Subtle Signs of Sickness: It Could be COVID-19

(April 3) I’ve been a family physician for three decades and over the years I’ve spent many an hour reassuring people with mild respiratory symptoms that they will be okay and to just give it time. Yes, I’ve encouraged people with a cold to isolate themselves, but I haven’t been insistent, because even if they give the cold to someone else, everyone sick will probably get better in a few days.

These days, that is not my message. Instead, I am encouraging everyone with even the mildest of symptoms to take them seriously. I want people to just assume they have COVID-19.

I can hear you asking: “But isn’t this allergy season? And isn’t the flu, and the common cold, still circulating?” Yes, and yes. The problem is that it may be impossible to tell the difference between mild COVID-19 infection and the symptoms of benign conditions. If we’re going to beat this thing, we can’t afford to ignore any symptom that might possibly be COVID-19.

We are in the middle of a pandemic that is causing a deadly viral pneumonia. How deadly? For the past three days, COVID-19 has been the third leading cause of death in the U.S., behind only heart disease (1,772 deaths daily, on average, in 2019) and cancers (1,662 deaths daily). On April 1 the U.S. crossed over the mark of 1,000 daily deaths due to COVID-19, and this disease is expected to be the leading cause of death for three weeks starting on April 7, peaking at 2,644 deaths on April 16.

But these projections, from the University of Washington’s Institute for Health Metrics and Evaluation, IHME, (www.covid19.healthdata.org), are actually the “best-case scenario”. That is, these numbers are based on the assumption that Americans maintain “full social distancing” through May, 2020. We Americans like our freedom to do what we want, when we want to do it. Are we going to maintain full social distancing that long? Are we doing it now?

I’ve heard stories about families wandering around Wal-Mart, looking like they are just killing time. And about friends getting together. And crowded birthday parties posted on social media. These people have obviously not gotten the message. The key to “social distancing” is to have as small a family circle as possible — and then to maintain that small circle with solid borders. If one person interacts with a human (possibly infected) outside the circle, then everyone inside the circle is threatened.

Without any social distancing, that is, if we had all just ignored this virus and socialized normally, 2.2 million Americans would have died of it. That is a hefty chunk of our 330 million population. The IHME scientists, with their optimistic “full social distancing” model, predicts 94,000 U.S. deaths by August. Other forecasts, more realistic I suspect, range from 150,000 to 300,000 deaths.

Yes, any human you interact with could be infected. Appearing healthy is no guarantee of actual health. This is such a sneaky virus. People might not have any symptoms that they notice, but still the virus is abundant in their nose or the back of their throat. When they talk or exhale, some virus comes out with their breath also. Also, people who have had x-rays of their chest for some other reason have been found to have pneumonia, unexpectedly. They were feeling well — no symptoms — yet they ended up testing positive for COVID-19.

So what symptoms am I talking about? Here’s a list:

· Cough

· Fever

· Fatigue

· Shortness of breath

· Sore throat

· Muscle aches

· Loss of smell

· Loss of taste

· Headache

· Chills

· Diarrhea

· Nausea

Not everybody gets every symptom. Some people start out with mild symptoms and they escalate — quickly. Others have mild symptoms for many days. Lots of people don’t have any fever ever. This is a problem — as it is in my hospital — if the only way to get tested for COVID-19 is to have fever in addition to other symptoms. My hospital doesn’t have many tests, so they are only testing the sickest patients. We are missing the chance to diagnose COVID-19 in many, many patients.

Other countries have tested far more people with mild, early symptoms than the U.S. has been testing. This allows those countries to identify the people with COVID-19 so they can urge them to isolate themselves and their exposed household members. Most people with the virus can recuperate at home. But the important thing is to truly stay home through that time. Nobody from the home should be going to the store or to work — even “essential” work — until all have recovered. And “recovered” means at least two weeks PLUS there has been three days since the last fever AND all other symptoms are much, much improved.

Since many places in the U.S. are like my hospital, with few people getting tested (compared to the large number of people with any symptom), you can guess that the number of people with COVID-19 is far higher than any official list of “positive tests”. Add to that the high number of people who actually have the virus even though their test said “negative”. That is what we call “false negative” tests. The person is infected with the virus, but the test says “negative”. This is 30% of all the tests. 30% is a lot. So if you are pretty suspicious you have the virus, or had it, but your test came back negative, you have a one-in-three chance of being correct.

Maintaining social distancing protects all of us. If you have a mask, use it when you go to the store. Keep it on, without touching it, until you get back to your car. Then carefully remove it by the edges and put it in a paper bag. When you get home, remove it without touching the outer surface and drop it in the washing machine, if it is washable. If it isn’t, hang it up to air dry for several days before using it again. Then toss the paper bag and wash your hands thoroughly.

By wearing a mask you may be protecting yourself from others, but you also may be protecting others from YOU if you are either: infected but asymptomatic, or infected but just not yet showing symptoms.

And if you have any friends or family members who think COVID-19 is “just the flu”, have them watch this Vox video: https://youtu.be/FVIGhz3uwuQ, called “Coronavirus is not the flu. It’s worse.” Social distancing can stop this infection from spreading. And the sooner it stops spreading, the sooner we will all be able to, once again, connect with each other face-to-face. “And let us not grow weary of doing good, for in due season we will reap, if we do not give up.” (Galatians 6:9)