11/24/20: DARE REPORTS 21 NEW COVID-19 CASES; EMERGENCY MEDICINE PHYSICIAN AT EMORY DESCRIBES HIS ‘LONG COVID.’

After three days of relatively modest case numbers, Dare County reported a surge today of 21 new COVID-19 cases, including a local man age 65 or older who was hospitalized.

There are now seven Dare County residents hospitalized outside of the area.

Fifteen of the 21 new cases are Dare County residents, according to the Dare County Dept. of Health and Human Services dashboard, and of those, an astonishing nine are in the 50-to-64 age group; four are in the 25-to-49 age group; and two are age 65 or older.

The five nonresidents who tested positive for COVID-19 are generally younger: Three are ages 18 to 24; one is age 17 or younger; and one is in the 25-to-49 age group.

In her Tuesday update today, Dr. Sheila Davies, director of the DCDHHS, looked at 27 new cases since Friday. The dashboard, however, only recorded 26 cases during this time.

Dr. Davies said the county had a COVID-19 positivity rate of 5.4 percent during the week of Nov. 16-Nov. 22.  

The DCDHHS Director’s rundown of the 27 cases shows that they generally adhere to the pattern that has emerged locally of the disease’s transmission being caused by close contact with a known infected person.

Dr. Davies again asks that people observe the three Ws, in order to prevent the spread of COVID-19. She does not mention the Governor’s stricter face-covering mandate, which takes effect tomorrow at 5 p.m. (See The Beacon’s post earlier today.)

LONG COVID IN A YOUNG DOCTOR WITH NO PREEXISTING CONDITIONS

In our continuing effort to inform people about post-[acute] COVID syndrome or chronic COVID-19 symptoms, we refer you to a compelling column in “The Journal of the American Medical Assn.” written by a young physician who is a COVID-19 “long-hauler.”

Dr. Jeffrey N. Siegelman, an assistant professor of emergency medicine at the Emory University School of Medicine in Atlanta, writes in “Reflections of a COVID-19 Long Hauler,” that he awoke on a Monday morning with a headache, “and I am not a headache person.

“Fever followed,” he continues, “and the next morning my blueberry yogurt tasted of nothing. Thick emptiness. I knew I had it. Now, after more than three months of living with coronavirus disease 2019 and the fatigue that has kept me couch-bound, I have had ample time to reflect on what it means to be a patient . . .”

See Dr. Siegelman’s JAMA article at https://jamanetwork.com/journals//jama/fullarticle/2773056.

Dr. Siegelman graduated in 2007 from the Albert Einstein College of Medicine at Yeshiva University in New York and did his post-graduate training at Harvard. He is probably about 40 years old, although he does not give his age.   

One important point the young emergency physician makes is that a “mild” case of COVID-19 can have “dramatic effects,” of long duration.

According to Dr. Siegelman, he had “no preexisting conditions, was never hospitalized, had minimal respiratory symptoms, and even managed to do limited office work throughout the acute illness.

“. . . And yet, living with this has been anything but mild. I quarantined in the basement for 40 days, staying isolated from my family because low-grade fevers continued, and the Centers for Disease Control and Prevention guidance was unclear for people like me.”

Another important point he makes is that “The lack of objective data does not preclude illness.”

Based on the known objective data, Dr. Siegelman recovered from his bout with COVID-19. His body was clear of the virus, as he writes:

“My test results were normal: nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), imaging, laboratory results, oxygen saturation were all fine. But I did not feel fine, and still do not.

“I have had a rotating constellation of symptoms, different each day and worse each evening: fever, headache, dizziness, palpitations, tachycardia, and others.”

Dr. Siegelman is fortunate that he can isolate safely from his family in a well-equipped basement and can afford to miss days from work. His supportive colleagues have covered his shifts. He also has long-term disability insurance that will give him financial security if his three-month-long illness extends beyond six months.

“With each negative test,” he writes, “my worry increased that my employer would ask me to go back to work too soon or my primary care physician would rule out COVID-19 despite strong clinical evidence.”

How many PCPs would simply dismiss a long COVID patient as having symptoms that are only “in his head” or attribute them to severe anxiety?

“[M]any physicians are not aware of long COVID,” writes retired scientist Debra Krummel, Ph.D., in a comment at the end of Dr. Siegelman’s article, who says she has been in the same “boat” for more than four months.

Finally, Dr. Krummel says, “research into this chronic condition is now happening.” COVID-19 morbidity, as well as mortality, is being discussed.

Dr. Siegelman says that he “doubted myself multiple times—thinking if I just pushed myself harder maybe I could go back to work and to my regular life, to move on.

“Then,” he explains, “I would eat something without taste, would feel my heart pounding uncontrollably for hours, or would get so dizzy that I could not even write a simple letter.

“Each evening as my symptoms peaked, I was reminded that my diagnosis was not in question.”

Ann G. Sjoerdsma, 11/24/20

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