Do we need to monitor the exposure of health care staff to COVID-19?
Let me share some general and mutual concerns, hard to be imagined when COVID-19 made its first appearance as a seasonal infection similar to SARS
It is a very difficult time to be a European now. Just three months ago, we couldn’t imagine that the first months of a 2020 “happy” new year will slowly transform, inviting everyone to participate, in a massive epidemiology. The word “epidemiology” derives from the Greek words epi and dêmos and it indicates something that is above people control and sense of will. Sounds like a familiar situation.
We’re calling it the COVID-19 pandemic, the new conquistador dominating populations and embracing us with charm, in a very democratic way. No differences between black and white, Hebrew and Arabs, migrants and citizens, gay and hetero, athletes and couch-potatoes, elders and young. Maybe smart politicians can learn something from its very clever and robust strategy.
Every one of us, no matter the level of our self-confidence, profession, medical knowledge, social involvement, and attention towards the precepts of science is struggling to not reveal weak spot to panic. Experiencing common anxiety and loneliness became the new hashtag trend in popular social media. Our worries tend to assume multiple shapes during long days at home or work trying to maintain distance one from another, keeping watchfulness even if we cannot see this mean enemy. I Yes, this corona virus is aggressive, and I’m one of the many that analyze its poisoning effect by new declared death, freezing the glance on the up-to-date international progression curve of contagion.
People converted to the “foodology” community to get some popularity of social media, cooking as crazy for the whole building they live in or eating unneeded quantities of ready pizzas and homemade cakes. Post photos on such colored artifact is a mandatory daily action. However, this is only one fact reflecting that our intentions reflect a trend: we’re silently tempted to say goodbye to the beach of tranquility by swimming (mostly unconsciously) towards the island of panic.
Chaos seems to reign even at the moment when alone and tired/ annoyed of being alone, we get access to online and offline information channels trying to have some more information on the outside world, aka the city we live in and the hospital situations and equipment for the unbearable inflation of patients. The alarming trajectory is not going well. When we’re not prepared, the unusual and larger fact that hundreds of young people manifest now COVID-19 harsh symptom can blow us some more meters into the tunnel of insecurity, anxiety and mild depression.
Is a new trend for people in their thirties and forties with no real health problems, and #IknowItToo.
Here we go fellas, and sorry for this rather long and personalized introduction.
I’m sharing these thoughts with you as I think that we need more open data regarding the overall level of the contagion in hospitals and new emergent local and worldwide epicenters. Part of our fears, at least mine, live and grow as I don’t know how the level of the virus progression is evolving and spreading. I’m trying to understand how governments want to define the future procedures of care and protection not just for us, citizens, but for who is every day in the first line to save lives!
Despite economic massive procedures to save the economy and workers staying at home as business needed to shutdown to face this crisis, we should hear something more detailed about what is done now to take care of physicians, nurses, volunteers, and medicine students busy and overwhelmed in our hospital corridors. This is important even for the ones, that want to reply to the request to actively participate in this war as volunteers. To help we need to know how to remain healthy.
During this first week of isolation, I identified three points/questions that may deserve some attention. Their comprehension and analysis can change the way actual infected patients are treated and managed to take some additional measures that grant more safety:
- With the quantitative data now at our disposal, how can physicians quantify the increase of the risk of infection, especially when people are exposed to high doses of the virus?
- Which relationship incurs between the first initial dose of the virus and the severity of the disease? In other words, is it correct to think that prolonged exposure to the potentially dangerous environment results in an automatic severe illness after x amount of time?
- Which are the days able to define the peak of the viral load of the patient body and how we predict, according to the symptoms and trend of illness, how infectious they are to others?
None of this question can be fully answered yet if the reference is the World Health Organization and its uploaded situation reports. I have the feeling that now the priority is to measure the spread of the COVID-19 virus ACROSS people and not WITHIN inhabitants, living communities or people of the same working area. OK, the latter may not be an optimal strategy. This is an assumable critique as it requires a set of resources and research hard to reach now, but you may agree on the fact that, generally, models become more efficient and sharper when they have better and complete data.
Considering the open data at our disposal, I’m eager to know how high is the percentage risk of being infected by the people who are daily exposed to hospital environments or areas with a higher percentage of people that diagnosed positive to COVID-19. At the moment the worldwide pandemic management is not clear about this fact. I’m convinced that we need more transparency on this point.
Italy is not the only one fighting with a war that has exploded at the end of February 2020. The battles are uninterrupted day and night, cases are multiplying, and the rate is circa 15-20 admissions per day for the same reason. Just yesterday I heard that in the United States, especially in New-York, cases are increasing and some physicians work like crazy trying to fight the emergency with overlapping shifts in overcrowded E.R. Some of them are getting the virus despite all the recommended precautions and the availability of PPE (personal protective equipment). In some cases, they become severely ill. I can bet that part of them are in their thirties or forties. Imagine the slight degree of stress manifested by a physician, 43 years old, single parent, mother of two children that have no immediate relative able to look after them if something bad happens. I mean, this is a real possibility and is just one of the many we can think about.
But the USA does not need quarantine. Mr. Trumph continues to proclaim and defend the cult of a capitalism god that will protect and bring the country to full production rates levels by Easter. I think this sounds as a very narcissistic bless, probably working for some people…
The situation is very different in our real world where thousands of health-care workers answer now to hundreds of 911 emergency calls, saving lives in a surreal COVID-19 pandemonium. When PPE will become scarce (this is a possibility) it would be fundamental to keep track of the medical staff total exposure and try to find a way to organize viral-dosimetry control systems. We need to find a way to shield and control everyone that have continuous interactions with patients with harsh symptoms.
We keep to heard that our children, friends and relatives embracing their dream to save lives, and have a role in the society are safe as long as they follow the rules of hygiene and have PPE. The high mortality rate is registered in older people, or the ones with previous progressive illnesses and with a poor immune system. BUT this automatic mantra is not sufficient anymore to calm us down as for some reasons that we don’t understand YET, every front-line worker in the health care system have now higher risks to be infected, despite hygiene precautions, equipment, younger age, etc. We still lack information on how other physicians and virologist explain this possibility, following the same scientific principles pointed out one month ago and bearing in mind that emergency measures are maintained.
In some models conducted with the SARS virus (part of the crown viruses family and pretty high transmissible), we can quantify how intense and prolonged is the exposure of the human body as the animal one after an injection of higher doses of pathogens. Almost everyone is likely to develop severe forms of illnesses. But I do not want to adopt a generalization saying that this is what is usually happening in every case and every organism. Following the logic of cause-effect, we can infer that the larger amount of virus would be able to trigger more severe disease by an indirect body response: inflammation and not an infection. But again, this is just the temptation to fall in the hands of hypothesis, as the relationship between a viral dose and the severity of the illness is still unclear.
A strong association between the intensity of how people exposure to the virus and the intensity of the subsequent disease in case they get it, is seen in influenza virus. In this case, we have clear indications that the severity of illness relates to the dose of exposure. A point that makes sense according to basic immunology principles: the interaction amid the virus and the carrier immune system is a race in time. The virus is eager to find enough target cells to accelerate its replication. Only the antiviral response of the immune system can eliminate it. However, if the virus is an athlete able to run fast and get all the bases at disposal, the bigger is the surface to infect the higher are the chances he would be the winner of the “greater disease” competition of the year.
We need to dedicate more attention to understand the link between the amount of the dose of COVID-19 people get in contact with, and the possible contracted disease harshness. I remember that when my father was in Germany, fighting with a severe lungs tumor, he accepted to go through the complex body change due to multiple medical treatments. Some canonical, such as radiotherapy and chemotherapy, some rather experimental, being one of the multiple warriors accepting to go in the defense line of the randomized phase II of “fantastic” treatments trials. During that time, he was under constant monitoring to measure its radiation exposure and I needed to avoid to see him immediately after therapy as he was still radioactive. Well, I am claiming that a similar procedure of radiation dosimetry, should be developed or at least set-up in our research priorities list to quantify the hospital worker total exposure to the virus over a defined period. I mean, we need new measures to protect doctors, nurses, paramedics and volunteers that have the RIGHT TO KNOW if they reached a recommended limit. By the way, what is the recommended limit?!?
Establishing a relationship between dose and venom (disease) severity could, in turn, affect patient care. If we could identify per-symptomatic patients who were likely exposed to the highest doses of virus (cohabitants of a sick family member or medical staff exposed to a set of patients with larger amounts of COVID-19) we might predict a more severe experience of the disease, and give them priority when it came to limited medical resources. This can enable a faster, earlier, or more intense treatment. Especially because the shortage of ventilators and reanimation units is already a reality.
I’m finishing saying that the care procedures of COVID-19 patients should change or at least be under careful experts’ analysis as we did not reach yet the peak phase. We need to begin to track virus counts. These parameters could be gauged using fairly inexpensive and easily available laboratory methods. Imagine a two-step process: first, identifying infected patients, and then quantifying viral loads in nasal or respiratory secretions, particularly in patients who are likely to require the highest level of treatment. We can optimize plans of care or isolation.
I’m leaving you as my homemade pizza (without yeast, as apparently it becomes as gold in a Mississipi river) is claiming some attention to get in the oven and transform itself into an eatable good. See, no difference between you, me and the multitude in terms of food relationships. What changed are my standards regarding the level of public clarity, for everyone.