Typhoid Mary

“ I heard a thing on a podcast this weekend, how Americans are really good at acute compassion, but pretty bad at chronic empathy. We, without question, haul strangers out of a raging flood, give blood, give food, give shelter. But we are lousy at legislating safe, sustainable communities, at eldercare, at accessible streets and buildings. It is the long-term work that makes the disasters less damaging. But we don’t want to give to the needy, we want to save the endangered. We don’t like being care workers, we want to be heroes. The world does not need more heroes. We need more care.” Sigrid Joy Ellis, 20-Aug-2017

One of the first people I learned about in public health classes was a woman named Mary Mallon, also known as Typhoid Mary. Ms. Mallon was an asymptomatic (showed no symptoms) carrier of Salmonella typhi – meaning that she carried the bacteria, but did not exhibit any symptoms of typhoid fever. It’s believed that she infected somewhere between 47 (3 of which passed) to 122 people (5 of which passed). There are multiple estimates on the exact number of those whom she infected as it’s really difficult to track a minute by minute account of human action and behavior.

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Here some articles and scientific publications that share her story:

The Frightening Legacy of Typhoid Mary – Smithsonian Magazine

The Strange Case of Typhoid Mary – Quanta Magazine

Recalling ‘Typhoid Mary’– San Diego Tribune

The Curious Career of Typhoid Mary – Bulletin of the New York Academy of Medicine

Mary Mallon (1869-1938) and the history of typhoid fever – Annals of Gastroenterology

To make this story relevant to the current COVID-19 pandemic, here is an image from an article in the Washington Post (article link in photo caption)  that exhibits 4 different scenarios of the COVID-19 pandemic given varying degrees of social distancing:

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Why outbreaks like coronavirus spread exponentially, and how to flatten the curve

“You know how everyone rushes to the stores at the same time and bought everything out at once instead of staggering their visits?

Now imagine the same thing in the hospital, but instead of TP, it’s ICU beds and ventilators that are out. This is why everything is cancelled.”

I’d also like to add to this quote above: Imagine your doctor’s and nurses getting sick and being unable to treat you and/or your loves ones that really need assistance. Emergency response HCP’s can’t just be replaced in the blink of an eye! Two Emergency Physicians in Critical Condition

For the sake of our hospital capacity in the USA, please stay home. (1) A COVID-19 coronavirus update from concerned physicians (2) How the Coronavirus May Force Doctors to Decide Who Can Live and Who Dies

Some words from Dr. Jason Bae:

Thoughts from the COVID-19 Frontline:

I wanted to share some thoughts from the frontline.

CONTEXT: I have been working in PAMF Urgent Care in Palo Alto, CA, which has started the Respiratory Care Clinic. Patients with respiratory symptoms are seen in a drive-thru and can get tested for COVID-19 in their car IF they meet the criteria for testing. I, along with many other providers, see these patients in their cars and in clinic.

1. There are MANY people working their hardest, day and night, to manage this COVID-19 pandemic at the local level.

I have seen my leadership and colleagues work 12+ hours 7 days a week, being on calls, meetings, responding to email, sharing latest updates. The great majority of people in medicine (including physicians, nurses, NP/PA, technicians, medical assistants, pharmacists, and many more) entered this profession because they want to help, and it reaffirms my faith in humanity and medicine everyday to see everyone putting themselves out there to take care of patients.

2. We are figuring things out as we go.

At the local level, very few people have dealt with an epidemic of this magnitude. This means often times we have to rely on the best judgment of the frontline workers to problem-solve on the spot. With guidance from the leadership, we are figuring out protocols and workflows and iterating on them on a daily basis. It requires everyone to be proactive, decisive, and flexible.

3. COVID-19 is not a “theoretical” risk; it HAS BEEN here and will get worse before it gets better.

Even compared to last week, I am seeing an increase in the number of patients coming in with a known contact with a confirmed case. Based on the limited testing we have had so far, the actual number of case in the U.S. is likely to be at least 5-10x of what is reported. We are no longer PREPARING for COVID-19 at this point; we are dealing with it now. Based on experiences in other countries, it will be at least another month or two before things get better.

4. Health care facilities are about to be overwhelmed, and some are already.

It just takes longer to take care of COVID-19 patients. There are precautions that have to be taken at the facility level (locking down rooms for a certain period) and the personnel level (putting on and taking off PPE and disinfecting equipment). COVID-19 doesn’t magically stop people from having a stroke, a heart attack, or an appendicitis, and those patients still need to be seen and cared for.

5. Testing availability and guidelines are changing daily; today we cannot test everyone with respiratory symptoms.

At this point, we are unable to test everyone with a cough, sore throat, or fever. We need to prioritize people for whom a positive test will make a meaningful difference (i.e. elderly, people with significant medical conditions, health care workers). Hopefully this will change as the testing availability ramps up in near future.

So, some suggestions from the frontline:

1. Be a good citizen and neighbor: stay home, socially isolate.

2. Be kind and be patient with health care providers: they are trying their best and they may not be able to address your concerns as quickly as they would like.

3. If you need to access the healthcare system for non-respiratory concerns, please allow extra time and see if you can access care virtually without being seen in person.

4. If you are having flu-like symptoms and are otherwise young and healthy, please understand we may not test you for COVID-19 even though we would like to. Please call your medical provider for their recommendation before walking into a hospital or a clinic, and isolate yourself as much as possible from others while you are having symptoms.

5*. Call your parents and grandparents and tell them to stay home: while you and your social group are being bombarded with #flattenthecurve #socialdistancing posts, people who are most likely get sick from COVID-19 (i.e. your parents and grandparents) may not fully understand or internalize the extent of this pandemic.

6. Lastly, remember that this pandemic, like all the other pandemics that have come and gone, will be over. That day will be here sooner, and with fewer deaths of our loved ones, if we take this pandemic seriously and practice social distancing.”

Lastly, Stuck at Home? These 12 Famous Museums Offer Virtual Tours You Can Take on Your Couch (Video)