting and morphing, we contacted our experts again and asked them the same question: “What do you wish people knew about COVID-19?”
We also asked how their viewpoint has shifted over the last few weeks, what their top concerns are, and what they consider to be the most significant challenges.
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A changing attitude
Cynthia Taylor Chavoustie, an experienced physician assistant, wants people to know that they do not need to be afraid. “Be vigilant, yes, but afraid, no,” she says.
She explains that about 80% of people with a SARS-CoV-2 infection will have “a mild case or no symptoms at all. For those who have more severe symptoms, we can help manage their symptoms and are learning more about this disease every day.”
However, she reminds us that this is not over and that “now is not the time to let your guard down. Don’t be afraid, but be smart and be vigilant.”
As the pandemic progresses, Chavoustie has developed a wary respect for SARS-CoV-2: “This is a smart virus. It has found a way to transmit itself undetected through asymptomatic vectors to have the widest spread possible. We all should have a whole new respect for viruses. More importantly, we all need to take hand washing and other healthy habits seriously to prevent spread.”
As for concerns, she worries about the “lack of treatment or effective management of severe symptoms so far. There’s no quick or even clear method of turning things around when they get bad, so far.”
Chavoustie also worries that politics “seem to be influencing all this and possibly hampering the progress of developing a vaccine and treatment strategy.”
A focus on testing
Over recent weeks, testing for SARS-CoV-2 has moved to the forefront of the minds of scientists, politicians, and the public. Dr. Michael Virata, an infectious disease specialist, explains how he has “dealt with both inpatients and outpatients, and, generally, their concerns currently are how to get diagnosed.”
“In the past month, I have learned a great deal about COVID-19, both from the clinical standpoint and also how the world deals with a pandemic,” he explains. “This disease has many unique features, and we are trying hard to understand how the body reacts.”
“One of the key components to handling the pandemic has been the rollout of testing. I wish that patients could understand how difficult it is to find the most appropriate test.”
“For now, we have been relying on PCR [polymerase chain reaction] platforms. Some work faster than others, but none are 100% sensitive or specific.”
Testing is important to track cases and understand how the disease works. Dr. Virata hopes that scientists will soon “have a reliable and accurate serologic test, as we are quite certain there have been a number of asymptomatic carriers in the community and even in my own clinic population.”
He also wants the public to understand “the slow and long process of finding the right treatment. Everyone is in a rush to say that one drug is the key, but what we really need is robust research with randomized clinical trials that help determine the best solutions.”
Dr. Virata believes that “treatment needs to start much earlier than has been described in the literature,” which is another reason why testing is so important. He explains that “peak viral replication occurs early on, even when patients are asymptomatic. [This can occur] in a matter of days, not weeks, from the time of infection.”
Mental health in lockdown
People across the planet are now many weeks into lockdown. For the vast majority of us, this is an entirely new way of life, so it is bound to require some adjustments.
Besides the physical effects of the virus, many experts are starting to take a look at the psychological aspects of this “new normal.”
Dr. Alex Klein, a specialist in psychiatry, wants people to know that it is fine to take it easy on yourself during these challenging times:
“Let yourself slow down, find moments to focus on gratitude even in these difficult times, don’t be hard on yourself if you aren’t as productive as you want to be,” he explains. “Don’t feel guilty if your kids are getting too much screen time, create routine and structure, and find ways to connect more than you have before with others virtually.”
As the pandemic rolls on, Dr. Klein says, we have to shift our expectations. “Back when this first started in February/March, I was initially anticipating ‘getting back to normal’ in a couple of months, and now my thinking has changed in that I’m not sure we’ll ever be fully back to normal.”
He is also worried that when some semblance of normality does return, there may be psychological consequences that continue for some time. “I’m concerned there will be a lot of delayed-onset PTSD [post-traumatic stress disorder] or PTSD-like symptoms, increased anxiety, and OCD [obsessive-compulsive disorder].”
“I’m worried that the longer this goes on, the more likely it is that those who did not have great psychological resources to begin with will spiral downward. I’m concerned about the pattern we see of mental health issues worsening during and after an economic crisis, so I think we need to be proactive and prepared the best we can.”
The ‘new normal’
Deborah Wetherspoon, Ph.D., an advanced practice nurse and university nursing educator, talks about what we should expect as our lives continue alongside SARS-CoV-2.
“Most everyone is going to get exposed to this virus eventually,” she explains. “The thing to remember right now is this is a novel virus. Novel means new, and no one is innately immune to it. Your immune system either fights it and wins or not.”
Staying at home is not just about protecting ourselves, Wetherspoon explains, noting that “the main purpose behind sheltering at home is to prevent everyone from getting sick at once and overwhelming our healthcare systems.”
Even as we reach a new normal, she says, our behavior will have to change, as we will “need to continue to exercise due diligence with masks, hand washing, and other precautions to keep the occurrence rate curve as flat as possible. That way, if you are unfortunate enough to need hospital care, it will be available to you. And if you are cautious and a little lucky, our medical researchers will develop a treatment or vaccine before you get exposed!”
Along similar lines, pediatrician Dr. Karen Gill also reminds us that we need to remain vigilant. “Wearing a mask is not a substitute for other proven infection control measures, such as hand washing and staying home when you are sick,” she explains.
“Wearing a mask shouldn’t make you more likely to do nonessential things you wouldn’t do without a mask, like visiting people who are at higher risk of infection or spending time in large groups. And still clean your hands after touching your face, masked or not.”
– Dr. Karen Gill
As it stands, even reaching a new normal seems some distance away. We need to remain on guard. As Dr. Virata says, “I wish that patients could understand the importance of isolation and social distancing in preventing the spread of the virus and that reopening the country, state, county, or city too soon may lead to worse outcomes.”
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