Opinion | Coronavirus, Pandemics and Philadelphia

Close Up Of Medical Staff Washing Hands. Hand hygiene.
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By Leon S. Malmud M.D.

In the 20th century, great pandemics occurred three times (1918, 1957 and 1968). Based upon recent experience with pandemics (influenza, SARS and MERS), we knew to expect and now know that the coronavirus has penetrated the United States.

We also know that only a portion of the total population would become infected, but of that portion, approximately 2% will die.

The coronavirus, now more specifically labeled COVID-19, is a sneaky virus because it infects people before they are aware of it while they innocently spread it to others through the air in droplets and on surfaces contaminated with droplets from sneezing and coughing. People with symptoms will find it difficult to distinguish this virus from those resulting common colds or flu. Vaccines are not yet available; their safety, efficacy, testing and distribution will likely not be completed until later this year, if then.

The first step in dealing with a new potential pandemic is government’s responsibility, that of “containment, then developing and implementing mass screening. Compared to our experience in the great flu pandemic of 1918, we are blessed with life-saving medical interventions and advanced medical support services.

Nevertheless, what we need now and have not yet seen are adequate testing kits and plans for additional staffed hospital beds to accommodate a surge of very sick or isolated patients. We also face the need for sufficient protective equipment for health care workers, who will by their commitment to patients be at the greatest risk. We must also prepare for those who serve in uniform.

As Jews, we are informed of the responsibility of tikkun olam. We have that obligation on behalf of all others, Jew and gentile, to protect all from harm. Rabbi Yudi Shemtov of Bucks County paraphrases Miamonides by stating that protective measures are a form of tikkun olam.

What should we as individuals do? Don’t panic, but be prepared for the probable risks. It is far better to look back and laugh at what may eventually have proven to be unnecessary, than to suffer the costly consequences of denial, delay, disease or worse.

Here is a list to start with:

Wash your hands before eating or touching your mouth, lips or nose. When people sneeze or cough, their droplets also contaminate surfaces. To the extent possible, clean surfaces with Chlorox wipes at home and at your desk. Avoid self-service salad bars. Others may sneeze or cough near them.

  • Cover your mouth or nose when you cough or sneeze.
  • Don’t use your cellphone while eating. Regard it and hand receivers as contaminated.
  • Stop greeting friends and others with hugs, handshakes or kisses. You or they may be asymptomatic carriers. When the threat passes, then you can resume your old practices. The threat hasn’t even peaked yet.
  • Stay at home if you are ill.
  • Avoid crowded conditions whenever possible.
  • Consult a physician if you have a fever with cough or if you think that you’ve been exposed.
  • Be aware of the prevalence of proven cases in your community or nearby communities.
  • Prepare your home and yourself for the possibility of being temporarily isolated, which we used to call “quarantined.” Keep your prescription medication supplies up to date and have adequate nonperishable food on hand.

What about our city? Philadelphia’s hospital bed capacity, while efficiently reduced for our ordinary needs, is not sufficient for a pandemic. We are the only major American city without a municipal hospital after Philadelphia General Hospital was shuttered more than 40 years ago. Subsequently, we witnessed the loss of most of our community hospitals, which attempted with insufficient reimbursement to serve with fidelity a predominantly medically indigent population.

We eagerly await word from the city and state public health officials regarding implementation of strategies to cope with a potentially large number of exposed and critically ill patients. When, not if, the virus surfaces in Philadelphia, let us not make the same tragic misjudgments as our city did in the great flu pandemic of 1918, when it chose to deny the risk of crowding and did not cancel our annual holiday parades, resulting in one of the highest death rates experienced in major cities in the United States.

Who then shall assume responsibility when coronavirus cases occur in our community?

You, and only you, are best equipped to protect yourself and your loved ones. Rely not, as Blanche Dubois, “upon the kindness of strangers” nor upon the supreme competence and efficiency, even that of our well-intentioned government at any level. We have as yet not been sufficiently informed of our government’s prompt implementation of the comprehensive advice of our own Centers for Disease Control and Prevention, which wisely predicted and planned for this eventual possibility years ago.

In conclusion, don’t panic; start following the above advice and the recommendations of our federal, state and local officials, as it becomes widely available. In the meantime, since COVID-19 it is already here, start today washing your hands now (not a ritual washing, but a thorough one with soap and water, while reciting the alphabet or aleph-bet silently to yourself for timing). Should you cough or sneeze, cover your mouth and nose. Avoid shaking hands with strangers and certainly avoid hugging or kissing as a form of greeting.
COVID-19 will pass: but not soon enough.

Prevention is the best cure. L’chaim!

Leon S. Malmud is the dean emeritus of the Lewis Katz School of Medicine at Temple University.

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