Read  the words of this Italian journalist and take heed!

“So here’s my warning for the United States: It didn’t have to come to this.

We of course couldn’t stop the emergence of a previously unknown and deadly virus. But we could have mitigated the situation we are now in, in which people who could have been saved are dying. I, and too many others, could have taken a simple yet morally loaded action: We could have stayed home.”

“According to several data scientists, Italy is about 10 days ahead of Spain, Germany, and France in the epidemic progression, and 13 to 16 days ahead of the United Kingdom and the United States. That means those countries have the opportunity to take measures that today may look excessive and disproportionate, yet from the future, where I am now, are perfectly rational in order to avoid a health care system collapse. “

Now some facts about US hospital beds and ventilators.

Although Europe has TWICE AS MANY HOSPITAL BEDS PER 1000 PEOPLE compared to the US, THE US HAS MORE ICU BEDS. (Our hospitals have disproportionately more ICU beds)

But COVID-19 patients in respiratory failure will need more than an ICU bed, they will need a ventilator (and healthcare personnel to manage the ventilator and other aspects of care.)

From the AMERICAN SOCIETY OF CRITICAL CARE MEDICINE

“Supply of mechanical ventilators in U.S. acute care hospitals: Based on a 2009 survey of AHA hospitals, U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators.⁷ Approximately 46% of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply.⁷ The older devices include 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8,567 continuous positive airway pressure (CPAP) units.”

The later mentioned “older devices” are not useful for treating Acute Respiratory Distress Syndrome associated with COVID-10. The use of these devices is contra-indicated for COVID-19 because they create an aerosol which is highly contagious. A patient with COVID-19 in respiratory failure needs intubation and mechanical ventilation with a “full-featured” ventilator. Other “non-invasive” measures for respiratory support cannot/should not be used.

There are already many patients in ICUs on ventilators for other problems like Flu, pneumonia, trauma, burns, COPD exacerbations, sepsis, asthma, post operative care after emergency surgery, etc. We cannot just take those patients off of ventilators to care for COVID-19 cases.

So the 62,000 fully featured ventilators in the US will not all be available for COVID-19 patients (which could easily cause 200,000 cases of respiratory failure in the US).

And if all the remaining unoccupied ventilators are used for COVID-19 then what happens to other critically ill patients with other problems that require mechanical ventilation? (Like your son, daughter, spouse, parent who is in a car wreck, develops bacterial or viral pneumonia, asthma attack, complicated pregnancy, premature baby, or has emergency surgery for any reason and requires ventilator support)

That is why flattening the curve is so necessary.

The protective measures needed to adequately flatten the curve HAVE NOT BEEN TAKEN.

Take heed of the Italian journalist’s warnings. They did not act quickly enough, they did not act intensively enough. What seems like “excessive measures” ARE NOT EXCESSIVE.

1.  STAY HOME EXCEPT FOR FOOD AND URGENT MEDICAL CARE AND OTHER NECESSITIES (BUT WALK OUTSIDE FOR EXERCISE IF YOU ARE NOT SYMPTOMATIC, MAINTAINING 6  FEET BETWEEN YOU AND OTHERS)
2.  ANYONE WITH SYMPTOMS OF AN UPPER RESPIRATORY ILLNESS MUST SELF QUARANTINE AT HOME (FEVER, CHILLS, COUGH, SORE THROAT, FUNNY NOSE, ETC.) WHICH MEANS SOMEONE ELSE MUST GET FOOD INTO THE HOME.
3.  FOLLOW THE CDC PUBLISHED GUIDANCE REGARDING how to clean and disinfect your home,
4.  AVOID PUBLIC TRANSPORTATION
5.  NO SOCIALIZING EXCEPT WITH FAMILY THAT LIVES WITH YOU
6.  WASH HANDS WITH WARM WATER AND SOAP FOR AT LEAST 20 SECONDS EVERY TIME YOU ENTER YOUR HOME FROM OUTSIDE.
7.  IF SOMEONE IS SICK IN YOUR HOME THE SICK PERSON SHOULD BE WEARING A MASK TO PROTECT OTHERS IN THE HOME, NOT THE OTHER WAY AROUND.
8. WASH CLOTHING AND SHEETS FREQUENTLY.
9. WIPE SHOPPING CART HANDLES WITH DISINFECTANT BEFORE YOU USE THEM AND WEAR GLOVES WHEN SHOPPING.
10.  NO KISSING, HUGGING, SHAKING HANDS. (Physical contact with infants, children of course is necessary)

The US still has not instituted adequate measures. “Shelter In Place” along with proper social distancing (when you must absolutely leave home) and hygiene precautions are all necessary to prevent a repeat of the Italian disaster in the US. Some services are essential such as first responders, grocery stores, urgent medical/dental care, mail, pharmacies, utilities etc. These must continue.

Do not eat in a restaurant. Be cautious with take out food. Every time you touch a door handle to a store or shop, your hands are potentially contaminated. So wash hands as soon as you get home, wear gloves whenever possible outside the home. You can use work gloves and disinfect them/leave them in a bag etc.

In my community people are still going for manicures, pedicures, etc. That is NUTS AND IRRESPONSIBLE.

Again the Italian journalist says:

“I heard from a manager in the Lombardy health care system, among the most advanced and well-funded in Europe, that he saw anesthesiologists weeping in the hospital hallways because of the choices they are going to have to make.”

“Until last week, the Italian public health care system had the capacity to care for everyone. Our country has universal health care, so patients aren’t turned away from hospitals here. But in a matter of days, the system was being felled by a virus that I, and many other Italians, had failed to take seriously.”

“The way to avoid or mitigate all this in the United States and elsewhere is to do something similar to what Italy, Denmark, and Finland are doing now, but without wasting the few, messy weeks in which we thought a few local lockdowns, canceling public gatherings, and warmly encouraging working from home would be enough to stop the spread of the virus. We now know that wasn’t nearly enough.”

Please share this as widely as possible with your network of friends, family, colleagues.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a green space, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love (but shelter at home), AND sleep well tonight.

Doctor Bob