By Dr. John R. Mishock, PT, DPT, DC
Seven weeks ago, we began this journey in shutting down our schools, businesses, and our familiar ways of life due to the impending doom of COVID-19. At the time, scientific knowledge was limited regarding this dreaded virus. There was a belief that our health system would be overloaded with greater than two million deaths nationwide. All hospital elective surgeries and procedures were eliminated to create space for the impending influx of sick COVID-19 patients during the “spike.” The goal was to “flatten the curve,” thought sheltering in place to eliminate the extreme spike in cases that would overwhelm our hospitals. There have been hot spots throughout the country, such as New York City. However, this spike never happened in Pennsylvania and many other states throughout the country. Indeed, it is better to initially error on the conservative side as all life is precious and worth saving. CDC preventative guidelines and sheltering in place has helped to slow the spread as we move toward herd or community immunity. Keep in mind; social distancing does not end the virus spread; it only delays the transmission reducing “hot spots.” As we begin to open up our society, it is crucial to understand the facts based on science.
The state of Pennsylvania health care system
Scientific research continues to mount, allowing us to make informed decisions about safety. According to the PA Department of Health, only 7% of hospital beds have been used for COVID-19 patients in the state. Initially, there was a panic to find mechanical ventilators (device to help sick patient breath); however, 1.5% of available ventilators were utilized in Pennsylvania to date. (PAdepthealth.gov) Conversely, most hospitals never saw the COVID-19 “spike”, becoming very slow, forcing layoffs of thousands of employees due to a lack of patient volume. Many physicians have taken pay cuts or have lost their jobs. Nationally 1.4 million help care workers have lost their jobs. (Dept of Labor, May) Locally, Tower Health had to lay off over 1,000 employees. (Mercury News Paper, 2020) Nationwide, some hospitals may be forced to file for bankruptcy or even close due to the economic fallout. In many hospitals, elective procedures and surgeries account for up to 80% of their profits. Even the typical sick person (heart attacks, strokes, accidents) is not seeking care at the emergency departments.
Our local community by the numbers
In our local communities, it appears the COVID-19 “curve has flattened,” and we are in the downslope of the curve.
At the time of the writing, Montgomery County has 5,037, while Berks County has 3,190 positive cases of COVID-19. According to the PA Department of Health, This year’s seasonal flu-infected 4290 in Berks County and 9650 in Montgomery County (13 weeks ending on March 28th). Seasonal flu can present similar to COVID-19; however, 20% of those at the highest risk may need hospital care versus only 1-2% with seasonal flu. (WebMD.com) According to the CDC, 5-20% of Americans get the flu each year, with 200,000 hospitalized and 20,000-49,000 deaths annually.
Of the 414 COVID-19 deaths in Montgomery County, 185 did not have positive laboratory confirmation of COVID-19. Keep in mind that many respiratory disorders could mimic COVID-19, such as seasonal flu. Pennsylvania has a total of 54,238 cases and 3,600 deaths. The number of COVID-19 infections is undoubtedly much higher due in part to insufficient testing, mild or no symptoms as all (25-50% COVID-19 infected individuals are asymptomatic) (CDC, 2020)
Protecting the Most Vulnerable
Science has clearly shown who the most vulnerable are to COVID-19. In Montgomery County to date, an astounding 85% of the total deaths were residents of long-term care facilities or nursing homes. In Berks County, 65% and statewide, 68% have died in those types of facilities. This population is vulnerable due to age and underlying medical conditions and must be protected. The average age of death is 79 years of age.
Those who develop severe symptoms are typically over age 65 with underlying medical conditions, hypertension (high blood pressure) (61%), heart disease (37%), diabetes (37%), chronic lung disease (30%).
Fortunately, COVID-19 has little impact on children ages 1-17. In Pennsylvania, 2% of all cases of COVID-19 are under 18 years of age. (www.health.pa.gov/topics/disease/coronavirus) Of all reported cases in the U.S., only 1.7% are children. Most of the kids are asymptomatic (up to 68%) or have minor symptoms of cough and fever. There have been no deaths in Pennsylvania due to COVID-19. In contrast, this year’s seasonal flu has killed 144 children. (CDC,2020) There have been some rare cases of what appears to be Kawasaki’s disease (rash, abdominal pain, vomiting, diarrhea, heart symptoms) of children. (Washingtonpost.com)
Scientific evidence continues to mount on the numbers of cases of individuals that have COVID-19 with no symptoms. Researchers say that 25% to 50% of people with COVID-19 are unaware they have the virus. (Clin. Infect. Dis, Lancet). Locally 942 prison inmates were tested for COVID-19 with 171 testing positive and having no symptoms. (Mercury,2020)
The fact that many people are asymptomatic is excellent news; however, it also means that COVID-19 could be spread to those most vulnerable unknowingly. This is why vigilance in continuing the CDC prevention techniques (frequent hand-washing, wear a face mask, clean and disinfect, social distancing, stay home when sick, cover cough or sneeze) is critical as we open up our communities.
Hand Washing and Sanitizer
COVID-19 enters through our eyes, nose, or mouth from a contaminated water drop via person-to-person or from a fomite. A fomite is a non-living object (doorknob, cell phone, car computer keyboards, etc.) that transmits the virus. The virus is transmittable from these surfaces for up to 3 days, depending on the surface type. If you touch the fomite, then your face the virus can be exchanged. On average, touch our face roughly 20 times per hour.
Regular hand washing is your one strategy to keep the virus from getting inside your body. You should wash your hands often throughout the day. Do it before and after you touch objects in the community, eat, after using the bathroom, after handling any raw meat, unwashed vegetables, or garbage. Also, wash your hands after coughing, sneezing, blowing your nose, or touching your pets.
Keep an alcohol-based sanitizer for hands if a sink is unavailable. It should be at least 60% alcohol. When washing hands or using hand sanitizer, rub the entire surface of your hands, fingers, and wrist for at least 20 seconds.
Mishock Physical Therapy is open and ready to serve you while using the highest level of CDC and Government preventative techniques to stop the spread of COVID-19.
Recent COVID-19 Articles Include:
COVID-19: Scientific Update 04/26/2020
Coronavirus (COVID-19): Strategies to Optimizing the Body’s Immune System at Home
Coronavirus (COVID-19): Understanding the Science, Improving Immunity, and Preventing Disease Part I
Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. Mishock Physical Therapy & Associates has 7 convenient locations in Gilbertsville, Skippack, Phoenixville, Barto, Limerick, Pottstown, Steiner Medical.