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March 22 Update: When should I call the Doctor?

  • March 22, 2020

March 22, 2020

Good morning MDIBL,

It is another beautiful Sunday morning. Most days during the last week were just as beautiful, making it difficult to image the growing epidemic out there. The pictures we see on the news, especially from Europe, seem more like they’re from a movie rather than real life. From all the evidence available so far, I’m hopeful Maine will not be hit by a huge wave of infected patients. Big cities, and crowded areas or neighborhoods, or institutions with elderly people like retirement homes, will be the epicenters of COVID-19.  

Here at MDIBL, we will improve and extend recommendations for faculty and staff in the coming weeks. Everyone is aware of and understands “social distancing” now and are following the recommendation to work from home. In addition, the decision has been made that visitors will not be allowed into MIDBL’s inner campus, to better protect everyone. Visitors will only be allowed on campus if they are deemed “mission critical” during MDIBL’s daily senior staff tele-conference.

Even with all these measures in place we still will have a significant number of patients in Maine. In fact, the numbers are already increasing. I think it’s important to review the pathogenesis of the disease and the clinical signs. If we, or somebody near to us, develops symptoms, when should we contact a doctor? Are there clinical signs that tell us when we should be more worried?

When COVID-19 patients present to the hospital, the most common initial symptoms include shortness of breath, fever, and, a mostly dry, cough. Fever and cough are easily recognized, but what exactly is shortness of breath? Shortness of breath may feel like a tightening in the chest and breathlessness; exercise, like climbing stairs, makes it worse. Shortness of breath can be measured: the normal rate of respiration for an adult at rest is 12 to 20 breaths per minute. A rate over 25 breaths per minute while resting is considered abnormal. These breathing problems indicate pneumonia, which is an inflammation of the lower bronchial airways. When the virus reaches these parts of the lung it damages the cells and the body reacts with an inflammatory response. Fever and cough accompany this inflammation. 

Fortunately, even when the virus infects your airways like this, only a small number of patients will develop pneumonia. These patients should call a doctor and will most likely be admitted to the hospital.

In other words, if you experience a high fever, dry cough and an increase in breathlessness: call your doctor. If possible, provide your body temperature, your respiratory rate, your heart rate, and blood pressure.

Once in the hospital it may be that your symptoms get worse and you might be admitted to ICU for observation of your symptoms. If you continue to get worse, you may need oxygen or more support for your lungs with ventilation. You may need ventilation support for a couple of days. Then your lungs will clear, and the virus infection will be over.

You’ve probably read in more than one place that the major risk factors for complications are age and comorbidities. Older people have a higher chance of having underlying heart disease or kidney problems. If so, their body may be too weak to support the fight against the pneumonia. For people who are otherwise healthy, their body will fight the infection and they should recover.

If you have questions about COVID-19 and comorbidities (for example blood pressure, diabetes or cardiovascular and renal disease) I invite you to send your questions to me. Although I’m not your doctor, I am happy to share my thoughts and try to answer these questions for you.

This was possibly more like a Sunday morning sermon than a brief daily update, but these are dire times. Even with the beautiful spring sunshine out there, the world has changed irrevocably. Eventually, we will be immune against this virus and importantly, stay immune. This virus does not mutate like the flu virus, it is “lazy” — once enough people have had an infection it will most likely go away. The distancing we are practicing will help slow the spread so that healthcare providers can adequately care for those that do need hospitalization.

At one point, hopefully soon, people will want to know whether they have developed immunity. Tests for immunity against COVID-19 are presently being developed.  

Remember, even while taking the recommended precautions, you can always go for a walk to clear your lungs and mind. We are fortunate to live where we can take a beautiful walk in isolation. I wish you a wonderful day.

Best,
HH


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