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Dr. Sarah Archer has partnered with the Chronic Disease Coalition to provide answers to frequently asked questions from our patients about COVID-19. Dr. Archer’s sixty-year career equips her with the knowledge and background to uniquely understand the pandemic and what it means for chronic disease patients. What has changed in the last three weeks since the original Q&A? Several things – with some light at the end of the tunnel.

Changes in the numbers, local regulations, severity, etc. will continue to occur daily here at home and the rest of the world.
The epicenter of the pandemic has shifted from China and South Korea to Europe. Italy is currently hardest hit; other European countries are bracing for drastic increases.
The US is experiencing rapid increases in numbers of cases and deaths in every state, influenced by the fact that equipment like test kits, N95 masks, gowns, gloves, ventilators, and additional hospital beds, are still not getting into the hands of first responders and medical facilities who desperately need them.
A number of laboratories around the world are working round the clock to develop vaccines for clinical trials against the virus in record time.

Does the medical and research community have a better understanding of the virus at this point? Prior to late 2019 nobody knew about SARS-COV-2, the scientific name assigned to the novel coronavirus that is rampaging through the world. We are still on a very steep learning curve that is dependent on observing what the virus does and collecting as much valid data about is as possible. We know a great deal more about it now than we did in December, but still far from enough. Complicating this whole process is the ability and propensity of viruses to mutate—to change their behavior and even some of their characteristics. Mutation is what enabled SARS-COV-2 to jump from its animal reservoir to humans. Further mutation has facilitated its rapid spread from person to person. Virologists and Epidemiologists are closely monitoring data and studying fresh SARS-COV-2 virus samples looking for evidence of mutations and their effects. How have immunocompromised patients been impacted so far? We do not know this yet. Unfortunately, mortality data are generally focused on immediate cause of death, in this case COVID-19 disease. The Centers for Disease Control and Prevention put out the first preliminary description of outcomes among patients with COVID-19 in the United States last week. Data indicated that fatality:

Was highest in persons over the age of 85, ranging from 10 percent to 27 percent,
Three to 11 percent among persons between the ages of 65–84 years,
One to three percent fatality among those who are between the ages of 55-64,
Less than one percent for those younger than 54,
No fatalities having been reported for anyone younger than 19.

Data on other risk factors, including serious underlying health conditions that could increase risk for complications and severe illness, were unavailable at the time of this analysis. Never forget that those of us who are over 65 and/or have underlying heath conditions are at the greatest risk of severe illness and death from COVID-19. DON’T TAKE CHANCES! What does the outbreak lifespan look like at this point for the United States? I wish I could tell you, believe me, but I cannot. We are hoping the COVID-19 disease trajectory in the US follows the trajectories reported by China and South Korea. Situations in the US are different, however. We can ask and even beg for everyone to practice social distancing and to with the President’s Coronavirus Guidelines for America, but, at least at present, we cannot mandate and enforce that compliance. If we all comply, fewer people will be infected and fewer will die; if not more infections and death rates will occur. It is absolutely essential for those of us over 65 and/or with underlying health issues: immunocompromise, cardiac, pulmonary, diabetes, etc. to comply AND to influence those close to us to comply for their sakes and ours. What do you wish more people with chronic diseases or who are immunocompromised knew? People over 65 and anyone who is immunocompromised must understand and act on the fact that COVID-19 is an existential threat. It can kill you. All of us must self-isolate from anyone else who has contact with other people. Please take the need to eliminate exposure to other people and objects that have been handled and breathed upon by others who are infected since even one of these kinds of exposures can be lethal for us. What’s your advice?

Please take care of yourselves and practice social distancing.
Self-isolation may be psychologically difficult for many: talk regularly with family and friends via phone, Skype, Instagram, Facetime or other platforms. Other people are lonely, too.
Ask for help if you need assistance with shopping and other essential activities.
Offer help to others if you are able to and if helping does not put them and you in jeopardy.
Keep physically active; take yourself and your dog, if you have one, on long walks, weather permitting.
Keep mentally active: read, do puzzles, crafts, cook, start a diary, write letters or emails to friends and family, even clean the house, if all else fails---anything to enrich your days and pass the time.
Get up and dressed every day—do not sit around in pajamas.
Consult reliable sources for information about CVOID-19: CDC, State and Local Health Departments, your own medical provider etc.
Beware of misinformation and disinformation on social media—do not believe anything you read on social media without fact checking it with reliable sources.
We are all interdependent and so we are all in this together.