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COVID Crisis Post 50: COVID is Poopy.

This is fucking senseless. A security guard at a Dollar Store in Flint, MI, was shot in the head and killed. Over a mask. A fucking mask.

These actions are what lead me to believe there will be many more deaths to come before this pandemic is over. Too many people do not value life besides their own, and therefore, they will not take the actions required to protect others.

This is why I believe the year will continue to be painful due to the actions of a very stupid and/or misinformed minority of the population. Just ugh.

And a bit more sobering news.

I have discussed this with many of my intensivist colleagues, and the consensus seems to be the following: no one has ANY idea if we have become any better at treating COVID-19. Yes, the patients seem to be SURVIVING longer. But the most important questions to ask:

- Are we impacting mortality or only prolonging death? - In those who survive, what disability and/or chronic health issues will they be left with, if any? - Will they require long-term care? - What will be their quality of life?

Saving lives is essential. But giving back a life the patient feels is one worth living is equally important.

Medicine constantly changes. And the hope is the later you get sick, the better your treatment options will be since our understanding of the disease process should grow. But our knowledge of this disease process has grown slowly, and if anything, the pathophysiology of the disease has become even more complex as new manifestations continually present themselves.

Remdesivir MAY be the first drug to alter the course of the disease, but I still have doubts. Decreased length of stay is not what I am interested in. I am interested in decreased mortality and improved long-term outcomes associated with the disease. THIS is still TBD.

BUT on a lighter note, I have learned throughout this pandemic how amazing and forward-thinking scientists can be.

And the area of research of Krista Wiggington, an environmental engineer at The University of Michigan - again, where you at, Ohio State??? - had me saying, "Shit?? Seriously?? No shit!!"

Her area of research, which focuses on how sewage may give insight into the spread of COVID-19, may be one of the few instances where being full of shit could save lives.

Surveillance of sewage water has been used for decades to predict the start or resolution of viral outbreaks, including polio and Hepatitis A. In the case of polio, measuring viral load in sewage water allowed the WHO to evaluate the effectiveness of their vaccine campaign (spoiler: the vaccine worked with a greater than 99% reduction in polio cases worldwide - shocking, not shocking). As of today, 2 out of the 3 strains of polio have been fully eradicated with only wild poliovirus type 1 remaining in Afghanistan and Pakistan.

Repeat after me: Vaccines. Save. Lives.

In regards to COVID-19, outbreaks could also potentially be monitored via sewage sampling, though the average viral shed of an infected individual is yet to be determined. Researchers have already seen examples where SARS-CoV-2 genes have been found in sewage samples days before the first confirmed case appeared in a town.

In addition, as the number of confirmed cases has increased, they have concomitantly seen an increase in viral gene load in sewage samples across the globe, including the US. The hope would be to further hone in on high-risk communities, such as nursing homes, and predict outbreaks so residents can be protected before the virus becomes more widespread.

That is some good shit, if I do say so myself.

Some quick comments:

1. The Kawasaki-like syndrome I spoke about on Day 44 is being seen more frequently. Please, be on the lookout with your kids and KEEP PROTECTING THEM, masks and all. Kids rarely get sick, but they still DO get sick.

2. If friends STILL do not understand how masks work to protect others, here is a visual 🙂:

3. There has been a tremendous economic stress placed on many. But also recognize how tenuous individuals finances were prior to the pandemic. Approximately 60% of the nation lives paycheck-to-paycheck, many who live with very little savings. There are people who had no other choice but to do so. But there are also many whose own choices left them wholly unprepared. And this has been a harsh reality for many as a result.

4. I just had to mention how badly I would scream and run if I ever saw an Asian Giant Hornet aka Murder Hornet near me. I literally would shit in my pants. Which would be a waste since I could have possibly contributed to improved COVID-19 surveillance. Poop.

If hindsight is 2020, this is going to be one shitty year to look back on.

*Last poop joke, but hey, cut me some slack - I AM a pediatric anesthesiologist. I need to be able to relate to kids. So therefore, enjoying poop jokes is a part of my job description. Duh.


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