Insert some cliche quote about surfing being the best medicine...
The Realities And Myths Of COVID-19 According To A Tube-Savvy ER Doctor
Dr. Mario Quiros discusses our shelter in place orders, why beaches are shutting down, and kills Coronavirus myths dead.
“I never sit closer than six feet from anyone in the lineup,” is the common harp in the face of COVID-19. It’s true, most of the time.
Social distancing in the ocean isn’t a difficult task unless you’re sardined-packed at breaks like the now-closed Malibu or Lower Trestles. We’ve seen two San Clemente renegades attempt to dinghy into Lowers on an empty, head-high day only to anchor too close to shore and have their vessel wash into the cobblestone, where they were cited on the beach. A SUP, two lifeguard boats and too many police officers walked into a slow speed pursuit at Malibu. There have been warning shots in Costa Rica. In Peru, a man and his surfboard were taken into custody. And, whatever this is…
“Basically, we got sucker punched. It [COVID-19] came up quick and our leadership did a very poor job preparing for this,” ER Doctor and Kandui Surf Resort Medical Advisor, Dr. Mario Quiros tells us on COVID-19 in America. “The healthcare system just can’t handle this many people getting sick at once.”
Mario splits his time between Emergency Rooms in Los Angeles and Miami. He’s been tracking COVID-19 since it came on his radar in January while acting as the medical director for Kandui Surf Resort. Now he’s on the frontlines fighting this virus. Dr. Quiros has been making moves within the surf, Los Angeles and Hispanic communities, attempting to educate as many as he can on the realities and myths surrounding the novel Coronavirus. He’s also quite apt in the art of the tube and is one of those gentlemen who seems to be on some of the best swells of the year in Indo, Fiji, and other hotspots around the globe—an unsung hero aiding in emergencies when well-overhead peaks cascade over the shallow, jagged reef.
Right now, however, he is dedicated to the battle against COVID-19.
We caught up with Mario to get an account of what he’s seeing in the ER, what information we should take seriously, what’s a fallacy, and why beaches around the world are being shut down.
Stab: Being on the frontlines of this, could you give us your take on the severity of the current situation?
Mario Quiros: It’s a tricky thing because you don’t want to freak people out too much. People shouldn’t be panicked to the point that they can’t function and completely break down, but people need to understand that this is not fake news either. I am seeing people sick and dying in my hospitals from this today and only anticipate it getting worse before it eventually gets better. Without social distancing and the aggressive mitigation measures put in place, I have heard estimates that as high as 40-80 percent of the population could get the virus in the next year. That being said, your chance of dying from it if you’re young and healthy is very low, but the risk is there. The bigger issue is if you are young and healthy and get it, the odds of you transmitting it to someone in your family that you care about who isn’t young and healthy is high and could have lethal consequences. As a society, we need to thread that needle between panic and appropriate respect for the virus and its potential consequences.
If you’re young and healthy, 99% percent of you are going to be fine. But if we don’t slow it down, a large percentage of the US population could get infected. When you do the math, even with conservative estimates, you are looking at approximately 150 million people infected without mitigation efforts. If 1 percent of those who get it die (another conservative estimate) that’s still 1.5 million people dead. If we don’t social distance, we will get so crushed in the hospital that the mortality rate could easily be up to 5x higher. We just won’t be able to take care of the people who are sick at the rate that they need our help.
The man can indeed do the tube.
There’s a lot of information out there, and it’s hard to decipher what’s real and what’s being blown out of proportion. What are some assumptions you’re seeing/hearing that aren’t true?
First of all, people look at China and think, 'Oh, China got it under control, so we’re fine.' But you can’t compare what happened in China to what’s happening in the U.S. When this broke out in China, they essentially put everyone in prison in their own homes. The measures they were willing to take against their citizens are not at all comparable to the U.S. If you look at the growth curve in the U.S. vs China, Italy or anywhere else, not only do we have the most cases, but we’re expanding more rapidly than any other country.
Second, no miracle drug or vaccine will bail us out in the foreseeable future. Any respectable infectious disease doctor, including Dr. Fauci [Director of the National Institute of Allergy and Infectious Diseases] who’s heading the response, will tell you that. There are currently no FDA approved treatments for COVID-19 and we are just starting clinical trials for a wide variety of treatments. The infectious disease doctors are basically telling us, 'Look we are trying these different medications to give them something and hoping we find something that works.'
To date, there is no proven cure and we aren’t seeing any miraculous results with the medications we have been trying. To complicate things further, most viral illnesses resolve on their own, so it's hard to say if the patient got better because of the medication you gave them or because it is the natural course of the illness. It’s similar to putting a Band-Aid on a bullet wound. The bullet wound may stop bleeding on its own in which case you might think the Band-Aid worked, but if the bleeding didn’t stop, then the Band-Aid didn’t do a whole lot.
Third, it’s likely not going away in the summer. People think the warm weather will make the virus disappear. Two recent Coronaviruses have been prominent, SARS and MERS. SARS ended in the summer, not because of the weather but that just happened to be when they figured out how to stop it. MERS was spreading in the Middle East in Abu Dhabi in 120-degree weather. COVID-19 shares about 50 percent of its DNA with the MERS virus so we can’t count on the warm weather stopping the virus for us. We can hope for the best but we still need to prepare for the worst.
From what you’re seeing in the ER and researching, how long are stay home orders going to be our necessary reality?
Something people don’t understand is that we are just getting started in a lot of the country and world for that matter.
The last few weeks in terms of cases, growth and the death rate are unlike anything we have seen in our lifetimes. New York just passed its peak a few days ago. Other parts of the country like Florida and California are either just getting to the peak or still climbing and waiting for that surge. Social distancing had definitely made a tremendous difference, but the outcomes are only as good as the people practicing these measures. Just because you are past the peak doesn’t mean cases won’t start to increase again if you let up prematurely. There is likely going to be two phases of this as well. We’ll have this phase where everything is shut down and probably will last until at least May/June. A lot of experts are predicting another wave that will likely come around in the fall.
Another myth is people think the recommended social distancing going on right now will be done in a month and that’s going to be the end of all this. What we’re trying to do is get the virus under control during this time to prevent our hospitals and our healthcare workers from getting overwhelmed so we can continue to provide the best care that we can. We’re trying to get through the peak of this with the limited resources we have by locking things down and trying to limit the size of this first wave. Hopefully we can regroup, ramp up our resources, and be better prepared to deal with the next wave of the virus if and when we get hit again. The mitigation efforts in place right now are necessary because we can’t have 50-percent of the population get infected in the next three months, which could happen if we do nothing.
L.A. and San Diego County closed down their beaches a few weeks back, and after weeks of 80-100-person thick lineups at Lowers, San Clemente just closed down all their beaches. Plus, all over the world, beaches are being shut down, surfers are being arrested or fined for surfing. Is this an overreaction?
It’s not so much about surfing. With that said, if you’re in the water and are sick around people you can infect them just like anywhere else. To make things more complicated 30-percent of people are asymptomatic and can spread it just breathing near you in a crowded lineup. Right now, you wouldn't go to a concert where there are 80 people, but people will risk it to go surf Lowers or Malibu on a fun south swell.
In terms of the response and shutting down the beaches, they just want to shut down anything they can and unfortunately beaches are a place where people get together. In the Malibu parking lot on any day people are hanging out, walking around, shaking hands, sharing joints. This thing is so highly contagious that all it takes is one dude to show up sick and start a small outbreak in their little surf community.
And, in terms of surfers traveling with international borders closed, it’s going to be a long time before we’re taking surf trips again.
What needs to happen for this to stop?
There are only a few ways to stop this thing. One: you shut down society completely until you get a vaccine. Then you vaccinate everybody and then it’s gone. Two: 60-80 percent of the population gets infected with this and then we have something called herd immunity. At that point, it makes it very hard for the virus to continue to spread. Three: essentially you shut the whole world down for long enough that there’s no longer a reservoir of virus in the world. Then we’d all be safe. But how long that would take and the effects on society are not realistic.
In my opinion, option two is probably the most likely one. We got a wildfire burning right now. We got to get that fire under control and then deal with the slow burn until this thing finally burns out or until we get a vaccine a year or so from now to put the fire out for good.
Mario wearing a different kind of blue. Stay home, if you can.
What advice are you giving people who are scared, or who don’t feel the need to take this seriously and stay home?
People are frustrated that things are locked down—that they can’t go to work, and they can’t make money. People have the attitude of why are we shutting everything down? I’d rather get the virus than lose my job and not be able to work.
But if you don’t have your health, you don’t have anything. People who are sick and dying will pay any amount of money to get their health back. We don’t have an economy if people are sick and too scared to go to work. In order to get to the point where we are all back to work and returning to normal, people need to adopt behaviors to get this under control. And we need to be consistent with those behaviors.
It’s important to understand that as scary as all this stuff sounds, 80-85% percent of people are going to either have no symptoms or symptoms close to the flu and not require any medical attention. They’re going to stay at home, watch Tiger King, take Tylenol and might have a rough week or so but they’re going to be okay. Thirty-percent have no symptoms at all, 55% have minor to flu-like symptoms. Approximately 10% get severe symptoms and require hospitalization, but most recover. Unfortunately about 5% of those infected get critically ill and about half of the patients in this group will die.
Based on the information I have gathered to date, the top experts are predicting a mortality rate of 1-2.5% overall. This mortality rate also varies significantly by age. If you are healthy and under 50 you are looking at mortality rates well under 1%. If you are chronically ill or elderly those rates jump significantly. The WHO data out of China showed mortality rates near 15% for people over 80.
We have to look out for the vulnerable population; we have to look out for our loved ones. Even if we aren’t high-risk ourselves, we need to protect the more vulnerable around us by mitigating the spread of this virus and mitigating the risk of transmitting the virus to someone who may not fare as well as you would if they got infected. We all need to be reasonable, rational, and responsible to get this virus under control.
Lastly, I want to remind everyone to stay the course. When you see we are flattening the curve or that we are making progress, it’s not a sign to let up—rather a sign to double down on your efforts. The sooner we all get on the same page and get this under control, the sooner than we can go back to living our lives. And for us surfers… the sooner we can all get back in the water!