Covid-19: A Physician’s Perspective II

I am an Internist practicing Washington State. I am relieved by the accelerated efforts to increase the numbers of Covid-19 tests available. In the meantime, I have advised patients to stay home if ill. I have converted office appointments for my elderly and other patients at high risk for death into telephone appointments. I have reiterated hand-washing guidelines, and I have done my best to remain up to date on the CDC guidelines.

Our local businesses and schools have been quick to shut down if a case of Covid-19 is identified. Others have closed their doors proactively. Members of this community have done a great job of staying home and keeping their children home if there is any question of respiratory contagion. Sadly, despite our best efforts, the virus appears to be making its way through our community at an alarming rate.

At this juncture, we really must take a step back. What we know about some of the common viral illnesses in our communities is helpful. However, we should be careful as that knowledge can mislead us. Clearly there is something different about the way this virus moves about as our current knowledge of how viruses operate doesn’t seem to be working for us.

What we know is that every virus has a prodrome or early symptoms. For example, influenza often presents with fatigue, body aches, and fever. The rhinovirus can present with a short-lived sore throat and always with nasal symptoms. Covid-19 must have at least a partially unique foot print.

Here is how I think about it. If I were a deadly virus that wanted to make its mark, what would I do? The first thing I would do would be to make sure I had a very efficient way to attach myself to a carrier. I would want to be the virus that wins in true Mendelian fashion. I would find a more efficient and effective way to survive and propagate than those other viruses. I devise ways to stay under the radar for as long as possible. I would move through your community without raising alarm. I would likely disguise myself as a much milder illness than some of the more deadly viruses already known. I would certainly not be as obvious as the flu or even as obvious as the common cold. I would have a longer incubation period than my competitors. The longer I stay hidden the farther I will travel. My active phase of the disease with viral shedding would last as long as possible, and I would have it be as mild as possible. Making people so enough to stay home would be counterproductive. I definitely would not cause fatigue or obvious signs of illness. I need my host out in the community as much as possible. Fellow viruses, if want to make the headlines of Virus Weekly, this is how you do it.

To summarize, the key to understanding how Covid-19 spreads so quickly though communities is as follows: identify similarities the virus shares with other viral infections, but, a crucial must is to determine how it differs. Understanding exactly how Covid-19 has achieved such stealth is pivotal in slowing its spread. We must make every effort possible to identify presenting symptoms of patients in our communities as early as possible. We must determine and record how patients with milder Covid-19 infections present. We have to engage a wider audience of symptomatic patients, not just the seriously ill. We must pool our knowledge in a single data base for analysis and incorporation into a master data base. Without our collective knowledge about early symptoms and what milder forms of Covod-19 infections look like, we are missing opportunities for containment.

The three symptoms listed on the CDC website, fever, cough, and shortness of breath, can occur in severe cases of many viral and bacterial respiratory infections. These symptoms can also occur in noninfectious illnesses. If you have fever, shortness of breath, and a cough, always call a medical health professional. If you don’t have a doctor, Evergreen Health has an excellent Covid-19 hotline or call one of our local consulting nurse hotlines for advise.

Thankfully, the CDC has just loosened the criteria for Covid-19 testing to include testing at the practitioner’s discretion. However, our capacity for testing is still somewhat limited

In the meantime, let’s continue to play our part to protect the most vulnerable in our communities. Let us maintain our mindfulness, remain vigilant and my friends, please be safe.

Faithfully Yours,
Dr. Ruth Freeman M.D.

Dr. Ruth Freeman, MD
Dr. Ruth Freeman, MD
After almost twenty years of practice in large multi-specialty practices, I decided to start a private practice. I did so at a time when it was thought that Primary Care Physicians could no longer maintain insurance based private practices. The cost providing medical care in the primary care setting had overshadowed insurances, thus reducing reimbursements because of the size of the facility. Defeat was not an option.