3/25
Greetings and Best Wishes, Dear Friends!

I hope everyone is hanging in there okay.  
Big Numbers

We will be passing 500,000 cases on the globe today.  Worldwide it took the virus 67 days to reach to 100,000 cases, and only 11 days to get to 200,000 and then 4 more days to get to 300,000 cases. That 300,000 milestone was on Sunday of this week!  The surge is starting.  The hospitals are maxed in some places.  Army corps of civil engineers is transforming available and suitable structures into temporary hospitals.  Retired nurses and doctors and medical students and foreign trained doctors are being drawn nearer to the front lines to help in any way they can.  The US reported an increase in 10,000 cases yesterday to reach 65,000 cases.  There are more than 21,200 deaths worldwide and close to 1000 deaths in the US.  We will soon be the world’s hotspot as no other country’s case count yesterday was nearly as high as ours.

Compare to the flu, please

To put this in context, in the neighborhood of 10% of the US population gets the flu each year. That might factor out to 3,000,000 cases.  The CDC estimates that in the US between 12,000 and 61,000 deaths annually can be blamed on the flu. Globally, the World Health Organization (WHO) estimates that the flu kills 290,000 to 650,000 people per year. We have a ways to go to match those numbers, but the infection rate for COVID-19 is expected to reach, eventually,  the neighborhood of 50%.  And as we know, the case fatality rate for COVID-19 is higher than the flu by 8-10 fold at least. That’s why we are all lying low. We are doing the work of social distancing and we will take the wind out of this surge. Guaranteed!

And the Berkshires?

The big news amongst the numbers trackers is that the Massachusetts DPH website is reporting Berkshire County’s jump from 26 cases on Monday to 37 cases on Tuesday to 71 cases on Wednesday.  But I say it’s no news at all.  I think I might stop watching the state case count (well, maybe not).  But my point is even with this increase I think this number is not only irrelevant but misleading. Here’s something for you. What do you think I’d say the actual number of cases is? Several hundred?  Actually, I would say several thousand!   In the Berkshires!  I would go out on a limb and say we have over 2500 cases here in the county.  Why?  Let me tell you.

First of all, I suspect I have seen between 7 and 10 cases in my testing cohort sample.  Three are confirmed, the others are waiting confirmation.  That’s a lot of cases considering I have tested around 40 people!  Testing is subject to delays of up to ten days to get results (although generally it’s 3-4 days total)!  It’s quite frustrating and handicaps the big benefits of testing.  If I’ve got ten in my small sample, then the county of 125,000 people has a lot more. Second, several days ago I heard the opinion, from someone who would know, that we have had large numbers of people with abnormal lung CT scans consistent with COVID-19, likely more than 100 people!  Abnormal findings on a CT scan are one and the same with severe disease. For every person with severe disease there are 10-20X that number at home with mild symptoms or no symptoms who would be positive.

I tell you this so you take good care, and keep your guard up. It’s not the time to fatigue on this. It’s more like the time we’ve been readying for! There’s one best inner position where you can weather this forever if you had to.  All the other positions drain you. My wish is we all can become familiar with the inner standing that makes us invincible to the ups and downs of the outer world.  Become familiar with it, then strengthen in it!  The real gift of hard times is that they force your focus to what’s important.
Red eyes

Not only is loss of smell and taste catching our attention as a symptom of COVID-19, so is redness of the eyes.  A study published in the NE Journal of Medicine found “conjunctival congestion” or red, infected eyes in 9 out of 1,099 patients with COVID-19.  The occurrence seems low, and there are other things that can cause conjunctivitis, of course.  Contact us if you’re not sure and want to review.
More Closures

Schools across the state are mandated to be closed until early May.  Parents are getting a crash course in Home schooling. And, our much loved Olympics scheduled to take place this year in Tokyo have been postponed

Front Line

And let’s tip our hats to the hospital workers: the nurses, doctors, administrators, and support staff who are caring for the sickest and most desperate of us.  Let’s send them wishes for strength and endurance to weather this surge. This is a difficult time for them, and they are making the brave choice to stand in and help, and we need them. And let’s tip our hats to the volunteers of every skill level who are helping out at the hospital.  And the citizens of our towns who are calling to offer their N-95 masks and other supplies that are in short supply.  And let’s pray that our efforts to avoid a colossal and overwhelming peak of cases are successful. 

Options for treatment

Reports are emerging of the use of Vitamin C intravenously in the ICU in New York state. There is an ongoing study evaluating this in China. We have several trials being started in the US for HIV medicines and other antivirals.  Chinese herbs are not easy to find and medroxychloroquine is in a worldwide shortage.  We will have options to support our patients no matter what happens to the supply of the high profile experimental drugs.  Whether it’s a daily check-in call and monitoring from afar or starting a Homeopathic regimen to support the liver and ease the chest, we will have you covered.

Be smart!  Stay centered!  Get after it!

Best Wishes on this Day! And Everyday!

Dr Cooney