A Doctor’s Perspective


Submitted by Jim Halvorson, MDImage of Salt Spring Island from Stoney Hill courtesy Chris IstaceSome time ago, planned a car ride down the coast to catch an NBA and MLS game. Switched that to a Tofino beach, with social distancing, just in time to watch the town roll up the welcome mat. It would now seem likely that school will not resume in classrooms until next Fall.
Scouring Thrifty’s for hand sanitizer last week I saw the Globe headline ‘Coronavirus Destroying The World’ 
Really?! Is the sky falling down? Are we all going to die? Time to retire to the basement with a case of canned tuna and toilet paper? 
This flu will be personally and internationally disruptive and destructive yes, but in general not personally fatal. Tragically there are going to be many deaths, predominantly in the elderly and those with significant health challenges. Kids have as yet not been severely affected, Pregnancies may add a modest risk to mom, however babies born to infected moms have been fine. Current estimates put mortality rates about 10 times the average influenza rate. Far less than SARS or MERS or Ebola. At the moment here we still have influenza virus making its annual rounds. 
Our evolving public health approach is about containment of potential cases, slowing transmission and protecting the vulnerable. Flattening the curve of infection. It is far more difficult to mobilize enough resources to treat a sharp spike of sick people all at once, than dealing with a slower steady increase in cases. Canada is taking effective public health steps in a reasonably timely manner. 
Recommended measures are as much about protecting your vulnerable neighbour or elderly loved one, as protecting yourself. 
We were self isolating for two weeks only after travel elsewhere. We should all be practicing this.
Wash your hands with soap for 20 seconds and don’t touch your face when in public. 
Wash surfaces you touch regularly. Though results vary, this Sars-Cov-2 virus has been reported to remain infective outside our bodies for less than 1 day, and to be quickly killed with soaps, bleach and alcohol sanitizers. 
Don’t cough on anybody. Cover with an elbow and stay 2 metres away from other people. Wear a mask if coughing, for the protection of others. 
Dispose of used kleenex in a lined garbage can, not your pocket. If you are not coughing or febrile, masks are not needed for your own protection, just a prickly 2 metres of personal space around yourself. 
Avoid unnecessary trips, visits and visitors. 
Initial reports suggest infectivity may peak about 5 days from the first symptoms and be negligible by 10 days. Recommendations continue to evolve.
Don’t shake hands. If coordinated or Italian, use your feet. Safer if the rest of us just smile awkwardly from a distance. Ironically, the kids may finally have a defense for their love affairs with their phones and virtual buddies. 
Though inconvenient, these practices are relatively easily done and will greatly help to keep yourself and others safe.
Don’t panic buy. No need to panic. Building up a small cache for your home is reasonable and recommended. Pet food, dry goods, toiletries, and prescriptions for a couple of weeks. This is probably reasonable to keep for all of us who may occasionally have to contend with just road closures or power outages.
If you are coughing or febrile, stay home.  Tylenol for fever and lots of liquids. Minimize visitors, keep your distance from housemates and avoid workplaces, school, concerts, hospitals, doctors or parliament. The measures in place give our infrastructure its best chance of keeping up. What we each do right now will be crucial to determining how we fare as a nation.
The BC Ministry of Health has daily updates. Healthlink BC or 811 can connect you with other resources. We are now starting to see more cases in BC. Scattered single cases were noted from January 15 until starting to rise at the beginning of March. ? of the 424 cases in BC were confirmed in the last 2 days (as of print date). 6 % of cases are in hospital, with ½ of those in ICU care. Most infected people are self isolating at home. There are 37 cases on the island with 1 in hospital.  
Symptomatic health care people, those admitted with symptoms, and contacts of known cases are being tested currently. Public health will try to contact all persons with positive tests the next day. If you don’t hear, call 1-866-370-8355 in 3-5 days to confirm.If short of breath or symptoms increasing, phone ahead and present to the ER, avoiding public transport or taxis.  Call 911 if needed. You will be triaged by a person in a protective gown, gloves and mask, and kept away from other vulnerable patients. Nothing personal, we care about everyone. Triage may soon be done at outside centers. There are no specific viral treatments at this time. Other causes and systems affected are treated and supported.
Other human corona viruses also arose from animal hosts. Some have shown a seasonal ebb and flow in people for largely unknown reasons. Covid 19 is a relatively easily transmitted syndrome and might become an endemic flu. It arises from a previously unknown virus so our future together is unpredictable. There are hopes for a vaccine by next year. Infection will hopefully confer immunity. There appears to be no reinfections.

Fortunately there is much beauty and nature, away from others, and close to home for you and yours to enjoy. Time with your family is precious. May you find nurture there and give nurture, virtually, to those you know and love who may be vulnerable and alone.