Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid.

(And it’s okay with me if you want to share.)

Today I’m talking about ways to make things A Little Less Unsafe and also predictors of severe Covid.    

Massachusetts is doing well.  All the metrics are staying great. We are so far tolerating our slow steady summertime reopening just fine.

And this week’s awesome news is about the large-scale free testing they did for protestors ten days ago.  They tested over 16,000 people and only found a little more than 200 were positive for the virus (ie actively infected).  That’s 1.2%!   So tiny! 

A lot of these people (although not all) had attended protests so these results offer continuing reassurance that demonstrations — as long as they’re outside and people are mostly masked— won’t be causing a big uptick in numbers.

Another sign of encouragement in Massachusetts is that the weekly Thursday afternoon informational phone calls between the Massachusetts Medical Society (doctors) and the DPH (the Department of Public Health’s epidemiologists and public health experts) — came to an end. 

Since mid-March, every Thursday afternoon at 3:50 I would run an errand by the Boys and Girls Club and then at 4 o’clock I would walk up to Pleasant Street and dial into the call.  I’d spend the hour meandering up and down the side streets leading to Spy Pond, listening intently to really smart people talk about the Massachusetts Covid numbers and the challenges and the logistics and the accumulating science.

Those first weeks of terror and uncertainty the calls were all about PPE and then they were all about ventilators.  The DPH ended up distributing about 8 gajillion pieces of PPE and over 600 ventilators, some from the Federal Government, some borrowed from other states. 

Last week, the last of the borrowed ventilators were shipped back to New Jersey.  Can’t you just see some Ryder truck, bouncing down the Pike with all these life-saving big machines in the back, tied up, cleaned up, and full of so many stories. 

The doctors at the DPH had incredibly soothing voices, very human, often using words like “troubling” and “grave concern.”  I’d walk down Pleasant Street getting tenser and tenser and then this calm, rational voice would continue: “so now we have plans to….” describing some data-based logical response to that week’s crisis — how to find more PPE, how they were calculating the numbers of ventilators they needed, how to disperse 5000 doses of remdesivir to the hospitals that had the sickest patients — and my stomach would loosen up.   By then I’d have walked to Spy Pond and there would be a swan’s nest, or a turtle, or a heron, and my shoulders would loosen, too.

Do you know the weather was beautiful every single Thursday this spring?  Every DPH call day it was gorgeous, and every day I would walk, and every day I would come home heartened, feeling a strong sense of being in good hands.  Not perfect, but thoughtful, and driven, and guided by the science.

So we made it through the surge in Massachusetts and we learned a ton.  Other states are now learning from their own painful experiences even as we speak. The situation in much of the South is, as our DPH friend would say, “deeply troubling,”  with horrible rises in numbers and hospital pressures and lonesome deaths.  A friend of mine, an ER doc here, said, “April was the only time in my life I saw grown men cry,”  and to think the same thing is happening down there — it’s just too terrible to contemplate.

How do we keep ourselves safe in the midst of all this?  Well, the bottom line is we’re NOT safe and we cannot keep ourselves 100% safe short of staying inside forever. 

All we can do now is try and follow the science to make things A Little Less Unsafe for both ourselves and our vulnerable loved ones.  All of these definitely help:

  • Masking
  • Staying a distance away (six feet, three feet, whatever, the more the merrier)
  • Minimizing contact time
  • Hanging with safe people
  • Handwashing
  • Being outside.

So am I going to go belly up to a crowded windowless bar for three hours with 200 people who haven’t worn a mask since Mardi Gras? No, I will not, ever. 

Am I going to go see my dearest bud who has been sheltering in place (except for maybe Market Basket) and sit at the opposite end of her backyard table and have a glass of rose?  Yes, except probably I’ll have a Cab and maybe an extra-large glass.

Do I go to an indoors baby shower with a catered table-long buffet? No: that is unsafe in too many ways including the mom’s risk. 

Do I go camping with a group of friends who have all been safe and who all get a negative virus (swab) test a couple of days before we go?  Well, no, I never go camping, I’m too big a fan of showers and power outlets and I think the rest of you are crazy to want to sleep on rocks with bugs. 

But. Let’s make it about you:  Do you go camping with kindred trusted buddies?  Without question there are some risks here: You could get a false negative test, you could get tested too early, you could get exposed en route to the campground, you probably don’t have access to hot running water for handwashing. 

But you could do things to make it A Little Less Unsafe, ie, not 100% safe but not 100% unsafe. You could really self-isolate for two weeks ahead of time, go with just a couple of friends and not a gaggle, go in separate cars, pee in the woods and not in campground bathrooms (watch for poison ivy or you’ll rue the day you were born), and then when you get home you could make a point to stay away from anybody vulnerable.

Speaking of which, this week the CDC changed their definitions of who is vulnerable, ie who’s at increased risk of serious Covid illness; it now includes:

  • older people (“risk rises steadily as you age”)
  • chronic kidney disease
  • COPD (emphysema)
  • immunocompromised after kidney or liver transplant (or any solid organ)
  • BMI>30
  • serious heart conditions (heart failure, coronary artery disease, cardiopathy)
  • sickle cell disease
  • type II diabetes
  • children who are medically complex

The CDC website also lists people who MIGHT be at higher risk  — it’s a long list.  I’m not going to write it out here as we’re really not yet sure about all the science, but you might want to take a look (google CDC and severe) to help you figure out your own risk.

If you’re in a highly vulnerable category you must have — there’s no getting around it — a low tolerance for risk.  If you’re not high risk — and you don’t hang with people who are vulnerable — it will be all about trying to keep you and your people A Little Less Unsafe. 

Living in the gray as we now are, we’re just going to have to get in the habit of thinking constantly and intentionally about our interconnectedness.  We’ll need to be in our own good hands — not perfect, but thoughtful, and driven, and guided by the science.