We are supposed to be practicing what’s called “social distancing,” essentially remaining out of communal settings, avoiding gatherings, and maintaining a proper distance (approximately 6 feet) from others whenever possible. But the point of this is not just to keep ourselves healthy, but to do our part in avoiding a disaster at the nation’s hospitals that could devastate communities and families, and cost many health care workers their lives. This is part of a mitigation strategy to help slow the community transmission of COVID-19, the disease caused by the novel coronavirus (SARS-CoV-2). But as health care systems across the country race (and struggle) to manage the surge of patients, some people are questioning the value of social distancing—and still others are ignoring it altogether.
As the COVID-19 pandemic infiltrates our communities, we asked Steven Choi, MD, who is in charge of overseeing quality and safety at both Yale Medicine and the Yale New Haven Health System, what people really need to know right now.
“More than ever, we need our fellow citizens to act responsibly in all our communities,” says Dr. Choi. “Being responsible means you have to consistently do all the things that we have been asking you to do: Wash your hands, cover your face when you sneeze, and practice diligent social distancing. Don’t travel using any forms of mass transit unless absolutely necessary. Don’t promote the spread of this disease by going to the airport and sitting in a plane for hours. And don’t help accelerate the transmission by going to parties.”
As individuals and for the benefit of our community, we shouldn’t start bending the rules by getting together socially at a park or in each other’s homes because we don’t think the situation is as serious as the news is reporting, he says.
“In the end, this battle will be won or lost by our communities, not by the doctors and hospitals,” says Dr. Choi. “There is very little we can do once the surge begins to overwhelm the resources at our hospitals.”
According to Dr. Choi, there are significant challenges ahead. Below are eight things he’d like everyone to know in the weeks and months ahead:
1. Every area is being hit hard with COVID-19
"There’s no area in the United States that is not at risk for an outbreak," he says. "For example, cases in New York have rapidly soared in just a few weeks. Every state in the nation now reports new COVID-19 cases that continue to climb every day."
2. It’s important to take every precaution we can
"The likelihood of people taking measures to completely isolate themselves for long periods of time—weeks, months—is really low. However, it’s important to take every precaution we can," he says. "Even if we 'bunker down' at home, eventually we have to go out and get provisions. Whenever possible, try to order your provisions, food, and your essentials. As long as you’re not ill, you can still spend time and enjoy the outdoors, but please continue to exercise social distancing."
3. We will need to be innovative to meet the immediate personal protective equipment (PPE) needs of health care workers caring for patients
"The current shortage of PPE will continue until this pandemic is over," he says. "We will never have enough for what we anticipate, in large part because many of the manufacturers are located outside the U.S. in countries that have already been devastated by this virus. It may take months before production can resume and/or meet the new demands for these supplies."
4. A surge of COVID-19 patients will overwhelm hospitals
"About 10 to 20% of those infected with COVID-19 will require hospitalization and about half of them will need intensive care unit (ICU) care," he says. "Yale New Haven hospital has approximately 1,500 beds—even if all of them could be converted to ICU beds, it still wouldn’t be enough. That’s because most ICU patients are only in the unit for a few days, whereas COVID-19 patients typically require far longer ICU stays [several weeks or more]."
5. Understand how social distancing can play a key role
"The chances of contracting the disease because you were briefly in the same room as someone who eventually tested positive is very low," Dr. Choi says. "But if you are in close contact—within six feet and/or for a prolonged period of time—you could be at high risk for the infection. Other interactions, such as an infected person coughing or sneezing in close proximity, would also increase the risk of transmission."
6. Take precautions and monitor your symptoms
"We are advising everyone to take twice-daily temperatures and monitor themselves at home for additional symptoms such as a cough, headaches, and body aches, as well as a runny nose, sore throat, and even gastrointestinal symptoms, including vomiting, diarrhea, or abdominal discomfort," he says. "Because COVID-19 is now transmitted in all our communities, it’s essential that we do this even if we don’t have a history of a close contact with a COVID-19-infected patient."
7. Understand how COVID-19 can be transmitted
"If you hear doctors use the phrase 'shedding the virus,' it means you are contagious—it can be transmitted, and it can infect others around you through respiratory droplets," he says. "Early reports have indicated that there is a very small percentage of COVID-19 transmission that occurs while patients are asymptomatic. Likewise, there is also a risk of transmission after a patient recovers and becomes asymptomatic. However, the highest rate of transmission occurs when people are actively sick with symptoms, particularly early in the course of the illness."
8. Self-isolate, when necessary
"If you have a close contact—a partner or family member at home with laboratory-confirmed COVID-19 infection—we recommend that you and others isolate yourselves at home—away from that infected individual—and monitor your symptoms," Dr. Choi says. "If you do develop symptoms, you should contact your primary care physician and be evaluated for testing."
For the reasons mentioned above, Dr. Choi is asking that people put off unnecessary medical procedures and take extra care to reduce the chances of needing to go the emergency department. “For everyone’s safety, we are deferring all non-urgent surgeries and procedures, as well as patient visits, to protect our patients and our health care workers, and to preserve our healthcare resources. PPE is critical to properly care for patients with COVID-19 and will be rapidly depleted during this outbreak.”
(Yale Medicine has increased Telehealth services, so that patients can have virtual visits to minimize risk to patients and the health care environment.)
In our communities, people seem to fall into two camps, says Dr. Choi. “Some people are not informed and not as worried when they should be,” he says. “And then there are those who are well-informed and very concerned. I am one of them. I am concerned for our patients, my colleagues, our communities, and our nation,” says Dr. Choi, who urges everyone to be kind, patient, and empathic during this crisis. “Take care of yourself and each other.”
Call the Yale Medicine/Yale New Haven Health COVID-19 Call Center, where health care professionals are available to answer your questions seven days a week, 7 am – 7 pm. 203-688-1700.