Don’t Eat the M&Ms

As a former Program Director, I couldn’t help but imagine the conversations that occurred after this event…

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After “WHAT WERE YOU THINKING?????” – which would have probably been my first sentence – I would have been upset, but I also would have realized that these residents were meeting in the way that residents and students have met forever. They were having a goodbye party for people who were leaving. Probably not outside, and probably not socially distanced, judging by the outcome, but I totally get it.

But the consequences of a casual party like this are real and it’s worth thinking about this by asking three questions…

1. What are the chances you’ll get infected at a party?

This one is easy. You have 100% chance of getting infected… unless it’s 0%… and there is no way to know which way it will go.

A recent report of 32,480 nursing home residents and staff showed that “Of the individuals who tested positive, 70.8% of residents and 92.4% of staff lacked symptoms at the time of testing.” The authors also showed that the viral load (which helps predict whether or not the individual is infectious) was the SAME in people who had symptoms and those who didn’t; “In a large cohort of individuals screened for SARS-CoV-2 by qRT-PCR, we found strikingly similar distributions of viral load in patients with or without symptoms at the time of testing.”

What this means in practice is that every single person we encounter has to be considered infectious.  And that means every event and every encounter has to be carried out in a way that will prevent transmission of the virus.

2. What are the chances you’ll get really sick or even die if you get COVID19?

Based on data from the CDC, for 20-40 year old people with no underlying medical conditions, here’s the answer to my hypothetical M&M question:

  • 700 of the M&Ms will give you fever, cough, and/or shortness of breath. Lots of patients describe it as having “lungs on fire.”
  • 440 of the M&Ms will give you some pretty awful muscle cramps and aches.
  • 120 of the M&Ms will make you lose you sense of smell and taste. It usually comes back, but not always
  • 3 or 4 of them will put you in the hospital (that goes up to around 20 M&Ms if you have an underlying medical condition)
  • 1 of them will put you in the ICU unless you have an underlying medical condition. In that case, 5 of them will put you in the ICU
  • It’s unlikely you’ll die unless you have an underlying medical condition, in which case 3 of the M&Ms will kill you. If you carry this home to your 70 year old grandparent with an underlying medical condition, they have a 20% chance of dying (the equivalent of 200 M&Ms for you).

3. If you are in health care, what effect will this have on your patients and your colleagues?

Whenever I struggle with a decision as a doctor, I go back to my “rules”, which serve as the reference point for my moral compass.

Rule 1: Do what’s right for the patient.

Rule 2: Look cool doing it.

Rule 3: Don’t hurt anything that has a name.

If, as a healer, you decide that “just this once” won’t be much of a risk and you end up with COVID19, you break all three rules. You will be infectious for a long time before you get symptoms… which means you will expose patients, friends and colleagues (who all have names) to this potentially deadly disease. And – there is nothing less “cool” than creating a avoidable situation that ends up with colleagues having to cover for you while you are in quarantine and/or recover from COVID19.

We all want this to end… and it will.

We have a special calling – and responsibility – as healers (which includes all healthcare workers since healing takes a team). It’s what makes our work so filled with awe, and so rewarding. It’s also a burden sometimes. But we all took an oath, we all made a promise, and when we are past this point in history and looking back, it will mean something that we held true to that promise.

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