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“We can’t stop COVID-19 but we can slow it down.” ...Cindy Firkins Smith, M.D.

April 3, 2020
Emmetsburg News

March 31, 2020. That's the day that I'm writing this. It's important that you note that date and the date on anything you read about COVID-19. What we know about it is changing so rapidly that what I say today might very well be different by the time you read this. So, I'll try to stick with things that we do know and are unlikely to change.

SARS-CoV-2 is the virus that causes Coronavirus disease 2019, or COVID-19. You'll hear it referred to by all three names. One of the reasons it's so dangerous is because it's novel, or new. Because it's new no one has developed any immunity or resistance to it and almost everyone who is exposed gets sick, many people get really sick and quite a few people die. Its death rate is about 10x that of influenza. On CNN's State of the Union Sunday, March 29, Dr. Tony Fauci predicted we'd see "millions of cases in the United States, but he didn't want to be held to that because it's such a moving target. He also predicted between 100,000-200,000 deaths. For comparison, on average between 10,000 and 30,000 Americans die of influenza annually (the number varies because people count influenza-related deaths in different ways.)

What makes COVID-19 so scary is the numbers. Eighty percent of people who are exposed catch the virus. Typical symptoms are cough, fever, and shortness of breath, but symptoms vary a lot and vary in severity. Some people barely know they have it and some people feel like they were run over by a truck. About 15-20% of those that get sick need hospitalization and up to half of those that end up in the hospital require a ventilator.

Why is that scary? Once again, it's the numbers. COVID-19 infections are increasing at an exponential rate. On March 1, the US had less than 100 cases. By March 31, our cases had surpassed 180,000, more than both China and Italy; 3564 people have died. It has risen to the third most common cause of death in the US behind heart disease and cancer. That's in just one month. The faster the number of cases increases, the greater the need for hospital beds, ICU units, ventilators, and health care professionals to care for sick people. I don't know the numbers for Palo Alto County but can share ours.

Carris Health is a rural regional health system with its largest regional hospital, Rice Hospital in Willmar, Minnesota. As a regional hospital Rice serves Willmar and the surrounding region with populations of approximately 20,000 and 150,000 respectively. Carris Health is part of CentraCare Health, in St. Cloud, Minnesota. For the past 3 weeks CentraCare and Carris have worked around the clock to prepare for our COVID-19 surge, which is currently predicted to hit sometime between mid-April and mid-May. At Carris we are prepared to serve as both a primary site and as the regional overflow for CentraCare for ill and critically ill Covid-19 patients. Rice Hospital normally has 100 beds, but we are prepared to surge to 180 and working to surge higher. We currently have 32 ventilators. As a state and as a region, Minnesota is also looking at what to do if numbers of severely ill COVID-19 patients surge higher than current capacity to care for them. An additional hospital has opened in St. Paul. A regional group in Western Minnesota is outfitting an old prison to work as a field hospital and other overflow sites are being planned. Why would we need to do that?

Again, it's simple math. So, let's to the math, just for Willmar and let's be conservative. Say 80% of Willmar's 20,000 people get Covid and 20% of those require hospitalization, that's 1600 people for 180 beds. If half of those 1600 people require ventilators, that's 800 people, for 32 ventilators. And that's JUST Willmar, not the surrounding region. Now, not all those people are going to get sick on the same day, but you get the idea. These patients can get very sick quickly and they need care and the more people that get sick at the same time, the harder it will be to take care of them. And that's just sick COVID patients. While all this is happening, we will still have patients with heart attacks and strokes and car accidents and cancer and mamas delivering babies and we'd really like to make sure they all come through it all okay too.

AND ONE MORE THING. We might run out of health care professionals before we run out of hospital beds, ventilators and other stuff. Your hospitals are struggling to find the personal protective equipment (PPE) that committed doctors, nurses, respiratory therapists and everybody else working to save your lives need to do their jobs safely. They're going to get sick too.

So, here's the key point. Don't panic. You can do something. We can't stop COVID-19 but we can slow it down. IF PEOPLE STAY HOME and practice strict social/physical isolation, we can SLOW DOWN THE VIRUS and not everyone will get sick at once. Less people will die unnecessarily because we will be able to catch up and have the supplies, the ventilators and the health care professionals to care for them.

Please do whatever your community needs to help during this pandemic, but the most important thing you can do is this; unless it's essential for work, supplies, or illness, PLEASE STAY HOME.

You may save a life and it may be your own.

Cindy Firkins Smith, MD, is a 1977 graduate of Emmetsburg High School. She is a graduate of the University of Minnesota Medical School, did her internship at Hennepin County Medical Center in Minneapolis and a dermatology residency at the University of Minnesota. She will finish a master's in health care Innovation from the University of Pennsylvania in May. She is former president of the Minnesota Medical Association and has spent her career advocating for rural health. She is currently CEO of Carris Health.



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