Don’t go back to normal – adopt and observe a “new normal.”

It appears that the expected second wave of COVID-19 infections has already arrived.

On June 11 Florida reported the highest number of new cases since the beginning of the pandemic, averaging an additional 128 hospital admissions per day. The day before, Texas recorded 2,504 new cases. This represents the highest number of reported cases in one day. Also on June 10, California recorded 3090 newly infected COVID-19 patients. Altogether more than 20 states have now reported a second spike in coronavirus cases.

As healthcare providers we must distinguish between:

• New COVID-19 diagnoses, and
• New COVID-19 related hospital admissions
• New COVID-19 related deaths

It appears that there are more diagnosed cases for COVID-19 right now. This is because:

• More testing is being provided for the public
• The reopening of the country and the reopening of businesses with the subsequent reduction of social distancing and gatherings likely is resulting in a higher transmission rate

There are multiple reasons for the higher rate of hospital admissions but they include:

• More testing is being provided for nursing home residents and positive cases are often directly transferred to the hospitals
• The currently increased transmission rate from asymptomatic individuals due to the lack of social distancing affects the elderly and more vulnerable patients who end up with symptoms in the hospitals

As a physician in California dealing with more than 100 patients every day in hospitals I am not seeing as many healthy patients who contracted COVID-19 in dire physical conditions as had been reported initially in Italy and in New York months earlier.

On the other hand, we see more chronically ill patients who are now diagnosed with COVID-19 and end up in critical condition with respiratory failure. These patients require intubation and ventilator therapy in the Intensive Care Units.

In particular the elderly (above 75 years of age) and those with underlying chronic lung conditions such as chronic obstructive pulmonary disease (COPD) and those with chronic heart or vascular illnesses such as congestive heart failure appear to be at highest risk for compromised respiratory conditions and subsequent death. Even though we have also seen a reduction in the number healthcare providers dying in California compared to New York or Italy, we currently do see more COVID-19 related death cases in those high-risk populations.

As a result of the recent mass gatherings with many people who are not adhering to social distancing recommendations we likely will see more transmissions from healthy people who remain completely asymptomatic. The R-value, which represents the reproduction value of the virus, has creeped up above 1.

The R-value is a virtual number, which means that if it is 1.5, 100 people transmit the virus to 150 others. The goal is to reduce the R-Value value below 1 so that less people will be infected and the virus would disappear in the future. At the current time, however, the R-value in many states has increased above 1, so more infected cases are expected within the next weeks.

Obviously, the virus is not going away and we may have to deal with coronavirus infections for a prolonged period of time.

Public heath experts are developing models which show the real numbers while frontline health care providers are now dealing with more COVID patients. The numbers we are now seeing might be also related to gatherings during the Memorial Day weekend, and recent mass gatherings might increase those numbers further.

As a healthcare provider I have the following suggestions:

• Continue to stay within your own community “bubbles”, which means to stay within your close family members or groups. Remind each member of each particular bubble to get COVID-19 testing, ideally on a regular basis and possibly repeatedly over time, so that anyone who tests positive should either be separated within the bubbles or asked to stay out and to avoid close contact with the elderly and those with underlying pulmonary and cardiac diseases.
• Continue to avoid exposure to large crowds. The soccer stadiums in Italy represented a Petri dish for the transmission of the virus and the attendance of mass events should be strongly discouraged at the current time.
• Evaluate the daily news with a critical eye. Several statements that have been made were retracted just days later. As an example, the hype about a registry demonstrating a very high death rate of patients receiving Hydroxychloroquine for COVID-19 published in the Lancet medical journal within the last month was retracted by the authors since they were unable to verify their own data. Still, in my opinion, Hydroxychloroquine remains controversial and should not be used at this time as a treatment or prevention for COVID-19 until further validated data are available.
• Continue adhering to precautionary measures such as using personal protection devices, masks, gloves and eye shields as well as frequent hand washing with soap and the use of hand sanitizers.
• Continue healthy habits of exercising at a distance to others, i. e. at least six feet away from others in a gym or an outside environment, observe healthy food habits by eating a balanced diet and avoid toxic substances.
• Adopt a “new normal” to protect yourself and your loved ones, rather than returning to the behaviors of the pre-pandemic era.

Almost everybody has contact with those at highest risk, whether it’s a family member, parent, grandparent or even younger people with immunosuppression. It is our duty to protect those most vulnerable ones even though the younger and healthier ones might not develop symptoms or illness from the infection.

We all welcome the opening of businesses, restaurants and gyms for the sake of the economy and our psychological and social well-being, but we should not underestimate the constant risk, which might stay with us for a prolonged period of time, at least until appropriate vaccination will be available.

Together we can fight the virus by staying healthy and safe and to some degree by keeping social distancing measures in place.