Buckle Up and Gobble Down
MEDICAL AND MENTAL HEALTH UPDATE
Once again we’ve got a mixed bag of simultaneously fantastic and terrible news about our COVID-19 situation.
The terrible news is that the virus is out of control. (Pick up any newspaper if you’ve missed the memo.) Particularly painful for those of us caring for patients every day is the ongoing epidemic of misinformation and, for far too many Americans, the flagrant disregard of science and the safety of others. It’s scary, infuriating, and truly baffling.
In fact, last night I ate an entire chocolate-covered fortune cookie the size of my HEAD—a gift to my daughter for her birthday—just thinking about the injustices in our world. (Which unfortunately now includes a mom eating her daughter’s birthday present.)
Anyhoo on a positive note, the vaccines from Pfizer and Moderna—and today from AstraZeneca!—are looking GREAT. On Friday, Pfizer and its partner BioNTech applied for emergency use authorization from the FDA which means that (if all goes well in the scientific review and regulatory process) we could see the vaccine available to healthcare workers as early as mid-December, then rolled out over the next few months starting with higher-risk individuals and ultimately to the general public by April. (To my patients: I will let you know ASAP when/if we have doses and how to get it here or elsewhere as SOON as I know—I promise!)
More fabulous news came on Saturday night when Regeneron’s monoclonal antibody treatment (the therapy that our current president received) was granted emergency use authorization by the FDA to treat newly diagnosed COVID-19 patients who are at higher risk for complications. This is a one-time intravenous infusion designed to prevent hospitalization in sick patients. It’s gonna be awhile until this treatment is widely available, but its existence is HUGELY promising.
Meanwhile back at the ranch, we’re all gearing up for Thanksgiving.
Here is my "Talk Turkey" post for a refresher on decision-making and risk management this holiday.
The bottom line? The safest way to celebrate Thanksgiving is to stay put and observe the holiday with your immediate household only. Indeed the CDC, Dr. Fauci, and myriad other medical and public health experts are urging (BEGGING) people not to travel in an effort to tamp down the raging forest fire of COVID-19. Please don’t risk it, people!!!
But if you insist on traveling and congregating with people outside of your household, here is my best advice on mitigating risk:
Quarantine NOW. (To have mitigated risk fully, you should have started quarantining 14 days in advance of a multi-pod gathering, but ANY amount of time under quarantine is better than none.) Quarantine means not going to work or school, no trips to the grocery store or pharmacy, and generally laying low to prevent exposure to the virus.
Get a test. Ideally get a nasal PCR test the results of which will be back before you convene with others. (The antigen test isn’t very sensitive in people without symptoms.) And definitely do not gather with other people until your test result is back.
Know that a negative test is not a green light. A negative PCR test means that at the moment the test was taken you probably did not have detectable levels of coronavirus in your nose. A negative antigen test means that at the moment the test was taken you probably didn’t have the highest levels of virus to infect others. Remember that you can test negative and still be harboring the virus. Why? Because the incubation period (the time between exposure to the virus and infection with it) is up to 14 days. Remember that the reason this pandemic is so devastating is that more than 50% of coronavirus infections are spread by people who do not exhibit symptoms.
Travel carefully. If you are driving, make as few stops as possible by filling the gas tank and not your bladder before departure. Pack a cooler of snacks plus hand sanitizer and wipes. Don’t be afraid of peeing behind a shrub on the highway! And if you must fly, call ahead to (ideally) make sure the middle seats are empty; avoid crowds at check-in, boarding, and baggage claim (ideally don’t check bags); empty your bladder before boarding the plane; wear two cloth masks, a K95, or N95 mask plus a face shield on the plane; and carry hand sanitizer and wipes with you.
Practice MOSHPIT on arrival. If you strictly quarantined for 14 days prior to departure and drive to your destination with little-to-no exposure to other people, you are probably not bringing the virus to your holiday meal (though others certainly could). But if you weren’t able to quarantine for the full two weeks prior to travel, even with a negative test prior to departure, you should wear a mask indoors, wash hands regularly, distance yourself six feet from others, and spend as much time outdoors as possible.
Add more precautions when risks are added. For example, if it’s raining sideways and you can’t be outside, open some windows. If you’re indoors and can’t distance six feet from others because the Thanksgiving table is small, wear your mask whenever you’re not eating. If you find yourself uncomfortably close to your uncle Bob gnawing on a drumstick and talking loudly about his taxidermy collection, pull up your mask, close your eyes (for cover: “Bob, give me a minute to imagine that beautiful collection…”), and keep the conversation short.
Plan your exit strategy. If you’re really in a bind (for example you show up to Thanksgiving dinner and your family/friends are showing zero regard for pandemic precautions), I suggest you pull an “aunt Emily.” This is what my high school friends and I would do in a pinch—like a blind date gone bad. “So sorry, my aunt Emily has suddenly taken ill. Gotta run. BYEEE!!!” The obvious problem with this plan, of course, is if aunt Emily happens to be your Thanksgiving host. So maybe you should get creative NOW, before the actual event. A white lie—and an escape to a local Red Roof Inn—is okay in my book if it could save your life.
Get a test upon return. Don’t bother getting tested until at least 4 and ideally 5 days after a potential exposure. Get another nasal PCR test. And of course if you mingled with someone who tests positive for COVID, you’ll need to quarantine for a full 14 days after the exposure to that person.
If you feel sick, stay in contact with your doctor to help you monitor symptoms and determine if you need to seek in-person or emergency medical care.
Are we having fun yet??
Personally I’m exhausted just thinking about the upcoming holidays. But whether you’re traveling across the country or simply to the other end of your SOFA this Thanksgiving, we can all be grateful for the light at the end of the tunnel. With vaccines and therapeutics on the way, we are closer every day to reclaiming our lives and rebuilding our future.
Hope is alive!
So keep up the good work staying safe and protecting yourselves and the ones you love (and even the ones you don’t). And know that we WILL get through this.
I’ll check in later this week—either Wednesday or Friday. Until then, be well.