Archives for Apr,2020

Andrew Daigle, MD
April 18th

Are we seeing the curve flatten? In Tennessee and locally, it appears that the social distance and safe at home strategies are successful in lowering the total number of people infected. Because of that, fewer people are in the hospital and we are seeing fewer deaths from this virus. So far, locally our hospitals are not overwhelmed and our ICUs are not overflowing. Clearly we have been fortunate and we have learned from other cities that were devastated: New York, Detroit, New Orleans especially. But the wave has not peaked here yet.

The virus hasn’t changed. It is still VERY contagious, and still is leading to rapid deaths in about 2-4% of those who get it. We still don’t have a treatment we can rely on — hydroxychloroquine and azithromycin have been used extensively and have not been shown to be the “magic bullet.” If anything, we are more aware of the rare but real side effect of “sudden death” from these drugs.

There is an antiviral drug (remdesivir) that is promising, and it worked somewhat well against SARS and Ebola. We are starting a phase 2 trial soon. Also, there are 78 vaccines in trial. (Typically, in other diseases, over 100 vaccines start out with the hope of having one ‘winner’. ) Although we can be hopeful for a ‘needle in the haystack’ discovery of the winner, the soonest we could see a vaccine is next year…

What is our best plan for saving lives? Continue what works! –> Social distancing, washing hands, wearing a mask, avoiding crowds. Once we FINALLY get better access to testing, we can confirm who doesn’t have it and allow them to return to working in groups. AND when we identify someone who DOES have it, we can quarantine them until they are no longer contagious.

Those who have recovered are donating plasma (part of their whole blood) so that this ‘convalescent’ plasma can be tried to help those who are significantly sick from the disease. This treatment is sometimes effective but also carries risk of side effects.

This disease has changed life for EVERYONE ON THE PLANET! There was little choice for us as individuals and for us as humanity except how we chose to respond. We are forced to take advice from various sources, and to determine which advice is ‘wise counsel’ and which is counsel from ‘Job’s friends’.

We have been forced into close quarters with family, and for those in our residential addiction recovery program, new family. Thankfully, we have not seen the virus penetrate our S2L Recovery program. God is merciful, and the team and leadership for S2L Recovery are faithful and diligent. We remain blessed!

Once again, our God presents us with opportunities for dependence on Him. Yes, there are life or death possibilities every day for each of us, but this pandemic is a much more blatant and clear threat. Many people are grieving the death of a loved one. (now over 34 thousand US deaths from this disease — sudden deaths and unexpected and unplanned deaths)

I try to stay positive while remaining realistic. If and when time is short, what are your priorities? Past regrets are only useful for future plans to make the present the best it can be. As Christians, the best ‘present’ is based in our identity in Christ our savior. Know Him to better know yourself. Make the choice, depend on wise counsel, accept His mercy as you acknowledge your frailty AND your power through Him!

Andrew Daigle, MD

Andrew Daigle, MD
April 10th, Good Friday

I continue to carefully watch the updates of our 2020 Pandemic, especially on how it is affecting the US and locally here in middle Tennessee. I am finding that, with our government proclamation but more importantly with our behaviors, that we ARE having a significant effect on this pandemic. The overwhelming wave of suffering, debility, and death that is occurring now in New York, New Orleans and Detroit has not yet hit Nashville and middle Tennessee. We expect it the peak to come here in the next 7-10 days, however, the infections are being spread NOW, with symptoms later showing up, after “the cat is out of the bag”. Each person with COVID-19 infects an average of 3 other people. In the next few days, we will know how effective our social distancing, masks, washing hands and staying at home has been at lowering death and suffering.

Today, there are a little over 4000 ‘confirmed’ cases of COVID-19 in Tennessee. Today, April 10th, in the US we have had over 17,000 deaths. Currently, 3.5.% of US COVID-19 cases result in death. Locally in Middle Tennessee, our hospitals are not overwhelmed and trying to be prepared. The dire situations in NY, NOLA, and Detroit are on social media everywhere and the medical community here is paying attention. Let’s make that 3.5% part of as small a number as possible! The fewer cases, the fewer deaths.

So, as a community, we ARE listening to wise counsel!

• Keep staying at home as much as possible. Redeem the time, keep in a beneficial routine, and use this as ‘spring training’ for when we transition back into more normalcy.
• Keep your social distance, as a service and kindness to others. Remember that the person you interact with could be an asymptomatic carrier. Keep your 6 ft or more, try to interact with people outside instead of indoors.
• Keep your mask on when you are out! This also is a kindness to others, as the goal of the mask is more to protect OTHERS than to protect you. If you interact with someone who isn’t wearing a mask, they could be an asymptomatic carrier of the virus and not realize it.
• Wear your mask and keep your distance to show others you are doing your part to slow this virus down and get us back toward normal. The fewer the cases, the sooner we transition back.
• Again, wash your hand. A LOT. Consider everything you touch when outside of your home to be full of germs, and remember that soap and water or alcohol kills them. Don’t let those germs near your face.

PLEASE, wait for treatments that are really helpful. We are finding out a lot in a hurry, but avoid ‘panic treatments’ that aren’t yet validated just as you would ‘panic buying’. If and when something really is working, we will all know soon.

We are getting more and more data, and that is helping to decrease the unknown which decreased the fear and allows us to plan. We are using the great resources of the US and international wisdom and intelligence to work together rapidly, all with a shared goal.

According to the best model we have, (the IHME model from the University of Washington), the peak day for deaths in the US will be April 12. April 12 is Sunday. Easter Sunday. On Easter Sunday we are projected to ‘turn the tide’ and have fewer deaths each day after that…Why?

The IHME model is completely academic, completely secular, completely non-political. This model does not control the virus but follows the trend. We, as Americans, do not control the virus but only control our behaviors, which includes who we listen to, and whose counsel we accept. Easter Sunday is the day in our Christian tradition that we celebrate OUR victory over death by way of Jesus’s victory over death. As Christians, we accept Jesus’s identity as the one true God and His identity as the only way for each of us to join Him in victory over death. I do not hesitate to believe this model predicting this date as a transition from death is purposeful and with meaning.

I firmly believe that there are no mistakes in God’s management and shepherding of us, His creation. The free will He granted us leads to much suffering, but it also allows for ultimate joy and salvation. When crises occur in life, we all reassess our priorities. Please continue to do this. Consider what is truly valuable and what is ‘important but perhaps distracting’.

Seek wise counsel, read His Word, and most importantly, speak to God directly, from your heart.

My best to each of you. Feel free to pass this on if you feel it could be helpful

Andrew Daigle, MD

Hello Team,

I want to let all of you know that I am keeping up with the COVID-19 crisis and will remain available to all of you. I will plan to give an update once a week and as needed. My goals are to:

1. Support the best practices and behaviors as we are doing now
2. Dispel falsehoods and partial truths
3. Quickly address any symptoms or concerns that occur

Here is a quick background. PLEASE pass this helpful information on to friends and family. The best management for fear and anxiety is information and planning.

COVID-19 stands for COronaVIrus Disease 2019.

Coronavirus is a TYPE of virus (other coronaviruses include the common cold…) So, think of this in terms of automobile Make and Model. Coronavirus is a Make, COVID-19 is a Model… and Influenza is the Make, influenza H1N1 is the Model

COVID-19 is a NOVEL (new) coronavirus and has NEVER been seen in humans before. It was a wild animal virus that mutated to infect a human, and then mutated again so one human could infect another. It is VERY CONTAGIOUS because the human immune system has never seen this before. Think of Europeans bringing illnesses to Native Americans whose population was very vulnerable.

This virus invades the body when the virus gets to the lungs. It gets there through inhaling larger droplets from someone near you within 6 ft or so, by cough or spray. Also, VERY tiny virus particles can hang in the air because they are so light when aerosolized, which is more common in a hospital setting, and why we need the N95s there. Regular masks filter droplets, N95 filters out 95% of aerosolized virus particles

OR the virus can invade through your mouth or nose after you TOUCH something that has the virus on it then go to your face. Over several hours to days, the virus moves into your lungs and causes infection.

Symptoms to look for:
ANY URI (upper respiratory infection) symptoms such as:

– Sore Throat
– Fever
– Cough
– Congestion
– Shortness of Breath
– Chest Pain
– Drainage
– Body Aches
– Loss of Taste and Smell

Other possible symptoms:
abdominal pain and diarrhea (in up to 20% of patients) usually lasting just a few days.

WHEN TO CONSIDER GOING TO THE ER:

For a small but real percentage of those infected, the lungs will be severely involved resulting in shortness of breath, especially worse with exertion. (Not “I think I’m a little short of breath…”) This shortness of breath can be associated with blue lips and fingers/toes and chest pain. However, you should only show up at the ER if you think you are so sick you need to be hospitalized (where the sickest people already are…). Your first step is contacting your doctor on any COVID-19 Helpline available.

FOR MOST PEOPLE, this will be a stay at home with achy, feverish, ‘flu-like’ illness. Your biggest risk may be spreading it to others.

TREATMENT is all supportive at this time:

– Zinc oral lozenges with early symptoms of sore throat. Zinc lowers the reproduction of the virus in saliva, so fever virus particles make it to the lungs.
– Acetaminophen (Tylenol) and NO ibuprofen or naproxen and NO prescription NSAIDs (non-steroidal anti-inflammatory drugs) as not clear yet if NSAIDs are safe.
– Stay well hydrated, indicated by having frequent and pale urine. Infrequent and dark yellow urine indicates dehydration.
– Multivitamins and extra Vitamin C, while remembering that massive doses of Vitamin C (6-10 GRAMS a day), will likely cause diarrhea.
– ISOLATE yourself, and everyone in your household. All are considered infected or at the least a carrier.
– Get tested by drive-through IF ABLE. Be aware that you don’t need the test to know that you have the infection. The positive test DOES NOT change how you are going to be treated at this point.

HOW SHOULD WE PROTECT OURSELVES AND OTHER?

Do these things to LOWER YOUR RISK:

HUNKER DOWN – stay home, go out in the open air and AVOID any contact with anyone other than your household. Bike, hike, garden, exercise, Facetime on the porch or patio, get some sunshine.

EASY RULE – for everyone you pass by when you are out – expect that they may begin having symptoms tomorrow – so stay 6-10 ft away

WEAR A HOMEMADE MASK WHEN YOU ARE OUT – save hospital-type masks and especially N95 masks for the hospitals and EMS/Police/Firefighters.
Consider bringing N95s to your local fire-chief or ER. There will be more and more ‘DIY’ type masks available. I found one that is made from a folded paper towel, staples and two rubber bands!

IF YOU HAVE A REUSABLE N95 MASK (workshop, industrial, etc) PLEASE CAREFULLY DONATE TO YOUR FIRE CHIEF OR YOUR ER. THESE WILL BE INVALUABLE FOR THOSE WORKING DIRECTLY WITH THE MOST ILL. (because these can be cleaned and reused)

WASH YOUR HANDS – a lot. You WILL get this virus on your hands, but it is really easy to kill. It is a fat layer (ball) around a single strand of protein. SOAP breaks down the fat and you have then destroyed the virus. Put your hand to your mouth or nose and you have allowed the virus to grow and infect.

EVERY time you touch something when you go to the store, etc., EXPECT you now have the virus on your hands. Wash with soap and water OR use 65% alcohol hand cleaner and wipe down purchases before they come into your house.

HELP YOUR NEIGHBOR – it is for times like this to draw upon positive character. Remember that everyone’s anxiety level is sky high, and everyone’s stress plays out differently – fear, worry, anger, denial, paranoia, with intelligent mature people making irrational and impulsive decisions.

HELP THE MOST AT RISK — consider things like helping elderly or other high-risk neighbors by calling and checking in regularly. They may need ‘runners’ for basic supplies and benefit just from your contact. Support your neighborhood by modeling calm but resilient behavior. Patiently dispel ‘myths’ with either facts or questions about the validity of their sources. Currently, the best sources are the WHO and the CDC website.

I’m available to discuss this, either by text, email or phone call. I am taking all precautions at my job in the ER. WE CAN FLATTEN THE CURVE, but it takes all of us. One carrier can unknowingly cause a full ICU in a short time…

And, importantly, this is NOT a surprise to our Lord and Savior. Remember, He speaks for Himself to each of us, through prayer, His Word, and through wise counsel. Each of us could ‘meet our Maker’ today or tomorrow in death. Perhaps we should all get to know Him a little better before that face-to-Face meeting. He is the Comforter, and Safe Place, and the Rock in this current maelstrom. He is loving and merciful and offers us the choice of dependence and faith in Him. Take his offer.

Depending on Him,

Andrew Daigle, MD

#HunkerDownWashYourHandsHelpYourNeighbor