Dr. Ricardo Maldonado

Editor's Note: The following column by EAMC infectious disease expert Dr. Ricardo Maldonado was written last Wednesday, Oct. 14. 

 

For almost four weeks, we have had a Covid-19 census at or above 30 patients, excluding one day. As I write this on Wednesday, one floor dedicated to Covid-19 is nearly full and our ICU is full — about half of them are Covid-19 positive and 10 are on ventilators. As I have mentioned before, patients with Covid-19 are quite complicated to care for — most stay way longer than they themselves expect, and several die after a prolonged and painful illness that can last weeks. Our frontline employees have witnessed way too much suffering this yearn — they are to be commended for their compassion and perseverance.  

Pandemic fatigue, at times it seems, makes us forget what we have painfully learned in the past seven months. America has the most Covid-19 deaths among developed countries. There is a reason for that; we simply have a hard time following public health recommendations and have allowed politics to divide us in the midst of the biggest health crisis of the past century.

Scientists and physicians, including myself, had to learn (and keep learning) about this virus. Some things we believed earlier were not true, and obviously, some are still holding true today with even stronger evidence.

Herd immunity (something I, personally, was somewhat hopeful earlier in the pandemic, including immunity passports) is unlikely to be an effective and safe way to end this pandemic. 

Even now, after seven months, we are still questioning masks. Some are anti-maskers who feel the same as anti-vaxxers — they refuse to believe anything scientists say and draw their own conclusions with painful consequences, but not necessarily to themselves. I still see some people not wearing masks at stores. Most of them appear young and healthy. Obviously, they are not fearful of Covid-19, but more importantly and troubling, they are not showing any care about other people, who may be at a higher risk from contracting Covid-19.

So far, there have been more than 215,000 deaths in the U.S. related to Covid-19 and as we brace for winter, I think only one thing should be expected: it will get worse.

We have all seen in the news what happens when mask-less events take place. A race for a safe and effective vaccine is underway, but we have to make sure it is effective and safe, so American residents — including here in our communities — feel comfortable getting one once available. Until then, the most effective way to prevent infection is no secret.

When I have patients ask for advice while planning a visit to areas with malaria (a mosquito-borne illness), I always tell them ‘I can guarantee you that if you do not get a mosquito bite, you will NOT get malaria.'

In a similar way, if we do not inhale or touch the virus, we will not get Covid-19. There is not a 100-percent effective way to avoid that, but it should be obvious to most people that a physical barrier that covers the nose and mouth decreases the ability of the virus to move from person to person. Likewise, washing your hands frequently will eliminate any virus we could have accidentally picked up after touching a surface a patient with Covid-19 just touched. 

I have been asked many times when Covid-19 is going to end, and when we can stop wearing masks. No one has exact answers for those questions. However, I would venture to say that it would be a lot wiser to understand that as we approach winter season — one that could be one of the most fatal this country has faced — we could simply embrace mask wearing. I know it is not easy or desirable, but a change in mindset will be needed to embrace the idea that this is going to be normal for the foreseeable future.

On another note, President Trump had Covid-19 and it is known that he received Remdesivir (an antiviral), an antibody cocktail (Regeneron’s REGN-COV2, investigational drug not available for public use yet) and Dexamethasone (a steroid) to decrease inflammation.

Regeneron officials have applied for Emergency Use Authorization (EUA) by the FDA. This medicine is not known to work yet, but appeared to reduce viral levels and improve symptoms on non-hospitalized patients. The ability of this drug to help on severe cases is unknown, but probably not great.  The other two drugs he received have been used for months already by most hospitals, and obviously none of them is a miracle treatment.

So, with no miracle treatment, no vaccines yet, no hope for herd immunity and with a pandemic fatigue that is affecting even our health care workers, we once again have to rely on our community to help us decrease transmission.

Reports from other states are showing that many cases of transmission are taking place in relatively smaller settings, involving family members or close friends. This would likely be because they feel ‘safe’ around them and likely choose not to wear masks.

Unless we limit our exposure to household members only, we probably need to wear masks in all other group settings — even with extended family members and close friends. This holiday season will be very different. No one likes our current situation, but like I always tell my fellow doctors, nurses and other health care workers: ‘We have to stay united, strong and focused.’   

Ricardo Maldonado, M.D. is an Infectious Diseases specialist and is the sole practitioner with East Alabama Infectious Disease.  He joined the medical staff at EAMC in 2009.  Dr. Maldonado is leading the clinical response to COVID-19 at East Alabama Medical Center.

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