The Vigo County Health Commissioner has written a post highlighting the "...immediate severity of what is about to unfold in Terre Haute and the surrounding area..." in relation for COVID-19.
He is in daily contact with the Indiana State Department of Health, spends hours researching data, studies from Europe and Asia, attending webinars and conference calls by the dozens.
He urges people to take the advice of local, state, and national health leaders seriously, and to stay at home.
Below is his full post.
“CoVID 19 is here, it’s upon us, and yet few people seem to really grasp the immediate severity of what is about to unfold in Terre Haute and the surrounding area in the next few weeks. People are already hospitalized, on ventilators, and have sadly died from the illness. It’s not curable, it’s even poorly treatable when the severity is high. Older people- meaning 50’s and up, especially the ones with diabetes, lung disease, poor nutrition, and poor social support are at an enormous risk of not only severe sickness, but of near certain death when the disease has spread into the lungs fully.
We seem to think “it’s not that bad here”, judging by traffic patterns in town and all of the ridiculous businesses and services that want to continue to operate “as-is” despite the warnings, really stretching the line of what is “essential” right now. In short, healthcare delivery, food line support, and first responders/EMS providers should be the only faces in public right now. What people need to understand is that our local, state, and federal healthcare delivery system CANNOT support what is predicted. Indiana is projected to be one of the worst hit states in the nation once this ends, with around 2,500 Hoosiers helplessly dying from the disease, and more than 100,000 people sick from the infection. If the idea is that “I’m young, it wont matter if I get it anyway” is the logic...some of that is true- as many as 80-85% will likely have only mild or moderate illness. However, if the young and healthy continue to blindly serve as carriers and vectors to spread the virus, their parents, older siblings, diabetic neighbors, grandparents, in-laws, and acquaintances will suffer a miserable end as we all stand by with disbelief on our faces. The scariest part... the worst is yet to come. The world’s leading epidemiologists predict Indiana to continue to exponentially fail in the coming 2-4 weeks- the whole month of April essentially, before the contagion starts to slow...dragging through May and likely in June by many models.
The ONLY way to not get this virus with certainty...is to go home, stay home, loculate themselves from everyone else in their lives for the next 2-3 weeks. If people have it now, they can get better at home, self quarantined. Many will not get better, they will get worse. They will need to seek care as they face the uncertainty of illness. We know many positive tested people have NO symptoms whatsoever, and many have only mild cold or flu-like symptoms, which empowers them to say “I’m not sick, it can’t be me worsening the problem”...yet...they are the problem. The time is upon us to start to break the timeline, bring about an end to the life cycle of this virus, for now.
The virus MUST occupy humans to survive in an environment for any length of time. Viruses are simply small pieces of DNA or RNA (as in this case). They live inside of our cells, high jacking their way into our own encoded DNA, using our cell processes to replicate, divide, replicate again, making us sick in the end. These tiny fragments of genetic material are encased in a capsid- like a protective capsule of proteins and lipid fragments that enable them to be generated for re-transmission. The droplets can survive 2-3 days on non-porous surfaces, and the aerosol mist created by coughing and sneezing may contaminate the air around an infected patient for a few hours. By us touching our faces, mouths, eyes with unclean hands, we can easily introduce these substances into our bodies. The viral particles are picked up by cells that live inside our respiratory tract starting with our mouths and nasal cavities, attaching to a receptor called “ACE-2”. It then invades our DNA of the lower respiratory cells within the lungs, causing disruption of the microscopically small membranes that are present in healthy lungs to enable oxygen to diffuse across to oxygen-poor capillaries to be carried by our blood to give life to our body. In a matter of hours or a couple of days, those sites are irrevocably damaged, and the lungs can no longer bring oxygen to the rest of the bodies. A massive inflammatory response ensues, and the body slowly starves of oxygen, with waste products of organ dysfunction accumulating rapidly, with no end in site. Death follows, despite heroic efforts of healthcare providers and the world’s best scientists. EVERY treatment we can try is “theoretical”, or “experimental”, or “unproven”...and decidedly ineffective. As many as 90% of the sicker adults who end up on a ventilator, will never survive it.
Then there’s another side of it to consider. These really sick people seek help-as they should- from the healthcare system. They call 9-1-1. Our EMS crews pick them up and take them to an ER- where nurses, doctors, respiratory therapists, phlebotomists, security guards, volunteers, and other patients are housed. These people try their best to help them, staring directly into the dangerous unseen particles, themselves now “exposed” and possibly to soon after become sick. These brave frontline people have families, have kids, have parents, and dozens- even hundreds of friends and co-workers in their life circles...are they now the vector to spread disease on to their friends, in 5 or so days when the incubation period has finally evolved fully? That “unknown” scares the absolute HELL out of every one us in healthcare. Protective equipment can only do so much, and we are never fully prepared for such a situation to unfold. Respiratory distress situations are not the calm, organized, well-orchestrated nursing and doctor movements as seen on television. Rather, they are absolutely chaotic- filled with spilled bodily fluids; with rushed, imperfect actions that lead to tiny mistakes and missteps that puts the healthcare workers in grave danger from this disease, without ever realizing it. Local Physicians and healthcare teams are meeting constantly with each other to compare notes, share research, ideas, etc- trying to collaboratively approach the situation as it develops in our laps. We do not have an unlimited supply of ventilators available to us. If unchecked, we could have every vent at both hospitals filled in a matter of days. As more critical patients arrive in our ER in need of a ventilator, none will be available. This what is happening in hot spots like New Orleans, Miami, and even Indianapolis already. It can very easily happen to us here at home if we all fail to stop the propagation of the virus in our community.
People saw the people of China walking the streets in masks, frantically avoiding each other, and then the streets went deathly quiet when ordered to do so. The only movements were healthcare delivery, military, and law enforcement. It worked. It’s been the only country in the world to date to accomplish recovery from the virus. Every other nation, including the United States, has been unable to get the same handle on it. Yet we seem to remain stupidly arrogant in our thoughts that “we’ll figure it out as we go.” The US and the rest of the world have proven this to be gravely far from the reality of the matter. The only way to shut the life cycle down is to stop the spread where it lays, absorb the illness in those presently infected, standing by as thousands more die from the seemingly unstoppable process, and to NOT allow anyone else to become infected. The way to not become infected, is to absolutely NOT put yourself in a position to contract the virus from others. Stay home, stay with family, but while practicing good common sense hygiene and social distancing within your small circle of contacts. Keep your hands away from your face. Cover your face with a tissue when you cough, or sneeze, discard the tissue and immediately wash your hands. We need to also TEACH our kids, our siblings, our family members how do to the same. Vigilance within the home can stop the spread of the virus within our own homes- that’s doing our part on the most basic level. “Universal masking” will be a hot topic in the days to come. Wearing a barrier mask of some type while in public, going to the doctor’s office, getting food, etc is NOT meant nor designed to keep you from contracting the disease, but rather to limit the spread of viral particles that my be in YOUR system already to others. If a person is living in your home that is under quarantine, that should be wearing a mask when they must be around others within the home even for brief periods.
All of us in healthcare delivery have accepted the inherent risk of placing ourselves in danger that comes along with the worst pandemic the world has ever seen. We are all terrified of what it might hold for us all as it spreads across the Valley. We are as well- prepared for this pandemic as we feel we can be, but question if we are “really ever ready”, as so much is unknown.
Everyone NEEDS to stay home, everything NEEDS to come a grinding halt across this entire area, the whole country, and across the world. If we act collectively here locally, perhaps we dodge the feared massively influx of critically ill patients that is set to absolutely run over our healthcare delivery system- at least locally. But if we continue to act as fractions, separatists, individuals- we are sealing our own fate with this pandemic. Hundreds will die, perhaps thousands. The “partial shut down” and social distancing will drag on for SEVERAL WEEKS yet, more likely MONTHS. The economic ruin left in the wake when the dust settles may also be unrecoverable for entire communities, and certainly many families. Trust the info from the CDC and reputable sources like Johns-Hopkins, the local health department, and the ISDH. Ignore the myths spread about on FB and advice from unnamed “specialists and experts”. There’s no magic trick to be found. If someone, somewhere had this figured out, we would not be approaching a million positive cases across the world. Gather up everyone you love in this world, and make plans to do your part with this virus. It’s here. The “planning stages” and “preparedness plans” are going to be tested dramatically, unless we all pay attention to the seriousness of the pandemic. It is no longer a “China problem”, or New York problem, or Italy...it’s a Terre Haute problem, a West Central Indiana problem...right NOW. We are just now getting started here locally. If the vibe is any different in our local society, it’s completely wrong.
Stay home, take care of those immediately around you, preach good personal hygiene, keep our older and most vulnerable residents free from exposures by doing everything in our power to stop the spread. Take no day for granted, and be smart while being kind to everyone. Do everything in our power to band together NOW, to help spare this community and our loved ones from this terrible disease process. God bless.
Darren Brucken, MD