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COVID Crisis Post 2: The Original COVID Mini-Primer.



So this is a VERY lengthy post because I wanted it to be a mini-primer regarding the virus itself and comment on the challenges doctors are facing for a variety of reasons, and I felt it would be helpful. I expect moving forward, my posts will be MUCH more brief. So please bear with me, and I hope by the end you found this worthwhile. Here goes:


Happy St. Patrick's Day, everyone.


Many people do not realize what a disaster NYC would've been today had Mayor de Blasio not signed the executive order for all restaurants and bars to be shut down - trust me, it would've been bad. And it would've been worse due to the additional stress it very likely would've put on our hospital systems. Because even despite of the executive order, there STILL was a group of people who did a mini-parade down 5th Avenue at 7am. Look, I'm Punjabi who are essentially the Irish of India. So I love St. Patty's. But jeezus people, seriously?? 🤦🏽‍♂️


Quick additional note: please still find SAFE ways to support your local businesses through this unprecedented time. Their existence and employees are depending on us.

There is a LOT we still do not know about this virus. We are learning as we go and we really appreciate your patience as we attempt to get a handle on this new type of Coronavirus (which is a family of viruses, one of which just causes the common cold and two of which cause MERS/SARS).


We have seen many of its short-term effects on the human body but still do not fully understand why they occur. And we definitely know little about its long-term effects/consequences at this point.


We do know that the elderly (60+), smokers, and those with chronic illnesses including pulmonary disease, hypertension, diabetes, coronary artery disease, being obese, and being immunosuppressed are all risk factors for more severe disease.


There is research being done on increased expression/up-regulation of ACE2 receptors being a significant risk factor for severe disease since this is the receptor in the lungs to which COVID-19 binds (https://www.thelancet.com/…/PIIS2213-2600(20)30116…/fulltext).


We are seeing the disease affect multiple organ systems (not just the lungs) in the most severe cases.


Children 18 and under seem to be very resistant to the severe effects of the disease, and pregnant women do not tend to be at increased risk (and as stated, even newborns who've been determined to be COVID-19+ seem to be completely asymptomatic). But they can still be asymptomatic carriers and spread the disease to the most vulnerable.


And we are also still learning from our grief-stricken colleagues in Italy who still are facing an uphill battle.


SOCIAL DISTANCING + HYGIENE = FLATTENING THE CURVE. So essential. And I will admit I did not take this as seriously as I do now. And I'm sorry for putting people at risk as a result.


And I am happy to be one of those people on the front lines to protect you all since I (fortunately) do not have many of those risk factors as a young, healthy adult, and my theory is that as healthcare providers we have exposed our own immune systems to numerous pathogens over the years and so are better able to deal with new pathogens as a result. But also...


PLEASE STOP THE DISSEMINATION OF FALSE INFO, THIS DOES NOT HELP ANYONE.


If you are unsure if something you heard or read is real or not, PLEASE JUST ASK. I have been getting inundated with questions about COVID-19 daily and have been super happy to answer any and all questions to the best of my ability!


And finally... PLEASE VACCINATE YOURSELVES AND YOUR CHILDREN. Many people are anxiously awaiting the development of a vaccine for COVID-19, and if you are someone who has made the choice in the past to not vaccinate for other diseases, I hope this entire ordeal has made you reconsider your stance!


VACCINES SAVE LIVES. HERD IMMUNITY IS REAL AND ESSENTIAL. END OF STORY.


There have been frustrations with the ramp-up of protections across the country. And many of us are self-advocating for ourselves AND our patients because it feels at times not everyone is on the same page regarding the ultimate goal: PREVENTING THE SPREAD OF COVID-19.


The belief was all elective cases in NYC would be immediately cancelled after the announcement of Mayor de Blasio's executive order. However, we were informed today there is a 96-hour timeframe de Blasio gave to ramp-down elective cases so hence the reason we are where we are. Our leadership has been working behind the scenes with our best interest in mind as well as our safety.


I am hoping once this FINALLY occurs that we find ways to minimize staff on a day-to-day basis, both to conserve resources and ensure in the case of an outbreak amongst some of us, there are healthy replacements to take their place.


Regarding cases - there are basically 3 types of cases: 100% elective unequivocally; 100% urgent/emergent unequivocally; a big mixed cluster-fuck because the distinction between elective vs urgent/emergent procedures has a VERY broad gray area for a variety of reasons, including the surgeons thoughts on the matter.


There are true gray areas such as should a woman with a likely benign mass of her breast but extremely anxious about it be asked to wait 3 months before she can have it removed?

And then seemingly not gray areas, such as a young child with strabismus, which most of the time, is a completely elective case.


I have taken it upon myself to be proactive with my scheduled cases, and so I emailed the surgeon so I could understand his reasoning for booking this case since we are trying to conserve resources and minimize exposure to COVID-19. He wrote back with a very elegant and reasoned response stating in this particular child with his complex history, waiting could be extremely detrimental to his long-term development because with binocular vision, these children tend to rapidly advance neurologically.


I could not have been happier doing the case.


Throughout the city, multiple confirmed cases of COVID-19 have arisen with many more suspected. Hospitals are in the process of ramping up testing. I and a few others have volunteered to be a part of the ICU "bench crew" should additional support be required in the ICU. These next few weeks will truly be our stress test.


There is still a calm here in the city. But only time will tell if our preparations were adequate, or if the storm barrels into us like many are fearing.


Stay safe, my peeps.



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