I am still working in the office. I’m seeing a few healthy children who need their routine childhood vaccinations in the morning and sick patients in the afternoons (mostly ear infections, strep throat, etc.). I am also holding telemedicine visits in the afternoon.
Since the pediatric population is not as affected, I am not on the front lines taking care of Coronavirus patients. However, I am on the front line fielding questions about Coronavirus. As you can imagine, every parent is scared for the health and wellbeing of their children. And rightly so.
Of all the questions I have been asked lately, the most common one is, “When will this end?” When will the mitigation strategy of social distancing end and when will we get back to “normal”? By “normal” I mean going back to work and school without concern for another spike of COVID-19 cases. We need to know that the virus is under control and hundreds of thousands–if not millions–of people won’t die.
I have thought a lot about this and have come to the conclusion that one of three things needs to happen for us to go back to normal.
1. We Need a COVID-19 Vaccine
First, we need a vaccine that is highly effective and available. Scientists and medical experts all over the world are currently working to develop a vaccine. However, once we have a vaccine, it still needs to be produced and shipped out. That is not an easy task.
I’ve seen this first-hand in my practice with flu vaccines. Whenever we have a surge in demand for flu shots, it can sometimes take months to get the vaccine out and distributed to different providers (doctors, pharmacies, etc.). And based on what I’ve seen so far with COVID-19, there will certainly be high demand once a vaccine is developed. I personally do not see that happening until the end of 2020, or early 2021, at best.
2. We Need Medicine for Treatment
Second, while we are awaiting a vaccine we need good medicine to treat the infection. That way, if someone gets sick, we can give them medicine that stops the infection from progressing to the severe stages involving respiratory distress.
There has been talk about malaria medication and Zithromax as a life-saving cocktail, but I would caution against this until we know more information. The data on this combination is shaky, at best. The only study I have seen is a case report of 26 patients who received the malaria medicine. As they followed the participants, their swabs turned negative earlier than the swabs of patients who did not receive the medicine. However, the addition of the antibiotic azithromycin helped the nasal swab turn negative faster.
This study did not show the things I care about. Did it stop people from progressing to acute respiratory distress? No. Not as far as I can tell. Did the patients have complications from this medicine? That is not clear. Unfortunately, I am cautious at best about these medicines based on the evidence we have today. It is not the answer we need and we will have to keep looking for medicine to abate the infection and help those infected to recover.
3. We Need Increased Capacity
The third issue to address before we can relax the social distancing requirement is the lack of capacity in our medical system. We cannot take care of all the critically ill patients at the same time. We would need to massively increase the number of ICU beds and ventilators.
While the medical community and the government is working on that, it will likely not be enough to relax these recommendations for probably a year. We are trying to provide enough critical-care availability for those who need it. But, as we see in New York and New Orleans, hospitals can get overwhelmed, despite the social distancing that we are doing.
Since I don’t personally think any of these options will occur soon, I believe we will have a “new normal” to live with until a vaccine is available. The vaccine is by far the best option for ending this pandemic and returning to the lives we had prior to mid-March (when we started the social distancing in earnest).
I am sorry this is not the answer most of us were hoping for, but I think it is the most realistic answer. Hang in there and we will get through this together!