#covid19: Primary Prevention is Not Enough
In quarantine for another 24 hours due to a cough with fever, now thankfully getting better. So here are my quarantine thoughts on how *you* can get through this stronger than ever.
First, I'll discuss some basic preventive medicine principles, then I'll give the specific measures I am taking and recommend you take as well. Finally, there's a personal note.
Preventive medicine involves primary, secondary, and tertiary measures. Primary prevention is the prevention of catching the disease. Secondary prevention is the early detection of disease. And tertiary prevention is the prevention of side-effects of disease, or in the case of covid19, steps to maximize your chance of survival if you get infected.
Primary prevention of covid19 involves measures to prevent ever getting the virus. Wash your hands. Engage in physical distancing. Quarantine affected individuals. Clean surfaces and the air.
Secondary prevention involves the early detection of of covid19. Get tested early if you have symptoms. Help make tests easily and widely available; make the tests free of charge so there are no financial barriers to being tested; and finally we need to make the tests available without a doctor's order.
Tertiary prevention involves taking measures to decrease the impact of covid19 infection if you get the disease, mainly by decreasing adverse side-effects. For example, a person with a coronovirus infection may be treated with hydroxychloroquine, but they may take another medicine such as ondansetron to prevent the side-effect of nausea.
For covid19 our public health officials so far are taking correct, but incomplete measures. They are doing great at addressing primary prevention by stressing we all take common sense measures to prevent catching the disease.
They are behind the curve, but rapidly catching up in terms of secondary prevention. Test kits for covid19 have been in short supply but availability is ramping up quickly now.
However, our public health officials need to work much more aggressively on tertiary prevention. This involves getting people to take measures right now to increase their chances of surviving if they get infected by covid19. All of us should stay active, eat right, and not smoke or vape. These measures are hard to implement widely, but even small improvements will significantly decrease the chances of dying if you get infected. So let's look more closely at tertiary prevention, since it has been largely ignored to date.
First, stay active. The most serious complication of covid19 infection is acute respiratory distress syndrome. The virus attacks the lungs, and this is generally how it kills people. So right now, make your lungs as healthy as possible. This means staying active and not smoking or vaping. We know from surgical studies that people who stop smoking even for a week prior to surgery have significantly fewer side-effects. We don't know how long this coronovirus pandemic is going to last, so right now is a good time to optimize your exercise program. Get your lungs and entire cardiovascular system as healthy as possible. Walking is a great exercise for your lungs, so is laughing, so is singing, so is weight lifting. Find an exercise you enjoy, do it in moderation but with a plan to gradually improve your health and strengthen your lungs.
Second, eat right. If you get infected by covid19 you want your entire body ready to respond quickly and aggressively. Many people who get infected don't even know it, because their body fights off the infection so fast. Others, however, get sick, some to the point of requiring hospitalization, and some to the point of death. The healthier you are prior to getting infected, the more likely you won't even know you got it and the less likely you are to die from it. Have the attitude that if you get infected, you'll be okay because you are maximizing your fitness right now.
Finally, strengthen your thoughts and your spirit. The will to live is a powerful force. It is real. But when you get sick, often it can be greatly challenging from a spiritual standpoint. Feelings of depression and hopelessness can weaken your ability to fight off the infection. The best strategy is to prepare yourself mentally for the possibility of getting covid19 or for that matter any other illness. Have the attitude that you will stay strong spiritually no matter what. Your thoughts will remain hopeful. You will continue to love life, love your family, love your friends no matter what. You will help strengthen other people's spirits by your generosity, kindness, laughter, compassion, and love. Love will overcome the fear and hopelessness, but it can be very challenging when you're sick. It is best to take measures right now to keep your spirit strong and healthy.
So your plan should be to take all 3 steps of prevention:
a) do everything you can to never catch the disease. Clean your hands, your air, your environment. Support the rapid development of a vaccine.
b) if you get exposed or start getting symptoms such as fever with a cough, get tested early because there are treatments available right now and new treatments will be identified. These always will work better early in the course of the infection. Early detection of infection will help you, and help you take measures to not infect others. Push the system to make tests widely available.
c) get as healthy as possible right now. Stay active and exercise regularly. Eat right. Don't smoke or vape. And keep your spirit strong, enthusiastic, and optimistic. Keep the love flowing in your life.
I share these thoughts with you not as a professor, or a doctor, but as a friend. We are all physically isolated now, but socially we remain strong and together.
As someone who has suffered from acute respiratory distress syndrome, who was placed in a medical coma and put on a ventilator; someone whose lungs were almost destroyed by an overwhelming infection; and someone who faced death very intimately but survived, I implore you to not just wash your hands and get tested if needed. Take major action right now to improve your overall health, and to strengthen your spirit.
I went into my medical misadventure pretty well prepared, yet it nearly got me. It was razor close. But the disease lost. Due to the measures I took ahead of time to stay as healthy as possible, due to my incredible doctors and nurses at Deaconess, due to the love from my family & friends, due to my crazy optimism, and by the grace of God I survived. Maybe just so I could pass along this message to you.
Stay safe, eat well, laugh often, and tell people you love them.