Editor’s note: This column by Dr. James Hinrichs was made possible thanks to the generosity of Dr. Jonathan Root, Dr. Norman Druck and Galia Movitz. 

I was asked by Jewish Light to host a column on the ongoing coronavirus pandemic.  I am board certified in infectious disease and medical microbiology and I practice part-time in telemedicine. I am also involved in an HIV clinic serving North St. Louis County and St. Charles County, as well as serve as Medical Director for Doorways, a nonprofit organization providing housing for HIV homeless clients. As such I have been involved in helping the organization with its coronavirus planning and in training nursing staff at the residential facility, which takes care of much sicker HIV patients that need ongoing nursing care.  

As I see this pandemic unfold, I am going to share some key recommendations and concerns.

1. My overarching recommendation at this time is to practice strict social distancing and repetitive hand washing.  

Keep to your family nucleus and consider expanding that further by not allowing play dates, or social interaction for your children until we see the scope of the pandemic locally.  For seniors, more and more stores such as Walgreens, Whole Foods Market, Schnucks, Dierbergs and Costco are offering hours only for senior shopping.  Soap and water are at least as good as alcoholic hand sanitizers so, please, make use of hand washing frequently.  Make it a requirement that anyone coming into the house from doing outside essential errands goes directly to handwashing before touching anything or anyone in the house.

 

2. The pandemic is still on the upswing and the trajectory is steep at this point, in part because of the delays in getting testing done on ill individuals.  This will continue to be the case as long as testing is in short supply and will be reserved for patients in the hospital setting, for immunocompromised patients who are having symptoms, and for health care workers who may also develop symptoms.  

 

3. We need to “flatten the curve,” a commonly used term by epidemiologists to employ interventions to blunt the steep curve that we are concerned about and make the epidemic slower to rise, but lengthen the duration.  

Now is the time to practice what we have seen work in the past, namely social distancing and vigorous contact tracing and quarantine by public health officials.  This worked in St. Louis in 1918 during the so- called Spanish Flu, where our numbers were much less than other cities like Philadelphia that did not cancel events and limit social gatherings.

 

4. I am very concerned at the lack of clear emphasis on ramping up the supply chain for critical hospital and health care worker Personal Protective Equipment (PPE) and an adequate supply of needed ventilators and tubing.  

Health care workers are being asked to reuse masks that are potentially contaminated, as well as repetitively work between infected patients without being able to completely change out of PPE and thus put themselves in harm’s way.

 

5. This virus has some similarities to influenza, as both are RNA viruses with the ability to mutate frequently, but there are clear differences.  

This coronavirus may be shed by individuals when they have minimal symptoms of their infection, as well as attacking deeper into the respiratory tree and causing a true viral pneumonia. As such, a patient presenting with symptoms has already likely spread the infection an average of two to three others. 

Many of the deaths due to influenza are because of superinfections by bacteria when the respiratory tract is compromised, which is what occurred with the 1918 pandemic and led to so many deaths, in part because of the lack of antibiotics.  The current virus can cause respiratory failure because of direct deep lung infection, responsible for the key symptom of  “shortness of breath.”  

We are assuming that this virus is a winter borne virus, as is influenza, but we don’t yet know enough about whether summer will lead to less infectivity.  

 

6. We may flatten the curve this time around, but if not enough individuals are infected and therefore presumably immune to subsequent infection, the virus may well come back and start all over.  We depend on enough individuals being immune, either by natural infection or by vaccination (at least a year out), in order to keep the infection from reappearing, a concept known as “herd immunity.”  So the odds are good that we have not seen the end of the virus when cases start to fall off.

 

I appreciate the opportunity to share my thoughts with you and hope to continue to comment on a critical time for our region and for the world, where we truly are discovering again that we live in a global community. 

If you have specific questions or concerns that you would like me to address, email [email protected] (include “coronavirus question” in the subject line).