A word from the Clinic: Any light at the end of this tunnel?

April 10, 2020
By Marcy Shortuse

BY TOM ERVIN, MD – It is April 8, 2020, five days after Governor DeSantis initiated a “safer at home” status for the state of Florida. COVID-19 cases continue to increase in our state and nationally.

The specifics of the pandemic and its mortality consequences are quoted daily. State directives regarding travel, work and public gathering are in place.  The medical opinions and advice are documented. All of these issues and interpretation are clearly outlined on the daily Boca Grande Health Clinic website (bghc.org). The information is updated daily by the BGHC physicians after review of the information on the cited national websites. This information is intended to provide valuable local and national information and guidance for our island and nearby residents and visitors.

Reading the COVID-19 news report daily is difficult. Since Wuhan, much has changed, but much has remained the same. It is necessary however, to understand this illness to keep us focused on the task at hand. As we move through the coming weeks, the task will become harder. The COVID-19 experience will be a marathon, not a sprint.

April 8 is also my late mother’s birthday and I have been trying to think of something good. Virginia was a very, very good person. She was an orphan at age 10 and a war nurse during WWII. Mom knew firsthand how hard life can sometimes be.

The world is now at war again. This time it fights a virus of unknown potential. While we can fall back on history and note that we have managed to survive as a species despite the Black Death, the Bubonic Plague, small pox and polio, we currently are challenged by the daily realities of COVID-19.

Even as millions in our world suffer from malaria and tuberculosis, the impact and suddenness of COVID-19 makes us unsure and often afraid. So, in all of this mess can I find some hope and good in the situation? I will try.

Despite national political differences, the countries most affected by COVID-19 have joined to fight collectively. Industry and medicine from China to Italy to the U.S. have shared clinical epidemiologic and research data on an unprecedented scale. Treatment protocols and diagnostic testing options are being developed. Prevention strategies (vaccine) and new therapies (antiviral agents) are being tested collectively. This is good news and there is hope that this international cooperation can lead to advances both in the treatment and prevention of COVID-19.

The pandemic has created a sense of unity where little existed. In 1981, I was a research physician attempting to identify and treat a new illness, now known as HIV. A disease of blood transfusion, specific populations, drug usage and sexual behavior, HIV produced separation which hampered the research for years.

The global response to COVID-19 however, is much different. Correctly this time, “we are all in it together.” COVID-19 puts us all in the effort. Social distancing will help, but we must all be unified to do the right thing to protect the common good. Watching us all follow medical directive to protect ourselves and the common good has been a welcome sight.

Worldwide there are heroes to admire. Those on the medical front are being asked to perform beyond the usual guidelines. Medicine itself has a chance to reestablish itself; independent from politics and big business.

Politicians have a chance to behave in a non-partisan way to do the right thing. Industry can redefine its mission to provide for the common good as well as the bottom line.

Yes, I think there is some good to see and hope for. But it is frustrating on April 8th, 2020. For now we focus on the infection rates, the massive loss of life and the economy. We are concentrating on our personal losses. Yet, our community and society must hold together to fight back collectively.

As individuals, neighborhoods and communities we must listen to our medical leaders and understand the facts of the pandemic. Social distancing and mask wearing, while a bother, are simple requests which can help bring more good news.

From here however, the fight will become tougher. Treatments will come, but not before more hardship.

Current testing for COVID 19 continues to evolve, but is inadequate to guide clinical decision making in the outpatient setting. Nasal and oral swab testing (PCR testing) is useful in caring for hospitalized patients, or some symptomatic patients who have underlying medical conditions which predispose them to more serious consequences of COVID 19.

In these dire medical settings testing also helps protect the safety of the medical personnel; indeed the integrity of the U.S. health care system.

In the outpatient setting PCR testing is insensitive (30 percent or higher falsely negative result) and in very short supply (for now).

PCR test reporting is too slow at this point to be clinically relevant in the outpatient setting. It takes 10 to 14 days to get a result of the test. Performing the test puts both patients and medical personnel at risk while using up precious personal protective equipment that is in short supply. We monitor this arena carefully with hope that the CDC and Health Department recommendations for widespread testing will change.

For now, we must continue to listen to the medical experts and do the right thing individually to protect us all collectively. At some point there will be more good news than on April 8th, 2020.

Until then, cover up, wash often and stay home.

Dr Tom Ervin is a physician at the Boca Grande Health Clinic