Saturday 03/21/20, 11pm

Good evening and I hope you all had a good and restful Shabbos.  There have been some developments since yesterday so let me bring you up-to-date.

First of all,  here’s a piece of good news if such a thing can be said about this. So far according to all reports there are over 24,000 cases of the virus in the United States. Looking directly at the death toll which in the United States I think we can take as fact, the death toll stands at 269 people. If you do the math that means that the death toll is 1.1 or 1.2% much lower than it is internationally!  I feel that although still high numbers,  that might give people a sense of hope and reason to think a little more positively.

Some things that we are learning, is that the infection seems to be different in each individual, which makes it much harder for healthcare to try and clinically determine who has the disease and who doesn’t. As I mentioned yesterday testing in New York State outside of hospitalized patients and emergency room patients has stopped. Of note NYU Brooklyn, Long Island and NYU Manhattan will continue to test patients who have already made appointments up untill Thursday.

So what does not testing due to the numbers? You’ll notice from the daily reports and from  governor Cuomo’s excellent daily Press conferences, the number of cases in New York continues to go up. That is expected because we’ve been testing for the last two weeks. As each of those tests comes back and comes back positive, the numbers will increase. So the good news here is that it’s not that the numbers are skyrocketing and tripling every day. Many people feared that once the disease hit, Hundreds of thousands of cases per day would be seen. That doesn’t seem to be the case. Caution though, epidemiologists (scientist and physicians who follow disease patterns ) warn that this is just ramping up.  So we can’t let our guard down.

Here is a very important point.  Since we are stopping testing, of course the opposite will now be true.  The numbers of new cases may not be accurate, however the number of deaths will be accurate. It will appear that the death toll is rising inappropriately out of proportion to the number of total sick. In essence the following equation 269(deaths )/25000 (Cases) .  So please over the next week remember that unless both numbers continue to go up and represent true values of sick and dead, the death toll will appear falsely elevated.

The next thing I want to bring to your attention as were noticing a change in the clinical course, or as we follow patients for a longer period of time we are seeing the following;  The Clinical  course seems to go in one of two ways. The patient has the virus with whatever symptoms they get and it appears to end and be done.  Then the second group appears to have mild or moderate symptoms and seems to be doing well, when all of a sudden a week to 10 days during the course they absolutely crash develops up severe pneumonia and end up in the ICU of a hospital.

What actually causes this, why it happens, is still unknown as this is all emerging data. So therefore, if you’re at home right now and not feeling well, or have been diagnosed with thenvirus, and are doing well that’s great, but you must remain vigilant. Keep an eye on your symptoms, and your temperature! Should you notice any change,  even if you think it’s not important, please contact your healthcare provider as soon as possible!

So for now, The virus is progressing. We are learning more about this disease and how it plays out every single day. There are constant changes to the protocol of how we manage people with this disease both at home in the hospital. All of which I’m trying to give you a front row seat to in this daily blog.

So while you and your family are at home have some fun. Introduce your family to the Marx Brothers the Three Stooges and Laurel and Hardy. Laugh,  be closer and take care of each other.
We will defeat this virus, and the way which we’re going to do it is by enlightening and not frightening, with facts, real data and each of us caring for each other!

Enjoy the weekend together, stay healthy and stay safe!

Warren J. Wexelman, M.D.

Warren J. Wexelman, MD
NYU School Of Medicine
Past President, Flatbush Jewish Center