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At the Front Lines of Coronavirus, Turning to Social Media At the Front Lines of Coronavirus, Turning to Social Media
(2 months later)
Last week, many people were astonished to hear that Dr. Kurt Kloss, an emergency room physician in New York, reached out to a Facebook group for some 20,000 of his colleagues seeking advice about how to handle the coronavirus outbreak. “If you were in charge of Federal response to the Pandemic,” his post began, “what would your recommendation be?”Last week, many people were astonished to hear that Dr. Kurt Kloss, an emergency room physician in New York, reached out to a Facebook group for some 20,000 of his colleagues seeking advice about how to handle the coronavirus outbreak. “If you were in charge of Federal response to the Pandemic,” his post began, “what would your recommendation be?”
The question wasn’t just hypothetical. Dr. Kloss’s daughter is married to the brother of Jared Kushner, who had been put in charge of the White House response to the pandemic. But many people commented in alarm: Crowdsourcing medical advice on social media, is that a reliable way to get life-or-death health information?The question wasn’t just hypothetical. Dr. Kloss’s daughter is married to the brother of Jared Kushner, who had been put in charge of the White House response to the pandemic. But many people commented in alarm: Crowdsourcing medical advice on social media, is that a reliable way to get life-or-death health information?
As an emergency room doctor at the front lines of the pandemic, however, I wasn’t surprised. I’ve been working back-to-back shifts at NewYork-Presbyterian Hospital, where the state’s first patient hospitalized with Covid-19 is being treated, and have had several patients test positive for the novel coronavirus. And like many of my colleagues, I have been gathering information from Facebook, Twitter and other social media outlets.As an emergency room doctor at the front lines of the pandemic, however, I wasn’t surprised. I’ve been working back-to-back shifts at NewYork-Presbyterian Hospital, where the state’s first patient hospitalized with Covid-19 is being treated, and have had several patients test positive for the novel coronavirus. And like many of my colleagues, I have been gathering information from Facebook, Twitter and other social media outlets.
One private Facebook group I’m a member of, created by Dr. Kabir Rezvankhoo, an E.R. and intensive-care-unit doctor in Texas whom I used to work with, is reserved for doctors who have or are likely to care for critically ill patients with Covid-19. The group quickly grew to nearly 15,000 members. When I asked Dr. Rezvankhoo why he initiated the group, his reply was simple: “Because information on the new coronavirus is difficult to come across.”One private Facebook group I’m a member of, created by Dr. Kabir Rezvankhoo, an E.R. and intensive-care-unit doctor in Texas whom I used to work with, is reserved for doctors who have or are likely to care for critically ill patients with Covid-19. The group quickly grew to nearly 15,000 members. When I asked Dr. Rezvankhoo why he initiated the group, his reply was simple: “Because information on the new coronavirus is difficult to come across.”
He’s not the only one who feels this way. Another Covid-19 Facebook group I recently joined, which is less restrictive and intended for all health care providers, has more than 100,000 members. The group’s administrator says hundreds of posts come through every hour.He’s not the only one who feels this way. Another Covid-19 Facebook group I recently joined, which is less restrictive and intended for all health care providers, has more than 100,000 members. The group’s administrator says hundreds of posts come through every hour.
For the past few weeks, after I get home from my shifts in the emergency room, I scroll through Facebook pages on my laptop, getting firsthand stories from doctors in Italy, China and Iran. I scan through their patients’ ultrasound and CT scans, review their blood tests, read day-by-day accounts of their clinical progress and listen to retrospective thoughts of what worked well — and what didn’t.For the past few weeks, after I get home from my shifts in the emergency room, I scroll through Facebook pages on my laptop, getting firsthand stories from doctors in Italy, China and Iran. I scan through their patients’ ultrasound and CT scans, review their blood tests, read day-by-day accounts of their clinical progress and listen to retrospective thoughts of what worked well — and what didn’t.
Then I open another browser tab and pull up Twitter, perusing the page for any new information. I pause at a small study here, a letter in an academic journal there. Any clinical information I can find, even an anecdote about a single patient, feels very useful.Then I open another browser tab and pull up Twitter, perusing the page for any new information. I pause at a small study here, a letter in an academic journal there. Any clinical information I can find, even an anecdote about a single patient, feels very useful.
This is a new virus, and best clinical practices about how to treat the growing caseload of infections is scarce and evolving. I don’t say this to frighten patients; I understand how they feel.This is a new virus, and best clinical practices about how to treat the growing caseload of infections is scarce and evolving. I don’t say this to frighten patients; I understand how they feel.
I, too, am distressed by the ever-changing guidelines, the seemingly inconsistent messages, the uncertainty. One day it is strictly mandated that we are to wear one type of mask; the next day, we’re told they’re unnecessary. Each evening, different instructions arrive by email, as policymakers try to piece together the latest evidence as fast as they can.I, too, am distressed by the ever-changing guidelines, the seemingly inconsistent messages, the uncertainty. One day it is strictly mandated that we are to wear one type of mask; the next day, we’re told they’re unnecessary. Each evening, different instructions arrive by email, as policymakers try to piece together the latest evidence as fast as they can.
But as I continue to open the Facebook group page each time a bell alerts me that a new post has appeared, I realize that doctors have to readily concede that we don’t always know what to do next, that we still need to figure out the best way to care for patients.But as I continue to open the Facebook group page each time a bell alerts me that a new post has appeared, I realize that doctors have to readily concede that we don’t always know what to do next, that we still need to figure out the best way to care for patients.
More than a century ago, Dr. William Osler, a founder of Johns Hopkins who revolutionized American medical education and training, said, “Medicine is a science of uncertainty and an art of probability.” He understood that medicine is not exact. It requires asking questions and openly expressing our concerns and our doubts — a surrender of confidence in our own knowledge, an admission that we may find ourselves in unfamiliar territory.More than a century ago, Dr. William Osler, a founder of Johns Hopkins who revolutionized American medical education and training, said, “Medicine is a science of uncertainty and an art of probability.” He understood that medicine is not exact. It requires asking questions and openly expressing our concerns and our doubts — a surrender of confidence in our own knowledge, an admission that we may find ourselves in unfamiliar territory.
Today, doctors are fortunate to be able to do this in online forums that span the globe. We are able to freely admit what we don’t know about this new virus, to try to translate what our colleagues in Italy and around the world have learned to the hospitals where we currently work.Today, doctors are fortunate to be able to do this in online forums that span the globe. We are able to freely admit what we don’t know about this new virus, to try to translate what our colleagues in Italy and around the world have learned to the hospitals where we currently work.
I also get to gauge how my fellow doctors are doing mentally and emotionally, how we’re coping with the uncertainty of what’s to come. Many compare their experience to being sent to the front lines of war, in some cases unarmed as supplies of masks and hand sanitizers run low. Others ask if they should move out of their homes so they don’t potentially expose their families to infection. We wonder how the two critically ill E.R. doctors in Washington and New Jersey are doing.I also get to gauge how my fellow doctors are doing mentally and emotionally, how we’re coping with the uncertainty of what’s to come. Many compare their experience to being sent to the front lines of war, in some cases unarmed as supplies of masks and hand sanitizers run low. Others ask if they should move out of their homes so they don’t potentially expose their families to infection. We wonder how the two critically ill E.R. doctors in Washington and New Jersey are doing.
Updated June 1, 2020
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
Under normal circumstances in the emergency room, before this pandemic, I admit that I often felt too busy to consistently make eye contact with my colleagues as we rushed about to care for our patients. But since the coronavirus outbreak, we all somehow manage to look at one another.Under normal circumstances in the emergency room, before this pandemic, I admit that I often felt too busy to consistently make eye contact with my colleagues as we rushed about to care for our patients. But since the coronavirus outbreak, we all somehow manage to look at one another.
With only our eyes showing behind our goggles and face shields and the rest of our expressions covered by masks, my colleagues and I are still able to communicate without saying a word. Sometimes, we exchange looks of bewilderment and confusion. Other times, I see the same fatigue and frustration reflected back at me. Occasionally, I glimpse my own fear in their eyes.With only our eyes showing behind our goggles and face shields and the rest of our expressions covered by masks, my colleagues and I are still able to communicate without saying a word. Sometimes, we exchange looks of bewilderment and confusion. Other times, I see the same fatigue and frustration reflected back at me. Occasionally, I glimpse my own fear in their eyes.
Most often, though, I see the conviction that we will get through this. We may still be trying to determine the specific clinical prescription to follow to most effectively care for patients critically infected with the new coronavirus. But we will continue to treat the sick as we have always done, even in the face of great uncertainty.Most often, though, I see the conviction that we will get through this. We may still be trying to determine the specific clinical prescription to follow to most effectively care for patients critically infected with the new coronavirus. But we will continue to treat the sick as we have always done, even in the face of great uncertainty.
Helen Ouyang (@drhelenouyang) is a writer, doctor and assistant professor of emergency medicine at Columbia University.Helen Ouyang (@drhelenouyang) is a writer, doctor and assistant professor of emergency medicine at Columbia University.