Surgical procedures, for Mario, aren't just done in the hospital. Photo: Dave Matthew
The Current Reality Of COVID-19 According To A Tube-Savvy ER Doctor
“The truth is, we’re still early in this” - Dr. Mario Quiros
Society is reopening, if only slightly. This spoonful of freedom, however, is bland. It’s hard to feel like we’re on the other side of this thing. Wearing masks in public is the norm, ripping that mask off when you get back into your car is a breath of fresh air no matter how long your wetsuit’s been baking in the back, and we’re all wondering how much longer/do we actually need to stay home?
At least, most beaches have opened for recreation.
It seems everywhere you look there’s a new theory, a different opinion, a new timeline for vaccination, and a slew of friend’s Instagram stories spouting conspiracy theories. COVID-19 is increasingly turning into a partisan issue and it’s difficult to decipher the gravity of our reality.
To get a better vision of what’s going on (particularly in the United States), we followed up with Dr. Mario Quiros, a tube-savvy ER doctor who's spent the past few months consumed in COVID-19 (read The Realities And The Myths of COVID-19 w/ Dr. Mario, here).
Mario splits his time between Emergency Rooms in Los Angeles and Miami. He’s been tracking and studying COVID-19 since it came on his radar in January while acting as the medical director for Kandui Surf Resort. He’s done the research, is working his day-to-day with COVID patients, and he also happens to be a fine surfer.
Here’s his take on where we're at after spending the past few months on the frontlines of this pandemic.
Stab: From the last time we spoke to now, what has changed? What’s our current reality in the US?
Dr. Mario Quiros: We’re opening up the country at a time when there are more cases than there were when we first shut down. And, the thing that’s concerning right now is people think this is over. They think, We did our part, we stayed home for two months. We’re good. But the truth is, we’re still early in this.
This is going to be a year/year-and-a-half-long reality and we’re going to have to adapt our lifestyles. When you see that the transmission rates decreased that doesn’t mean we cured this thing. The virus hasn’t changed, the only thing that’s changed is our behavior—how we restructured society, stayed home, and the way we now interact with each other. If we stop wearing masks in public, practicing good hygiene, and practicing social distancing, we’re going to see this thing ramp back up again.
As the government eases restrictions, it is going to be on each and every one of us to determine how this pandemic plays out.
“Flattening the curve” has been a goal of this two-month isolation, has it flattened? And, what does flattening the curve mean, exactly?
We’ve flattened the curve, yes. But there’s a difference between flattening the curve and getting transmission rates all the way down to where they need to be to safely reopen the country. The "curve" was starting to transition from linear to exponential growth. This means we were seeing an increase in cases at a rapid rate thus the steep upward slope of the curve. When you flatten the curve it means you’re reaching a steady state of cases without continued growth in the cases per day. Right now, we're on a hill that's plateaued or has dipped down only slightly. We want to get to the other side of that hill where the number of new daily cases is low enough to track, isolate, and keep under control.
Other countries that were more severe in their shutdowns, like Italy or Spain, had a rapid descent down the other side of that hill. In the US, our shutdown wasn't as severe. Right now, we have a leveling off of cases but it’s not decreasing at the rate we wanted it to or the rate we need it to. In California we hit a peak, came down, leveled off, and, actually, in LA it’s starting to come back up again. Not at an exponential rate but it’s still trending back up.
California’s done a better job than most states because we’ve, for the most part, stayed the course. We aren’t where we were hoping to be at this point, but I think our leadership is doing the best they can to safely reopen. The federal government put out guidelines on what it would take to reopen, and nearly every single state in the US has begun to reopen before they hit those benchmarks. The way I see it, a lot of the country just got fed up and quit before they finished what they set out to do.
Slipping through a dreamy underpass in the Ments.
Some people would argue that we’re better off opening the economy back up and letting this thing run its path, that they're sick of staying home, losing jobs, and taking such a hard social-economic hit due to life in a pandemic.
People are cooped up and frustrated. From a medical perspective, we want to get it back to very little new cases a day because cases are going to increase as society opens back up. If there’s a low baseline of cases, it will take a while for the virus to spread and we have a better chance at keeping new cases under control through things like contact tracing and widespread testing. Unfortunately, we’re not seeing a significant decrease in cases, we’ve just leveled out. Right now, we’re at roughly 1000 - 2000 deaths a day and it was recently reported that the CDC had internal projections estimating 3000 deaths per day in June. That's 90k deaths in June alone. The likelihood of us having the rate go down when we’ve only been able to level it off with what we’ve already done so far is small. In my opinion, it is unrealistic and irrational to even think that way.
Right now, we are in a scenario where we have the worst of both worlds. We took a huge economic hit by shutting down, yet we didn’t stick to the plan until the end, so we aren’t seeing the public health benefits we were hoping to see by locking everything down.
I’ll put it this way, it’s like we set up for a massive barrel, then halfway through decided we didn’t really want to pull in and jumped off. Anyone who has been in this situation knows you're definitely not making it unless you commit, and a lot of times it ends up worse for you than if you just rode it out and stuck with the plan. Half measures don’t work in surfing and they are not going to work for us trying to find our way through this pandemic.
What have you been seeing in hospitals? Has the medical system been overwhelmed?
There are places that have been overwhelmed and places that haven’t. New York hit their breaking point, bent but didn’t fully break. Louisiana and Detroit did too. But we have this crazy scenario where people are so scared of COVID that they aren’t coming to the hospital when they need to, with potentially lethal consequences.
Despite COVID being the leading cause of death in the United States currently, COVID is not the only cause of mortality in the US. There are still Heart Attacks, Strokes, Brain bleeds, Sepsis, etc. On an individual case basis, many of these diseases have a much higher mortality rate than COVID. During this time, people didn’t stop having heart attacks, but they did stop coming to the ER with chest pain. I had two cases that really affected me in the past month where people stayed home and suffered complications from non-COVID illnesses out of fear of contracting COVID if they came to the ER. One patient had heart attack symptoms starting three days before he presented to the hospital, waited too long, and only called 911 when his lungs were so full of fluid he couldn’t breathe. I had another patient who developed a severe headache and stayed at home for two days as she deteriorated until her husband could barely feed her or get her out of bed. By the time I saw her she was critically ill, within 30-minutes of arriving in the ER, we find a large bleed in her brain, and we had to rush her straight to the operating room to save her life. Both these cases would likely have been treated way earlier under normal circumstances and with much better patient outcomes.
It seems like the hospitals not being at capacity has made people skeptical of all the measures we’re currently taking to combat the disease.
That’s the thing, people are underestimating COVID because they’re hearing the hospitals are empty, but they don’t appreciate the reason the hospitals aren’t that busy is that everyone’s been locked in their houses for two months. If we went outside and acted the way we’re used to acting, the hospitals will be full in 3-4 weeks. So instead we have these conspiracy theorists out there who are complaining that "it’s bullshit, this isn’t a real disease, it’s a cold, it’s just the flu." But like I said, it’s hard for a virus to spread if people aren’t leaving their homes and aren't in close contact with one another.
Then you look at the news and we have 90k people dead in two months from this thing, and that’s with people being locked in their homes. The flu killed 34k people last year and we were living life as usual. The comparisons being made are absurd. This thing is very contagious, it’s very capable of spreading and if it infects enough people, a lot of people will die.
It is true that the majority people who die are elderly or have other comorbidities, and this is true of nearly any disease. I had a conversation with my friend who is working in the ER in New York right now and he said it best, “these people are our parents, grandparents, aunts, uncles. They are the nurses and doctors in my hospital, they are the pharmacists at the pharmacy down the street. To treat them like they are expendable is crazy!” My cousin asked me what scares me about the virus last week and my answer was simple, “I am scared of losing someone I love.” As this thing runs its course, eventually it will affect all of our communities and my personal fear could become a reality for any of us.
There’s talk of a vaccine being ready to go by January. Is it possible to turn the vaccine around in a little over half-a-year?
If you look at the news, the Corornavirus Task Force said potentially January. I watched another interview where Dr. Fauci [The United States’ top infectious disease expert and face of the Coronavirus response] said if everything that can possibly go right goes right, then January is a possibility. But how often in life does everything that can go right, go right?
It’s one thing to have a vaccine, it’s another thing to have 300 million copies of that vaccine. Even if you have it today, it might take another six months or so to build up the capacity to vaccinate everybody. I’d like to be optimistic, but you can’t count on it coming that soon. Four years is the fastest a vaccine has ever been made, and that was for mumps.
There are a lot of viruses that kill a lot of people in this world that we don’t have vaccines for. HIV, RSV, Dengue, Hepatitis C to name a few. We’re hoping with the whole world working on this thing someone will have a breakthrough in developing a vaccine, prove it works, prove it’s safe, produce it on a massive scale, and distribute it in a timely manner. We hope this can happen in that 1-1.5 year window, but it is no guarantee. I keep saying this over and over again, we have to hope for the best and prepare for the worst.
"It’s like we set up for a massive barrel, then halfway through decided we didn’t really want to pull in and jumped off."
So, with society opening back up, what needs to happen so it doesn’t shut down again?
Everyone holds Sweden as this example. People point to Sweden saying, "They didn’t shut down, look at them, they’re doing fine."
What Sweden did was educate its citizens and made everything voluntary. They put the onus on their citizens instead of imposing strict restrictions and enforcing them. In that scenario, you’re only as safe as the behavior of your citizens. To get to that point for us, people need to understand we’re still early in this pandemic and it is going to go on for a long time. Our worst days are likely ahead of us in the majority of the United States and the world, for that matter. Only by acknowledging this, accepting it, and realizing that the way each one of us acts individually determines the health of our communities can we begin to move forward and take the steps we need to take to get through this.
Right now, the government is starting to back off restrictions and going forward hopefully will be telling us less and less what to do as individuals. Ultimately, if we do what we need to from a public health perspective, we can limit the growth of this disease. If we keep infection rates low, we can open up society more and more, and hopefully that translates to alleviating some of the economic pain inflicted by this disease. But if we act recklessly, and this thing gets out of control, then we'll have overwhelmed hospitals, an increased mortality rate, more restrictions, more economic pain, and potentially another shutdown. Nobody wants that.
Right now, if you’ve been social distancing and your friends and family have been too, should you go hang out with them? It feels like if you haven’t gotten COVID yet, or don’t have anyone close to you who has gotten it, that you’re in the clear. Is this a false sense of security?
If you go over to some friend's houses and you sit and stay six feet apart from each other, wear a mask, don’t touch your face, and wash your hands after you touch a communal area, the chances of you getting infected is very low. You only have to slip up once to get infected but if we are all smart and consistent it’s not hard to protect yourself.
We probably have about 5-10 percent of our population in California infected and we haven’t been operating in a high-exposure period because we shut down so early. So, odds are if you’re healthy and your friends are healthy and there hasn’t been a huge outbreak in your neighborhood, your chance of getting it is low right now. But that’s also considering that your friends and you haven’t been to work, haven’t gone out, and have been healthy for the past three weeks. As everyone starts to spend more time near each other and come out of their shells, then the risk of seeing your friends and family is going to go up significantly. Especially if you’re hugging, high-fiving, and hanging out like usual.
My advice to all of my friends has been to find a level of risk you are comfortable with, adopt behaviors consistent with how much risk you are willing to take, and be prepared to adopt those behaviors consistently for the next year or more. Locking yourself in the house for two months only to act recklessly when we start opening society back up doesn’t make much sense to me.
We are at the safest point we are going to be in for the next 6-12 months. The disease hasn’t gone anywhere, we’ve just been in a maximum defense posture. As we move away from this posture, we should expect to see the virus become more prevalent in our communities.
"This isn’t a liberal or conservative thing; a pandemic is not a political issue."
A lot of people right now think this is all hype and the death toll and infection rates are being inflated, or that the media is feeding the public fear. What do you think of the conspiracies running rampant at the moment?
I get these texts all day: "They’re making up the numbers, the doctors are cooking the books," stuff like that. People don’t want to think this is real, so they just find information to convince themselves they don’t have to deal with this. There’s no way around it, it’s something we’re going to have to deal with. The only way out is through.
I try not to have a bias. Like what benefit do I have saying, "Oh, we’re all fucked!?" I have friends who tell me I’m just a liberal and I’m feeding into the media narrative. And I’m just like, "Look, I’m not a liberal. I’m a scientist. I’ve studied science for the past 20 years of my life and am looking at the data. This is the conclusion the data is pushing me towards."
This isn’t a liberal or conservative thing; a pandemic is not a political issue. It’s always the same friend who calls me up when they’re sick or need advice and now, they’re like, "You’re crazy, don’t buy into the media conspiracy, we need to open up!" But when I’m in the ER and a patient dies from COVID in front of me, that’s not the media exaggerating. That’s real life. When I am intubating a patient with a helmet on, two face masks, a Tyvek suit, two pairs of gloves, covered head to toe, and I am worrying about the nurses next to me getting sick from this exposure, worried about them infecting their family members, worrying about someone they love dying because they got sick at work trying to save a life, that’s not the media. That’s not a conspiracy. Just because you haven’t seen it, or it hasn’t affected you yet does not mean it’s not real.
I tell everyone the same thing, "I hope I’m wrong. There’s nothing that I hope for more than being wrong." I don’t want to be in this position. I don’t want to wear a mask when I leave my house just like everyone else. It sucks not being able to surf or travel when and where I want to. I don’t like having my hours cut because people are too scared to come to the hospital, but I would rather take a pay cut than have a line out the door and people dying preventable deaths because our hospitals are over capacity. The shutdown was terrible, but I can tell you our hospitals were not prepared to deal with this two months ago when the shutdown started. I don’t think society in general was either. I hope we learned something about our new normal, how to act in public, how to effectively socially distance, who we need to protect and how to protect them. Now it’s time for all of us to do our part and try and prevent this thing from getting out of control again as we move into the next phase and try to reopen society. I don’t want to be the doomsday guy and scare people. But all the research I’ve done and all the clinical experience I have tells me that magical thinking is not the way we’re going to get out of this thing.
We've covered a lot of ground here, anything else worth noting?
Don’t let fear cripple you but don’t be stupid either. Every one of us has a different baseline level of risk from a COVID-19 infection. Likely 98-99.5% of us will be fine, but this virus is very contagious and can and will spread rapidly if we are not socially responsible. You can do the math but if we don’t get bailed out by a vaccine and this ends through herd immunity, that is a large number of people dead. Hopefully we don’t hit those numbers but that’s what we could be looking at if this goes on for long enough or we are not able to contain the next big wave of infections that we are likely to see later this year. I don’t have the perfect answer on how to solve this crisis and I am pretty sure nobody reading this does either. If this was an easy problem to solve, we would not be in this predicament. What we can do is focus on what we can control and do our part to help shape the future of this pandemic.