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Edelman: Advice from one on the front lines for dealing with the coronavirus crisis

The Cleveland area is rather like Baltimore; both metropolitan areas have about the same population size, and both have world-class hospitals — the Cleveland Clinic and Johns Hopkins rate in the top three in the country. Dr. Steven Insler is the director of cardiothoracic and vascular critical care and respiratory therapy and associate professor at Case Western college of medicine. Dr. Insler is on the front line of dealing with COVID-19 cases. He graciously agreed to take some time to answer some questions about the illness.

What advice would you give to people for dealing with the coronavirus?

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If you can, stay at home and watch Netflix. Social distancing is especially important for people at greater than average risk, the elderly and people with compromised immune systems, for a multitude of reasons. Washing your hands with soap is critical. Soap traps viruses, so that when you rinse off your hands, the viruses go too. Hand sanitizers are useful, but they don’t work as well as soap when your hands are dirty or have oils on them.

And I recommend getting information from reliable sources. People need accurate information, without which you are more prone to getting stressed out. Watching the daily presidential press conference raises the fear factor among the general public. And without good information, you see a lot of people emptying the shelves in grocery stores. What are they going to do with all that toilet paper, anyway?

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As a nation, how prepared are we for dealing with COVID-19?

There’s a lot of uncertainty about the disease. We don’t know how far into the future its trajectory goes. It could conceivably go into the fall. We need to do a better job of mitigating its spread, especially among the elderly.

The epidemic exposes some pretty serious issues in our medical system. Forty-six percent of the country’s doctors are older than 55. Parts of the country are seriously underserved. Even if medical students went into the field now, their training is incomplete, and they’d probably need supervision. More generally, the prohibitive cost to attend medical school is a disincentive to many college students. And while PA’s and RN’s can do routine treatment, there’s a lot about this particular outbreak that’s not routine. Only about 38,000 doctors are in critical care or emergency medicine, and a serious rise in the rate of infections will just overwhelm the supply. That’s why flattening the curve is so critical. It won’t reduce the total number of people who get infected, but it will prevent them from completely saturating our resources for dealing with the disease. My worst fear is being forced to choose between treating, say, a 35-year-old father of two young kids, and an 18-year-old. We absolutely must flatten the curve to avoid those kinds of awful scenarios.

Social distancing, isolating infected people, and personal care, like washing your hands, will help keep people from getting sick, and that will allow the medical system to better deal with the people who do get sick.

What about medical supplies? Will we be able to keep up with the demand?

Right now, my hospital has enough masks, gowns, and ventilators for our immediate needs, but as the rate of infection increases, our supplies will quickly be depleted.  We need to improve the supply chain for manufacturing and distributing them. And flatten the curve until we increase our capacity for producing PPE and ventilators. You heard the president talk about reusing N95 masks [these masks trap airborne microbes and viruses]. Forget it! They’re single-use items and can’t be sanitized and reused.

Health-care providers are part of the supply, so keeping them healthy is an ever-present challenge. In Italy, for example, doctors are getting sick at the same rate as the general population. Spain is also on the verge of an Italy-type overload.

One thing I agree with the president about is saying that we are at war against this virus, and we need to act like this is a war. That means making it a national priority to devote resources to take care of sick people and prevent people from getting sick in the first place. There’s only so much the government can do. And there’s only so much that people can do on their own. Everybody needs to do what they can to control the spread of Covid-19.

Mitch Edelman writes from Finksburg. His column appears every other Tuesday. Email him at mjemath@gmail.com

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