If I were a family doctor, I’d reach out to my patients about COVID

I have been saying for a while that it makes no sense for those claiming that COVID-19 is a hoax to be relying on their politicians for information about infectious diseases rather than talking to their doctor, the person in their life who actually has expertise about infectious diseases. However, we know that these people claiming hoax are not talking to their doctors. That being the case, I think under the circumstances that their doctors should reach out to them. We need a way to get people who are not conscientious about avoiding spreading the virus to get with the program, and it seems to me the most promising path is for a conversation with their doctor to take place. However, if they’re not initiating it, it is in the national interest that their doctor should.

If I were a doctor, I’d write a letter something like this and send it to all my patients. I might use email but I might use mail, Not one per household, one per individual. This is important.

Dear [Patient – do not address this generically]

I’ve been hearing a lot of ridiculous things about COVID-19. As your doctor, I think it’s important for your safety to set the record straight. Politicians and pundits are not experts in infectious diseases. Doctors are. That’s why I’m writing to you. This is too important to get wrong.

Let’s start with the most ridiculous thing I’ve heard: that COVID-19 is a hoax. It is not a hoax. I have had patients with COVID-19. I’ve spoken to many colleagues who have had COVID patients, and some of those patients have died from this. Many patients who survive have long-term health problems. This is a serious and highly contagious disease that has overloaded hospital capacity in some places. So far, over 170,000 people have died of COVID-19 in the United States alone.

The next ridiculous rumor is that COVID-19 was exported deliberately to kill people overseas. No. This strain of COVID first appeared in Wuhan, China. It spread because local officials were too afraid of their bosses to tell them what was really going on, and so it wasn’t contained early enough and has spread all over the world.

There are ridiculous rumors about all sorts of drugs that can cure you. Right now there is not a drug that can cure you. Period. Believe me, I’d know. Even if they find a promising one, first they have to test it extensively because if they don’t we could end up with a drug that doesn’t work, a drug with dangerous to fatal side effects, or both.

Some people will tell you that small children are less likely to get it. Small children seem to get milder cases most of the time, we don’t yet know why, but they catch it just as easily as everyone else and they spread it just as easily as everyone else. Even if a child who contracts it doesn’t get a serious case, they’re likely to spread it to someone who will.

I’ve also heard a rumor that COVID-19 can’t kill young adults such as traditional age college students. It doesn’t kill them as often as it kills older people, but it can definitely kill them. The people most at risk are people with compromised immune systems, people with lung problems – because COVID-19 attacks lungs, and people over 65, especially men. Everyone is at risk but these are the people most likely to die from COVID-19.

Now I’ll tell you most of what you need to know about COVID-19. It can take up to two weeks from exposure until the first symptoms and during that period it can be spread, so if you interact with someone who has no symptoms they could still be carrying it and could still infect you. The first symptom is typically fever. If you’re getting other symptoms without fever, whatever you have probably isn’t COVID-19.

There are two ways most people get it. One is by touching a surface with the virus such as a doorknob, water fountain button, or someone’s hand, then touching their face. If they touch their eyelids, nostrils, or lips, the virus will easily enter the body. This is incidentally a very typical way to catch a cold. This is why we advise against touching your face and why we tell you to wash your hands thoroughly and often. It is very rare that the virus spreads through packaging, so you are highly unlikely to contract it from touching your groceries, for example.

The other way, the more common way, is they inhale droplets in the air that contain the virus. The way to inhale enough to catch it is either to inhale a high concentration quickly or a lower concentration over a long enough period. If, for example, you’re in a car with someone who has it, you both wear masks, and you drive for hours without opening a window, you’re at serious risk. Long periods in small enclosed spaces are dangerous. This is why being outdoors is safer than being indoors.

The more infected droplets get into the air per breath (like by singing, which has the further disadvantage of having other singers inhale droplets particularly deeply into their lungs, or by exercising with others in a gym, same thing) and the farther they project, the higher the risk of spread. Coughs are dangerous because of how far they project, which is why you’re encouraged to cough into your elbow. Not into your hands, because if you then touch a surface that someone else touches, you spread it the other way.

This is why masks are important: they strongly reduce how far droplets project. Keep in mind that after a while droplets drop out of the air, and we’re way better off if that happens before anyone inhales them. The reason we distance by six feet is because droplets don’t normally project that far through masks. Without masks the necessary distance would be far greater. Masks may protect you, particularly if you’re wearing an N95 mask properly, but their main purpose is to protect everyone else. If you refuse to wear a mask, it is not primarily your own health you’re risking, it’s the health of everyone around you. As to your right not to wear a mask, assuming you don’t think minimizing the risk of infecting anyone else is important, limiting how far you might project infected droplets is not very different from limiting your ability to bother people around you with second hand cigarette smoke. In fact, not wearing a mask endangers others far more. Everyone understands they can’t smoke indoors and yet some people think they should be able to go into public spaces without wearing masks. This makes no sense; no one has the God-given right to infect people around them. [Thanks to my stepfather for the smoking comparison.] If everyone wore masks whenever interacting with anyone else, COVID-19 cases would drop to almost nothing very quickly. Masks are that effective.

Masks only reduce the projection of droplets if they cover where you exhale. If you leave your nose and/or mouth uncovered, your mask is essentially useless.

Before I wrap up, let me go back to who is at risk. Those who are young and healthy and not too worried about catching COVID-19, even though it can get them really sick, should be very worried about who they could spread it to if they catch it. If they bring a case home they could endanger their parents and really endanger their grandparents. A young person who goes to a party because they don’t feel at risk could easily kill a member of their family by doing so and, if they don’t, they could easily spread the disease to a peer who could kill a member of their family. Remember, people can be contagious without showing any symptoms.

Testing those around you doesn’t always protect you, particularly if it takes a few days or more to get test results. A person can be tested, get infected in the next couple of days, then get back a negative result, at which point everyone will assume they’re safe. Even if you get results within hours, the only way to stay anything like safe with testing is if everyone you come in contact with is tested. I know of a university that is opening to students and is administering fast result tests to everyone in the residence halls. That’s great but they’re not testing students who live off campus and the two student populations interact. This is a recipe for early closure.

The most important thing I have to tell you is that masks are important. The only way we’re going to get through this any time soon without tens of thousands of additional deaths is for everyone to wear masks. This means covering your nose and mouth, it means wearing one whenever you’re indoors outside your own home, it means if you’re in a restaurant you wear one if you get up to go to the bathroom, it means wearing one at the drive-through window, it means wearing one outdoors if you’re anywhere near anyone else. It means assuming you’re contagious whenever you’re in public.

Don’t wait for other solutions. People will tell you about herd immunity, vaccines that are showing up tomorrow, drug cures, whatever. All of that is premature and we don’t know by how much. What we know is that masks work now.

So wear one. If you find one with multiple layers of fabric it will probably keep you safer.

Your Doctor