March 13, 2020

First of all, let me state that my own insightful wife Adi has warned me against writing up anything about this. There is a true glut of information (as well as misinformation) at the moment with everyone and their grandmother giving social media advice that range from things as Xenophobically racist and scientifically incorrect as “Stay away from Asians” to things as overprotectively unnecessary as “Buy all of the toilet paper you can and never leave your house again”.  

Have you noticed that some of the statistics being thrown around seem to contradict each other? How can it be that Coronavirus is killing over 3 percent in some stats but then in other places it is well under 1%? Why are we so concerned about this if we aren’t terrified of the flu which kills even more each year? Why are we closing schools if it doesn’t affect children?

Let me be clear, I am not an epidemiologist, and I do not work for the CDC. I am a nurse. I work with the general public in the city of Santa Monica. I have read the same news as you, so I know many are running for the hills panicking, while others are screaming at those first ones for creating a hysteria over this. None of us quite know what to make of it, because we only know what we read and are told. Well between the CDC, my job, and my colleagues who ARE epidemiologists and who talk to the CDC and County on a daily basis, let me try to make things a bit more helpful for us all.

And please keep in mind that things are changing rapidly by the day and hour, so my advice is based on what we know NOW, and could easily be different tomorrow when we have more information. In fact just in the time of my writing this I’ve had to make adjustments to increase precautions for all ages.

What are the actual statistics?
We don’t know. All of the data so far is from a rather rushed, small sample size. When you are taking a few hundred or a few thousand cases, and in a matter of weeks trying to create statistical conclusions, you are using the scientific method in an extremely rushed, inadequate way. And before that all of our data was being handed to us by China, with plenty of skepticism attached. In addition to that, we all know that the testing has been extremely hard to come by and limited, so clearly we cannot know how many ACTUALLY have caught this horrible virus, nor the actual mortality rate. If you wanted to know the percentages you’d have to take a large population and test EVERYONE there and see how many are positive. That’s not gonna happen, they are currently still quite strict as to who can qualify for the test in most places, so many and quite possibly most will never know if they ever actually had it. You can probably therefore deduce that whatever the mortality rate you read is actually quite a bit lower, as you can’t know what you don’t know; and we can assume we’re finding out about most if not all POSITIVE cases that result in death or hospitalization, but are certainly not finding out about many if not most of the ones which are mild enough to not seek medical attention. But as to what the actual numbers are? Nobody can tell you that without speculation and guesswork.

Yes we know that influenza (aka the flu) kills many each year. And we have a right to be exasperated with the millions who decline the vaccine (without a medical exemption) and take a risk with that while being terrified of catching this. But the fact remains we do not have a vaccine yet for this. We do not have any idea how many more will die from this. And we need to do what we can to keep it from spreading even MORE out of control like wildfire.

What we actually know
We know that those who are seriously ill or dying are MOSTLY elderly or have serious acute or chronic immunocompromising medical conditions. If you are someone who is prone to getting pneumonia you are more prone to getting this. If you are more likely to not survive a case of pneumonia you are more likely to be in danger here. What this means, as most of us already know, is that most of us are relatively safe from harm, but we have a responsibility to the rest of society, and our vulnerable loved ones, to protect them from actual harm. Let’s break this into general categories:

-Children 0-10 – For whatever reason they appear to not have severe illness because of this virus. On the other hand, they are the most likely to be sticking everything and every germ into their mouths, and onto their hands. So children are important not for their safety, but for the danger the germs they carry (that are causing only mild illness) can infect the vulnerable.

-Anyone (without immunocompromising or other major health conditions) under 60 – Again relatively unharmed. The majority seem to get between a mild cold and a bad cold. Not all but certainly most.

-Over 60 – This is where general medical conditions start to occur more likely. This is when any of us would start to be more prone to having health issues including pneumonia, so here is where people need to start taking extra measures to protect themselves.

-Over 80 – Here is the age where people not only are the most prone to having health issues, but those health issues are the toughest to get through. You don’t need to be a medical professional to realize that you are both more likely and in higher danger if you catch something such as pneumonia when you are 84 than if you were 44. This is the population we most need to protect, all the MORESO if it is someone over 80 who is already sick or immunocompromised.

Keeping those categories above in mind, here are my suggestions to help give you a life balance that is considerate to protection of the rest of society, while also not restricting you to a full-on quarantine.

What you should do

Over 80:
-Stay home AS MUCH AS POSSIBLE. Your social outings should stop, you shouldn’t go to your place of worship, and if you are a grandparent who takes your grandkids to kid classes you should DEFINITELY stop that. Remember what I said earlier about small children being the biggest receptacles of germs? That’s great for them, but right now it is the last thing a vulnerable person needs to be around, a whole group of kids coughing and snotting all over the place. And honestly I would suggest that anyone over 80 just not be around unhygienic children right now, period. Let me give you a personal example. My mother is not only over 80 but she battled Lymphoma this past year; she is immunocompromised. She is therefore the last person I would allow my 22 month old daughter Natalia to be around. She can FaceTime with her or, as Adi figured out, they can go on an outdoor walk together while keeping her in a stroller – assuming Natalia doesn’t have a cough. My own brother and sister-in-law are not coming in for Passover anymore because it would involved bringing the kids who simply should not be around my parents. It is a sad turn of events, but a necessary one. I have told my parents to not go to any more movies, concerts, museums or anywhere until this passes. We will shop for them. 

-Can they still have a social life? Sure, friends and family who know they have no fever and no cough can come over, wash their hands carefully when entering, avoid physical contact, and enjoy a nice evening together. As I said, just modify the behavior with extra hygiene, lack of the usual physical contact, and at all times staying away if sick.

Under 60:

-Stop large social gatherings. How large? Anything where you cannot control who else is with you, or if they are sick. Right now I would recommend avoiding going anywhere nonessential, where there are too many unknown variables. And the way to help stifle this is by lowering the opportunities for transmission. It appears to be within about 6 feet. So if you don’t need to go out for the time being, it might be the safest and wisest thing to do, not for your sake but for the others who may not practice hand hygiene who you come into contact with, and carry those germs to others.

If a friend comes over, great, but again make sure they aren’t coughing or sick, and washing their hands when they enter. But my usual huggy nature is on a temporary hiatus. And I will have to be “that guy” who reminds people as they enter my home to please take off their shoes and wash their hands as they arrive. I will shop if I need to, but try to order via delivery services. 

Between 60 and 80:
-Use your judgment. Is your general health closer to the under 60 bracket or the over 80 one? Have you had prior hospitalizations? Do you have serious medical conditions especially of the lungs or heart? Would getting pneumonia be  especially devastating? Then you should probably take the same precautions of the 80 plus year olds. Are you an active 68 year old who plays tennis and if you fell you’d get up and keep playing? You might be able to think of yourself more in the under 60 group. This is not an exact science, use informed logic.

Extra Tidbits:

-Let me be clear, nobody should be going out, at any age, if they have a cough or fever. We should all, at every age group, be staying home at all times if we have a cough of fever. And we should at this point just stay home when there’s no need to interact with the general public. This is how the disease spreads, a cough or sneeze expels the germs, those germs go onto our hands or wherever else they hit, and those germs stay there for some unknown amount of time. It could be up to a few days. So if I have a cough, I am not going out, and I’m not going to work, it is what needs to happen for the safety of others. If you are sick enough that you need to go to the doctor or hospital, call first, let them know you are coming, so they can prepare a safer entrance for you away from others.

-Washing your hands is still of primary importance. 20 to 30 seconds with warm water and soap is best. Hand sanitizer is good but second best. 

-When you get home, take off your shoes, leave them outside perhaps, why drag things inside. And when you first arrive somewhere, WASH YOUR HANDS. These instructions are rinse, repeat, pun intended.

-Just get used to not hugging, kissing or shaking hands for the time being. My compassionate and insightful Rabbi, Rav Yosef Kanefsky, gave a wonderful talk this past week at our synagogue Bnai David Judea, where he reminded us how every handshake and hug that we are NOT giving now is one that further distances us in ways we can not calculate from one another. It is therefore of the utmost importance that we are doing even MORE to make up for this. Our body language must be all the more warm, our words must express the things we often do not say aloud. We need to remind each other that we still care about and love one another, because with touch being lessened, we do not want the IMPACT of touch to be gone with it. While social-distancing is now crucial, it is equally important not to let others feel socially distant.

-Anyone who is not in the vulnerable population, please stop buying things in bulk as if you will not leave your home for months. You can still go to the market, but please use precautions. The people who actually NEED to stay home are the ones who need to stock up on things such as toilet paper; let’s not shame them as they actually are doing what is best by staying home for an unknown amount of time. But it is the responsibility of the rest of us not to deplete the supply of such items that we will continue to have access to, and prevent those who need to stay home from having enough.

-Do not walk around wearing masks unless you are sick and for some reason have to be out of the house. And do not walk around wearing gloves under any circumstance, as you are simply taking what you touch and spreading it everywhere else. 

Let’s look forward to the day we soon have a vaccine, but until then let’s take the aforementioned measures to slow things down and make our world safer for the millions who are at risk.

Boaz Hepner grew up in LA in Pico/Robertson and now lives here with his wife and baby girl. Thus, the neighborhood is very important to him. He helped clean up the area by adding dozens of trash cans that can still be seen from Roxbury to La Cienega. When he is not working as a Registered Nurse in Santa Monica, he can be found with his wife and daughter enjoying his passions: his multitude of friends, movies, poker and traveling.