The new coronavirus, COVID-19, is real. It is not a political fabrication and it is not a hoax. Its dangers have not been exaggerated. With over 1,300 confirmed cases in the United States as I write this, we are now in the acceleration state of the pandemic.
In Italy, there were only three confirmed cases of coronavirus less than a month ago. Now there are over 12,000 cases and 827 deaths. The Italian government has ordered all shops, bars and restaurants to close, and a nationwide lockdown prevents 60 million people from traveling outside areas where they live.
Although the trajectory of this coronavirus is difficult to predict, we can look at the history of other viruses to know what might happen in the U.S.
Within a week or two, there will probably be tens of thousands of Americans who have the coronavirus. Most likely, the virus will remain a threat for at least a year. We almost certainly will not see a vaccine before then. By the time we have developed a vaccine, the virus will have infected millions of Americans and will probably have mutated in unpredictable ways.
As I wrote in a previous column, the people with an increased risk for severe symptoms and possibly dying of COVID-19 are seniors and those with chronic illness. Of course, people in chronic pain are part of this high-risk group.
The lethality of COVID-19 was initially reported to be about two percent, but the World Health Organization now estimates the overall fatality rate to be 3.4 percent. For people over age 60 or with underlying health problems, the rate is even higher.
We still don't know how many people have been infected, so it is impossible to know the true rate of mortality (the number of deaths compared to the number of people diagnosed). As we improve our ability to test for the virus, hopefully we will see the rate of mortality decrease, although the number of deaths will continue to climb.
The 1918 Spanish flu infected one-third of the world's population. Even though the pandemic lasted only 15 months, it still killed between 50 million and 100 million people worldwide. An estimated 670,000 of them were Americans. Adjusted for population growth, that would be more than 1.8 million Americans today.
Just ten years ago, the H1N1 swine flu virus infected 60.8 million people worldwide. Up to half a million lived in the U.S. and 12,469 of them died. The swine flu spread slowly compared to coronavirus. In April 2009, a 10-year-old boy in California became the first American to test positive for the H1N1 virus. By October, President Obama had declared swine flu a national emergency.
One of the takeaways of past pandemics is that we must recognize the speed at which a virus can spread and the importance of preparing as early as possible.
Every person in the United States should have a plan in place for dealing with the coronavirus. In the best-case scenario, our lives will be relatively unaffected. But we would be remiss to count on the best outcome. Wishful thinking won't help us. Preparedness may.
One of my colleagues told me that during Hurricane Katrina, hundreds of patients in the Mississippi area with intrathecal delivery systems for conveying pain medications to the spinal canal were unable to be seen by their physicians. Many of the pumps ran dry during and after the hurricane because patients could not reach their doctors or the doctors could not obtain medications from the a compounding pharmacy. Patients experienced a tremendous increase in pain and many were forced into severe opioid withdrawal.
Pain patients weren’t the only ones who suffered. Intra-abdominal pumps delivering insulin also ran dry. Thousands of patients experienced insulin withdrawal or diabetic coma. Many people with complex medical problems, including cancer, could not receive life-sustaining therapies. Some people died.
Think of COVID-19 as another natural disaster, and anticipate the same potential problems. Begin your planning immediately by talking with your doctor. Some of the questions to cover are:
Some experts recommend stockpiling additional medication in case of an emergency. Ask your provider how they feel about that.
How long can you last if there are supply problems and your doctor, nurse practitioner or pharmacist can't get your medication? What are your options? You may need to go to a different doctor. However, that can be problematic because fewer doctors are accepting new pain patients.
Also, if you do need to find another doctor, the prescription monitoring database may show that you have obtained medications from two or more different providers. You may be labeled as a doctor shopper. Ask your doctor how to avoid this problem. When meeting with your provider, be transparent about your concerns. Avoid panicking.
If you are infected, the virus may affect your ability to breathe. Opioids can add to breathing difficulties caused by viral infections, so be prepared to reduce the amount of your medication. Discuss with your doctor how to decrease your dose to remain safe.
Be prepared to ask your doctor the right questions and come up with a plan together. Think of coronavirus as a serious threat, but trust that you can prepare to mitigate the harm.
This is like war. But the invader is not a human enemy. It is an enemy of humans. It is an infection.
Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.
Opinions expressed are those of the author alone and do not reflect the views or policy of PRA Health Sciences.