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Adapting to the Ups & Downs of COVID-19

Adapting to the Ups & Downs of COVID-19

Written By Melissa Bean Sterzick

The success of the shelter-at-home measures in decreasing COVID-19 transmission rates is clear. However, a new stage of the pandemic is developing. Cases of the virus are increasing while phases of opening and closing commerce and community are adjusted to control the spread. South Bay residents are considering this reality and asking themselves what feels safe.

The activities outlined in each phase are a sensible guide, but every outing should include masks, social distancing, hand washing and common sense to keep rates of infection down. Every individual has the power to protect their health and the health of those around them.

“My biggest emphasis is the idea we should try to get things open, but we have to understand while that means life is more normal, we still have to take certain precautions. If we do that, we can manage this with the least amount of people getting sick again,” says Dr. Eric Milefchik, a Torrance Memorial Physician Network infectious diseases specialist and chairman of infection control for the medical center.

Dr. Milefchik recommends individuals avoid being around unmasked people within a 6-foot range or the “respiratory droplet zone.” Passing through a droplet zone is low risk, but staying in one for more than a few minutes could be dangerous.

“The more congested the location is, or the more time you are spending in a closed off area with less air circulating, or if somebody is not wearing a mask and you are exposed for a period of time, the more the risk,” he says.

Residents should feel comfortable going to stores, ordering take out, eating in restaurants where seating is limited and spending time outdoors. Wearing masks and reducing proximity are important precautions even outside, because droplet zones can be formed outdoors among large groups.

Parks, trails and beaches are low risk but can create chances for infection if crowds gather or people from different families share transportation to those sites. Sitting in a closer environment like a car, with people from different families and talking while not wearing masks is not advised.

Besides regular physical activity, safe socializing, healthy diets and regular rest, individuals should also resume annual checkups and doctor visits. The hospital is a safe place to address medical needs, and the consequences of deferred care are high. Elective surgeries are now being done, and Torrance Memorial has reached full scheduling capability.

Dr. Milefchik says there is a lot of variability in the virus’ spread around the country and that variability will continue. Besides different conditions, transmission of the disease goes in stages – some places are at the beginning of the spread and others at the end.

“The uniform thing is that testing is definitely better everywhere. Theoretically, we have the ability to control it more by finding out where it is and quarantining contacts better than we were in the beginning,” he says. “The key will be to identify those who are sick quickly and take measures to limit the spread.”

Although there has been an uptick in case numbers for Los Angeles county, it is still manageable in the South Bay. Many aspects of a return to normalcy are not known and will be made clear as weeks pass.

Torrance Memorial is preparing for a possible second wave by fine tuning its procedures. Testing processes will be improved by adding a third platform for rapid testing and gathering more supplies.

One thing that won’t change is the hospital’s triage system. Patients are separated at the door so all respiratory suspected COVID-19 cases go one way and the rest go the other way. Dr. Milefchik says Torrance Memorial has not identified a single patient who caught COVID-19 at the hospital.

Every individual is adapting differently to the pandemic. As more businesses and venues open, there will be those who do and do not take precautions. Dr. Milefchik says those who do not will be more likely to contract and spread the virus.

However, he says, it’s time to compare the risks and benefits of reopening. The pandemic has affected peoples’ health in ways that can’t be measured yet. Physical and mental health are both jeopardized by business closures and strict shelter-at-home measures. Anxiety is prevalent among those who have lost work or experience isolation.

Dr. Milefchik says the stress of the pandemic and the challenges of isolation and unemployment have created an increase in mental health issues. An article by Moe Gelbart, PhD, on page 4, outlines ways individuals can protect their mental health as pandemic response evolves.

“There’s an unmeasured effect. People just want to see some good news after all of this. They want to know they can get out there safely,” Dr. Milefchik says. He thinks if residents of the South Bay do all they can to help keep the spread of the virus low, rates of infection can be controlled. Case numbers must be kept from rising exponentially to keep hospitals under their capacity lines.

Dr. Milefchik recognizes people can be confused by the information they read from different sources. For the South Bay community, he recommends Los Angeles County Department of Public Health and the Centers for Disease Control for straightforward, digestible information about the virus, its treatment and containment.

“The faster we get things to move toward normalcy - and we’re talking another year before realistically things reach actual normalcy - the better,” he says. “We can’t ignore it. We have to respect certain measures and the better we can respect that, the better it will be for everybody’s health.”

Front-Line Heroes

From the time the pandemic began until most recent days, the medical community around the country, including Torrance Memorial, has been manning the front lines carrying out treatment and research at the same time. What has been found so far, according to Dr. Eric Milefchik, Torrance Memorial infectious diseases specialist, is a treatment based on multimodalities is best.

“In this situation we share info with other centers. We look at the studies as they come out and we try to choose what is potentially helpful without causing harm,” he says.

High pressure oxygen techniques such as nasal cannulas and oxygen masks address respiratory distress. Proning - placing patients on their stomachs – also supports lung function. Different medications including immune modulating drugs and steroids are administered depending on the patient’s condition.

While COVID-19 has no proven treatment, plasma donated by those who have recovered (called convalescent plasma) may help patients fighting COVID-19. This is because the body develops antibodies against the virus. Historically, convalescent plasma has been successfully used to treat similar diseases such as the Spanish Flu, SARS, MERS and H1N1. Plasma donations are received through the American Red Cross (www.redcross.org) and San Diego Blood Bank (www.sandiegobloodbank.org).

Dr. Milefchik says the emergency department has been instrumental to successful COVID-19 management. Those providing patient direct care including nurses, respiratory therapists, phlebotomists, physical/occupational/speech therapists, hospitalists from each of the groups, pulmonary/critical care physicians, anesthesiologists and many other specialists have shown strong teamwork.

“Torrance Memorial nurses are smart, dedicated and have been the source of many of the innovations in care of patients,” he says. “Torrance Memorial administration has been quick to act, and great leadership has been demonstrated at all levels. They have listened to all players and enabled us to be well-prepared throughout this time.”