By Jason Skyles, MD
President, St. Louis Metropolitan Medical Society 2020
The coronavirus pandemic is without precedent in our lifetimes. The last pandemic that affected our daily lives to this magnitude was the influenza pandemic in 1918. Unlike today, medical care was much less developed than it is now. But then and now, there is no vaccine for the virus. Other pandemics of the last century have occurred in 2009, 1968 and 1957.1 Recent years have brought serious epidemics (Ebola, SARS), though they did not reach the level of pandemic.
In 1918, St. Louis Health Commissioner Dr. Max Starkloff and Mayor Henry Kiel—with the support of the St. Louis Medical Society—were credited with saving lives and reducing the spread of Spanish flu in our region by enforcing large-scale shutdowns of public events. St. Louis had the lowest death rate among the 10 largest U.S. cities.2,3
Why is the COVID-19 disease so serious and so feared by infectious disease experts? First, coronavirus is showing a slightly increased death rate compared to typical influenza. This rate varies greatly depending on age and overall health. Early data estimates a death rate of around 3%, which compares to .1% for typical influenza.4 The 1918 influenza was estimated to have had a death rate of 2-3%.5 Secondly, researchers found a high reproduction rate of 2.28,4 compared to around 1.5 for the 1957 and 1968 influenzas.5
When the virus first started becoming a major issue in the United States, I reflected upon what my role was going to be. As a radiologist, I struggled at first, as I’m sure many sub-specialty physicians also have. Then the deluge of questions started from patients, friends and family. None of them cared that I really didn’t have any particular expertise in infectious disease.
I came to the realization at that point that as physicians, all of us can play an important role in education. Most of us are not infectious disease or public health experts, but as physicians our patients look to us for guidance and assurance. When questioned by an older individual, there is usually a tinge of fear in their question. The same question from a younger individual usually revolves around why there is so much hysteria about the virus (after all, “it is just like the flu,” they say).
Advice to Patients and Families
At the time I’m writing this, as a society we are moving past the “containment” stage and beginning to implement measures that aim to slow the infection rate. This is a critical time for the health profession to unite in our message. If the virus is allowed to go unchecked, we run the real risk of overloading the medical system. This could mean that patients who need advanced supportive care may not receive it.
We need to provide assurance to those who are anxious and remind them that four of five infected with the virus will show only mild cold and flu symptoms. More importantly, for the dismissive we need to provide education on the seriousness of the disease and stress the importance of adherence to the control measures put in place by our public health officials. We need to remind those who seek to diminish the seriousness of the disease, that these measures are being put in place not only to protect them, but also to protect our mothers, fathers and grandparents. Symptoms may be mild for them but can be deadly for our seniors or for someone with an underlying serious health issue.
Yes, this will be an inconvenience for many, but it will save lives. Social distancing is imperative. This means no kid playdates, parties, sleepovers or families/friends visiting each other’s homes. We need to remind our vulnerable populations to be extremely cautious around children (yes, even grandchildren).
As school cancellations become more frequent, the job of caring for our children is often shifted to grandparents. So far, younger individuals have predominantly shown only mild symptoms of the disease but yet are fully capable of transmitting it. If you or your children are even mildly unwell, do not go out and do not have the grandparents watch the children. I know how hard this is. I have four young children, but it will help protect your parents and grandparents.
Advice to Medical Practices
As physicians, how the pandemic affects us and our practices varies widely. Primary care and emergency medicine are seeing heavy caseloads. Other specialties may see little effect or a slowing of patient volume. We all need to think of ways to reduce patient-patient interaction and if possible patient-physician interaction. Consider rescheduling or canceling non-essential appointments. Limit the number of people in the waiting areas. Insist that patients use hand sanitizer before or upon entering the office.
The CDC has extensive recommendations regarding healthcare facilities, which can be found at https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html.
We all have a unique opportunity to educate and assure our patients, family and friends. We need to reinforce that we cannot be complacent if we want to limit the infection rate. Basic hand hygiene and social distancing measures are imperative—to control the rate of spread and limit the risk to our most vulnerable population. The reports from Italy are a disturbing look at what could be our future if we as a society do not start taking preventative measures seriously.
Thank you to our public health department and St. Louis County Executive Dr. Sam Page for leading the local response and keeping us informed. Thank you also to our physicians, nurses and allied professionals in primary care, emergency medicine and urgent care who are treating coronavirus cases. The St. Louis County website http://stlcorona.com/ is a good resource to direct our patients to for up-to-date information from the county and the CDC.
During this time of crisis, we need to pull together as a community. Complacency is not an option.
1. Past Pandemics. Centers for Disease Control and Prevention website. https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html
2. Belshe RB. A century of influenza prevention in St. Louis. Mo Med. 2012;109(2):119–123.
3. Rapid Response was Crucial to Containing the 1918 Flu Pandemic. National Institutes of Health news release. April 2, 2007. https://www.nih.gov/news-events/news-releases/rapid-response-was-crucial-containing-1918-flu-pandemic
4. Zhang S1, Diao M2, Yu W3, Pei L3, Lin Z4, Chen D5. Estimation of the reproductive number of novel coronavirus (COVID-19) and the probable outbreak size on the Diamond Princess cruise ship: A data-driven analysis. Int J Infect Dis. 2020 Feb 22;93:201-204. doi: 10.1016/j.ijid.2020.02.033.
5. Pandemics of the 20th Century. European Scientific Working Group on Influenza. https://eswi.org/knowledge-center/pandemics-in-the-20th-century/