An Obligation to Educate

by Dr. Chris Cherubino, Medical Director ARCpoint Labs

             In the last few weeks, the media has erupted with reports about the novel coronavirus, which has led to an astonishing level of social and economic disruption. Nowhere has this fear been more apparent than in doctors’ offices across the country. Every person who so much as sneezes is suddenly faced with suspicion. While fear is driving stock prices down and Lysol revenue up, it’s our responsibility, as healthcare professionals, to educate and de-catastrophize. One of the ways we can do this is by quantifying and explaining immunity.

Know the facts

As a physician who works with a diverse group of patients, you have an opportunity to educate. According to the CDC, the vast majority of people who contract COVID-19 will recover at home, with minimal outside intervention; they will overwhelmingly survive with moderate symptoms during the illness and little-to-no after affects[i]. Mortality rates are currently being estimated at 0.2 to 3.4%[ii]. This range is wider than most epidemiological statistics because of the newness of this disease, and because most people who contract COVID-19 will not require hospitalization, will never be tested, and will recover without incident.

Exercise caution, not isolation

Preventing disease transmission is, of course, one of our biggest goals. Because COVID-19 has an asymptomatic incubation phase of up to two weeks, patients should be encouraged to exercise personal caution, even when feeling well, by avoiding unnecessary physical contact with others, washing hands frequently, and refraining from touching their faces. These same guidelines should actually be in effect every day of the year, whether there is a novel coronavirus at play or not. Almost all respiratory tract infections have a similar mode of transmission and can be mitigated by following these few simple steps. Encourage patients to treat themselves as if they are infected, rather than other people[iii], and exercise altruism by washing hands, avoiding contact, and being hygienically courteous in social situations.

While we haven’t yet developed functional herd immunity to this new infection, we can cultivate behavioral herd immunity, as outlined by Peter Hall, a professor of public health, in an essay from the University of Waterloo: “with a large portion of the population consistently implementing behaviors that reduce transmissibility, epidemics can be prevented or vastly limited, without the reactionary measure of [social] quarantine.”[iv]

Knowledge is Power

For patients who are worried about their potential ability to fight an infection like COVID-19, think about running baseline testing to assess overall immune function. The agency for Toxic Substances and Disease Registry (ATSDR) recommends a basic panel of immune function tests for this exact purpose[v]. These include CBC with differential, CRP, total IgG/IgM, ANA, and total protein. The combination of these results can indicate if a person is able to mount a normal immune response. For a patient who tests within normal limits, this information can act as a mental balm. Conversely, for a patient whose tests suggest lowered immunity, this can be part of the impetus for implementing behavioral safety protocols and a holistic approach to boosting overall immunity.

Research has definitively shown that stress – whether psychological, physiological, or environmental – reduces our body’s ability to fight infections[vi]. Immunity can be bolstered by self-care activities like meditation, hydration, nutrient rich nutrition, and sleep. Encourage patients to implement these changes whenever they can. While no one can control what happens to other people, we can control these simple daily habits and that might make the difference between adequate and lowered immunity – not only to COVID-19, but to all similar infectious diseases.

Ultimately, as healthcare providers with more knowledge than the general population, we have an obligation to educate, to assuage, and to bolster. Armed with clinical experience, research, and simple coping strategies, we can help our patients weather this emergent epidemic, like we have so many others, and build our doctor-patient relationships in the meantime.

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Dr. Chris Cherubino is a chiropractic physician and certified medical examiner. She is committed to healthcare information access and demystifying the diagnostic process in the realms of musculoskeletal, neurological, and laboratory medicine. In her work with ARCpoint Labs, she attempts to provide information and education to other physicians in order to increase patient compliance, understanding, and wellbeing.

 

[i] Interim Guidance for Implementing Home Care of People not Requiring Hospitalization for COVID-19. (February 2020) National Center for Immunization and Respiratory Diseases. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html

[ii] Ducharme, J, Wolfson, E. (March 2020). https://time.com/5798168/coronavirus-mortality-rate/

[iii] Stigma and Resilience. (Updated March 2020) CDC. https://www.cdc.gov/coronavirus/2019-ncov/about/related-stigma.html

[iv] Hall, P (March 2020) https://www.realclearscience.com/articles/2020/03/03/how_to_build_behavioral_herd_immunity_against_covid-19_111309.html

[v] Irimia R, Gottschling M (2016) Taxonomic revision of Rochefortia Sw. (Ehretiaceae, Boraginales). Biodiversity Data Journal 4: e7720. https://doi.org/10.3897/BDJ.4.e7720

[vi] McLeod, S. A. (2010). Stress, illness and the immune system. Simply psychology: https://www.simplypsychology.org/stress-immune.html

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