Re: [FairfieldLife] Well-informed Covid-related choices, moving forward by cardiologist

[Bhairitu noozgur...@gmail.com [FairfieldLife]]

If you want an interesting documentary to watch, check out the Frontline 
doc on Italy's experience with Covid-19 which is now available streaming.

On 5/21/20 9:57 AM, Alex Stanley j_alexander_stan...@yahoo.com 
[FairfieldLife] wrote:
> The top five comorbidities of hospitalized NYC covid-19 patients are 
> hypertension, obesity, diabetes, morbid obesity, and coronary artery 
> disease. Right now is clearly a particularly good time to lose weight 
> and improve metabolic health.
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> On Thursday, May 21, 2020, 10:14:26 AM CDT, Brianna Delott 
> briannadel...@gmail.com [FairfieldLife] 
>  wrote:
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> " but it is not clear if other diseases like obesity, *asthma, immune 
> disorders*, etc. increase risk appreciably. "
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Re: [FairfieldLife] Well-informed Covid-related choices, moving forward by cardiologist

[Alex Stanley j_alexander_stan...@yahoo.com [FairfieldLife]]

 The top five comorbidities of hospitalized NYC covid-19 patients are 
hypertension, obesity, diabetes, morbid obesity, and coronary artery disease. 
Right now is clearly a particularly good time to lose weight and improve 
metabolic health.

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Post with 0 votes and 4 views.
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On Thursday, May 21, 2020, 10:14:26 AM CDT, Brianna Delott 
briannadel...@gmail.com [FairfieldLife]  wrote:  
 " but it is not clear if other diseases like obesity, asthma, immune 
disorders, etc. increase risk appreciably. "
     

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[FairfieldLife] Well-informed Covid-related choices, moving forward by cardiologist

[Brianna Delott briannadel...@gmail.com [FairfieldLife]]

This was posted from Dr. James Stein, cardiologist based at U-Wisconsin at
Madison. Well-informed update on how we can make smart and reasonable
Covid-related choices going forward. I found it helpful.

COVID-19 update as we start to leave our cocoons. The purpose of this post
is to provide a perspective on the intense but expected anxiety so many
people are experiencing as they prepare to leave the shelter of their
homes. My opinions are not those of my employers and are not meant to
invalidate anyone else’s – they simply are my perspective on managing risk.

Key point #1: The COVID-19 we are facing now is the same disease it was 2
months ago. The “shelter at home” orders were the right step from a public
health standpoint to make sure we flattened the curve and didn’t overrun
the health care system which would have led to excess preventable deaths.
It also bought us time to learn about the disease’s dynamics, preventive
measures, and best treatment strategies – and we did.

For hospitalized patients, we have learned to avoid early intubation, to
use prone ventilation, and that remdesivir probably reduces time to
recovery. We have learned how to best use and preserve PPE. We also know
that several therapies suggested early on probably don’t do much and may
even cause harm (ie, azithromycin, chloroquine, hydroxychloroquine,
lopinavir/ritonavir). But all of our social distancing did not change the
disease.

Take home: We flattened the curve and with it our economy and psyches, but
the disease itself is still here.

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x
so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic
Fever where 25-90% of people who get infected die. COVID-19’s case fatality
rate is about 0.8-1.5% overall, but much higher if you are 60-69 years old
(3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years
old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%).
The infection fatality rate is about half of these numbers.

Take home: COVID-19 is dangerous, but the vast majority of people who get
it, survive it. About 15% of people get very ill and could stay ill for a
long time. We are going to be dealing with it for a long time.

Key point #3: SARS-CoV-2 is very contagious, but not as contagious as
Measles, Mumps, or even certain strains of pandemic Influenza. It is spread
by respiratory droplets and aerosols, not food and incidental contact. Take
home: social distancing, not touching our faces, and good hand hygiene are
the key weapons to stop the spread. Masks could make a difference, too,
especially in public places where people congregate. Incidental contact is
not really an issue, nor is food.

What does this all mean as we return to work and public life? COVID-19 is
not going away anytime soon. It may not go away for a year or two and may
not be eradicated for many years, so we have to learn to live with it and
do what we can to mitigate (reduce) risk. That means being willing to
accept *some* level of risk to live our lives as we desire. I can’t decide
that level of risk for you – only you can make that decision. There are few
certainties in pandemic risk management other than that fact that some
people will die, some people in low risk groups will die, and some people
in high risk groups will survive. It’s about probability.

Here is some guidance – my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease – people
over 70 years old, even more so. They should be willing to tolerate less
risk than people under 50 years old and should be extra careful. Some
chronic diseases like heart disease and COPD increase risk, but it is not
clear if other diseases like obesity, *asthma, immune disorders*, etc.
increase risk appreciably. It looks like asthma and inflammatory bowel
disease might not be as high risk as we thought, but we are not sure -
their risks might be too small to pick up, or they might be associated with
things that put them at higher risk.

People over 60-70 years old probably should continue to be very vigilant
about limiting exposures if they can. However, not seeing family –
especially children and grandchildren – can take a serious emotional toll,
so I encourage people to be creative and flexible. For example, in-person
visits are not crazy – consider one, especially if you have been isolated
and have no symptoms. They are especially safe in the early days after
restrictions are lifted in places like Madison or parts of major cities
where there is very little community transmission. Families can decide how
much mingling they are comfortable with - if they want to hug and eat
together, distance together with masks, or just stay apart and continue
using video-conferencing and the telephone to stay in contact. If you
choose to intermingle, remember to practice good hand hygiene, don’t share
plates/forks/spoons/cups, don’t share towels, and don’t sleep