re: Coronavirus Disease 2019 (COVID-19) ***W.H.O. DECLARES A GLOBAL PANDEMIC***

“I'm not an expert on this virus or any other virus for that matter. I am a US trained OBGYN Ex-Pat living in Verona Italy (Northern Italy, in the hot zone). I was asked to share my thoughts so here goes.

We all started off thinking that this was some overblown flu, making jokes and not understanding why China was in lockdown. Then the cases began to multiply at a freakish rate. We believed this was because we were testing EVERYONE and finding cases that had no symptoms. Then the ICU’s of some parts of Lombardy (all around Milan) began to fill up and overflow. Today March 9th 2020 some hospitals in those areas have implemented a triage system as to who will be intubated and who will not (people over 70 and or with co-morbidities).

Let me back up a little. This is not a zombie apocalypse. The actual percentage of people dying is really low. Children and young adults seem to not be affected with more than flu-like symptoms. In the beginning only elderly with comorbidities or smokers were getting really sick, just like a really bad influenza outbreak. This was all great until younger (think 50’s) and relatively healthy people began to become very ill in addition to the large number of already sick.

The real problem is 3-fold here in Italy, 2 virus related. (again my opinion)

1) It seems to be stunningly infective. Surviving 12 hours on metal surfaces (that’s right, door handles and all).

2) Here, about 10% of the infected need ICU beds and around 4-5% need ventilators due to ARDS. This is the BIG BIG problem and why Italy quarantined 16 million people and why multi-billion-euro soccer games are played in empty stadiums (What is 4-5% of 16 million? We don’t have that many ventilators).

Italy is not a third world country and our hospitals are set up pretty much like the ones in the US. You might debate that we have a lower threshold for admission and longer stays vs the US but this is a RESOURCE ISSUE. There are not enough ventilators for the number of people who need them. This is due to sheer volume and THIS is the REAL problem. This is why countries are in lockdown and freaking out. This is a real medical emergency and doctors are now deciding who lives (gets intubated) and who does not. Couple this with the median age of the sick becoming younger and things get worse.

3) Italians (the people, not doctors) are undisciplined in some things. They have been given guidelines, like stay at home as much as possible and many do whatever in spite of this. The ski resorts are full for example. This helps to continue the spread of the disease. On the other hand, at the supermarket the other day, for the first time in 15 years I saw a single file line with people 3 feet away from each other without police or guns involved.

So: The faster the virus is contained the lower number of ventilators will be needed.

1. Wash. Your. Hands. Wash them so much. If you can’t wash use the gels and hand sanitizers. Maybe stop shaking hands, some kind of elbow bump would be cool.

2. Don’t pick your nose. Or put your fingers in your mouth, on your lips, or in your eyes.

3. Surgical masks seem to be enough to limit the spread AND protect you from disease. FFP2 / 3 only if you are working directly on a Covid-19 patient. Also do not put an FFP mask on a sick person, most have valves and that allows the virus OUT – provides NO protection for others.

4. Sanitize the objects that lots of other people touch,

5. Social distancing. Do it. This means keeping people apart from one another (preferably 6 feet apart, and sanitizing shared objects).

6. Travel is about to be screwed. Plan for it and around it. I would not say travel somewhere I would not be happy to be stuck at for 3-6 weeks.

7. If you are sick, stay home. For the love of all that is holy. Stay at home.

8. If school or other events are cancelled and or you are asked to limit non-essential movement. Just do it.

I didn't write this for professional purposes, I am not an expert but I do have a brain (at least I think I do). Hope this helps in some way.

I LEAVE YOU WITH: THIS IS NOT A NORMAL FLU.

Don’t panic, toilet paper will continue to be made, at the same time do not BLOW THIS OFF.

Let’s hope warm weather comes very very soon.

J.Stefano Lehman MD, OBGYN