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When anyone looks for guidance for best practices for COVID-19, confusion reigns: will there be a safe and effective vaccine? Is Regeneron's antibody cocktail a cure? Does Remdesavir reverse the effects of COVID-19 on the body? How can we reduce the spread of the virus? Questions continue to mount up as high as the Empire State Building.

In our topsy-turvy world, I am discouraged that many of our citizens use news media outlets and Facebook news feeds to give them information about the Pandemic. The Pandemic is one political hot mess. No matter who you are, or where you live, or what race you are, or who you pray to at night, or whether you pray at all, the only way to reduce the upcoming disaster in this country is for everyone to wear a mask in public and find a way to keep a safe distance from anyone not in your bubble.

If anyone doubts that the impacts of COVID on our medical system are significant, think again.

RH is a patient who has had a super-bug infection. He has tried everything to rid himself of the chronic active condition to no avail. Several years ago, he flew to Tbilisi, Georgia, to undergo an experimental procedure. Scientists gave him a bacteriophage to infect the drug-resistant bacteria causing him several serious medical problems. Initially, the treatment was successful; over time, the success wore off.  

Over the past few months, physicians at the Mayo Clinic finally accepted him in consultation.  An infectious disease consultant took an interest in him. At Mayo, his care team notified us that he was under intravenous treatment at Mayo, and he needed follow-up antibiotic infusions for seven weeks in Memphis. Surgeons had put in a PIC line for his chronic ongoing therapy. The care team at Mayo insisted that our patient receive treatment by an infectious disease specialist. They identified the Threlkeld Infectious Disease group (TIDG) for follow-up care in Memphis.

My nurse Tammy called the TIDG. Initially, she had trouble getting anyone to answer their phone. After several calls, she finally got a human on the line. Tammy explained the situation to the scheduler. The scheduler replied, "We are not taking any new patients at this time. We had to move all of our nurse practitioners in the hospitals to care for the COVID patients. There is no one in the office to see patients. I'm sorry, but you will have to find someone else to care for him."

There are four physicians and seven nurse practitioners seeing patients in the TIDG practice; four of the nurse practitioners work exclusively in the hospital setting. Coronavirus infections have depleted the infectious disease specialists in the city. The H1N1 influenza pandemic in 2009 had 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States. Our city was not devoid of infectious disease specialists evaluating new patients or taking transfers-of-care in 2009.

The impact of Coronavirus infections in our community is critical to anyone suffering from illnesses other than COVID-19. According to the National Center for Health Statistics, the overall number of U.S. deaths between March and May was 781,000—or 122,300 more than the historical average for the period. The overall number of for the same three-month period, the number of deaths officially listed due to COVID-19 was 95,235—or 28% less than that excess number. In a nutshell, many more deaths are associated with the Pandemic, not directly attributed to viral infection.

Nationwide 7,636,944 people have tested positive for the virus; 212,844 have died. The virus has infected 211,003 Tennesseans, 2,732 have died. In Shelby County, 32,477 people have tested positive, 529 have perished.

These are sobering statistics. If our citizens do not start to take measures to reduce the spread of COVID-19, I predict that 300,000 people will be dead in the U.S. by Thanksgiving, and 400,000 people will have died in the U.S. by Christmas. If our citizens still cannot reduce the spread, 600,000 will be dead in the U.S. by Easter 2021.

Anyone can argue the validity of the death count related to those who have died by coronavirus infection. In the 2009 H1N1 pandemic, mathematical models were used to predict the number of deaths from the flu. U.S. officials are counting the number of dead in this Pandemic, not estimating it.

People in our community must wear a mask and refrain from being moderate to large gatherings to reduce the virus's spread. We have to protect ourselves and others. As far as answering the other questions, their answers are complicated and beyond my blog's scope.

What is going to happen to RH's treatment? Who will care for him? As usual, we'll figure it out at the Stone Institute. We always do.

Doc

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