You have liver disease, what next under COVID

[nash2]

We are reaching the end of the beginning of the COVID pandemic. As society tries to return to some kind of normal the challenge is how, as an individual, to manage being a part of society if you have a medical issue.

If we look at some recent data from New York the issue is very clear. About 96% of the deaths are people older than 45. We have to remember that anyone can get it, but while it is hazardous for mature adults, most younger people will be OK. What that actually means is that it takes about 40 years for a typical person to develop some kind of chronic illness which puts them at risk.

That is all very interesting, but as part of the "at risk" population how do we think about the near term future? There aren't many good models but it is probably wise to keep a perspective even in the face of horrific news every day.

We have about 2.6 million deaths in the US each year. We have about 550,000 of those due to heart failure. Clearly, even if the COVID event produces 200,000 deaths, the death rate will hardly change at all. The categories will shift around some but as genuinely terrible as this disease is on a personal level it doesn't change the death statistics of the nation very much.

That is the purely pragmatic view of the population, but even in the midst of what is personally terrifying, I think this will lead to a host of amazingly good things. It is sad that we will pay for future good with the lives of our older generation but tragedy is often the fertilizer of rebirth and growth.

I was a child of the computer revolution. Looking back at the last 50 years it is nearly impossible to wrap your mind around how much knowledge has been gained in all fields and how the pace of change is accelerating. Broadly we speak of the growth of knowledge as its "doubling time". How long does it take for our total knowledge to double. It is estimated that in 1950 it was 50 years. By 1980 it was 7 years and it was only 3.5 years in 2010. By the end of 2020 it is projected that total human knowledge will double in only 73 days.

We are so very fortunate to be at risk of dying from COVID in this time of amazing expansion of knowledge. These viruses have been a known threat for decades but no one really chose to combat them. The threat of dying badly has a way of focusing the mind and societies everywhere have focused on the corona virus. We don't know what the outcome will be, but the vast resources of medical research have become engaged in managing this threat.

The research that will ultimately save our lives is riding on a wave of progress in all fields of medicine and the doubling time of knowledge about this virus is days to weeks. Compare that to the doubling time for HIV which was decades or smallpox which was centuries and understand why I am optimistic about our future as patients. We don't know what the details are, but it is a safe money bet that those who look backward for guidance about what is possible will not see the vast progress before us.

I'm reminded of the smartphone. In one generation society worldwide has fundamentally changed as a result of that invention but few predicted that. Medicine, medical care, and public health will never be the same after we pass through this crucible of the corona virus pandemic.

From a personal perspective, the goal must be to avoid infection until help arrives. Good hygiene habits, caution with relationships, and a bit of luck are the elements but it is helpful to understand that help is on the way.

[Bbohnie]

I can only hope your optimistic view is proven in the course of time. Additional considerations in this current situation are not all the people who are listed as died of COVID-19 truly died as a result of it. Some were fraudulent as there was a financial incentive to diagnosis as COVID-19 and an even bigger incentive ($38, 000) per patient to place the person on a ventilator. The numbers are skewed for another reason - it was here long before they admitted it was and had a test for it. I know of people in my area who had it in February and also a group of 22 people who were sickened in late January from attending the funeral of someone who died with it but was not diagnosed as having it. The person died before the test was here but tested negative for flu and other things and everything about his illness fit the profile. Every person at the funeral came to his home either before or after the services so they literally walked into a house which reeked of the virus. OF course, they were all in close proximity, hugging each other, crying , eating and drinking in the house together.

Also, some of the people were incorrectly treated: especially in regards to being placed on a ventilator which was not used correctly. So not only were patients ventilated who would have been better served on a CPAP or BiPAP but those who were appropriately placed on a ventilator were not given appropriate care by the nursing staff or incorrect orders from the Dr. as to treatment.

While it is true the knowledge may be doubling in 73 days, it does not mean the information is being disseminated in that amount of time or that personnel are training in line with that new information expeditiously. Change in procedures, training and policy changes take time and are not always followed by all staff. Doctors are some of the most resistant to change. As we see in the case of liver issues - the information is there but look at how many people on this site have received precious little appropriate information and concern from the first time a Dr. noticed elevated liver enzymes.

While the Corona viruses have existed for years, the COVID-19 already has mutated and last time I checked there were 14 different strains. One of which is so different that the vaccine they are working on will have no affect on it. I figure it will be like the flu - many different versions and the vaccine for the year is a guess (often incorrect) as to what will be prevalent.

I do agree with your suggestions for what we can do to protect ourselves and loved ones. My Mom just turned 94, my husband has various health issues but most concerning COPD. I will probably continue to wear my mask in public places such as the supermarket. I will continue to wash my hands frequently as I already was doing before and sanitizing when I leave a location, changing out of my clothes once home before touching my Mom, husband or dogs with the clothes going to the wash. In time more research may give us more answers or it may confound the issue with different researchers reaching different conclusions and suggested solutions.