Dr. Michael Szabo - MSH International Travel Blog

February 3, 2021February 3, 2021

Getting Worse Before It Gets Better: Why This May Be the Toughest Time of the Pandemic

Here we are at the end of January 2021, and it will soon be a year that we have been living through the pandemic. It’s been a difficult year with ups and downs, but I would consider right now to be the toughest time in the pandemic.

When it all started in March 2020, we were in a state of shock. Suddenly, it became apparent how widespread the infection had penetrated in North America and around the world. We saw a serious situation unfold in Italy and New York City. We quickly shut everything down, hoping to gain some understanding of what exactly was going on and what we needed to do to contain the outbreaks. Then we slowly relaxed the stay-at-home measures and instituted newer ones, like wearing masks and physically distancing. In short, we learned how to be able to move around the world more safely: what to do and what not to do.

Our new “freedom” helped our collective moods. In the summer, camps for children were cancelled and indoor dining in restaurants remained a risk, but at least we could be outside and gather socially with friends in small, physically distanced groups. We could visit an outdoor patio at a restaurant, or swim at a pool or beach. We could play sports like tennis, golf, or baseball. It wasn’t in any way completely normal but at least it was something.

With the arrival of fall, we have seen a gradual restriction of our activities. The virus has surged again. This is understandable given the change in climate which restricts outdoor activities. People are congregating more inside, and viruses really like that, because that makes it easier to spread. Viruses also tend to spread more easily in colder climates as warmer weather makes it harder for them to survive. We knew it was likely for things to unravel again in the fall and winter, and we were right. We have lived through and are now in the midst of the second wave and it isn’t proving to be easy.

But we have a big reason to have hope now. The COVID-19 vaccine is here. It’s the durable solution that we had all hoped for and it came much more quickly than we expected, thanks to the wealth of resources devoted to its development. It has a strong safety profile and most importantly has been shown to be very effective. As a front-line emergency physician, I have had both of my doses. Being vaccinated has allowed me to go to work with some peace of mind, with the ability to better focus on helping the many people in need of assistance at this most difficult time.

Unfortunately, this good news is tempered by the reality of some recent developments. There are new variants of the virus circulating. These new variants are more infectious, meaning that the virus is passed more easily from person to person. It remains unclear, but there are also some concerns that these variants can make you more sick and more likely to have complications.

This development is a bit of a setback. It means that we need to be even more careful now. The public health restrictions need to be intensified. The fact that we are in the thick of winter when this situation has changed doesn’t make it very easy. Most of us are stuck inside our homes all day, working from home, some of us with children doing virtual school, with all the inevitable technological glitches and challenges that complicate our days. Many people are even more isolated than before, as even sitting outside or going for small walks can be hampered by the weather. The impromptu small social interactions are fewer and fewer. At least in the summer we could go and sit on a park bench or on a beach and feel somewhat normal. Most of us are feeling far from normal right now, and that is hard.

But then there is the reality of the vaccine which is the light in the distance. It will be there eventually for all of us, just like the spring and warmer weather… if we can just get there. The vaccine is still effective against the new variants, thankfully. The next few months will be tough, but we must hunker down and get through them and do our part to keep the virus at bay. Especially now with the variants in our midst, we must double down on our efforts to avoid close contact with others outside of our household. No social gatherings. No travel. Keep shopping trips to a minimum, as we know indoor spaces are the riskiest places. We should wear good quality, 3-ply masks whenever we are in those locations and limit our time there.

Most importantly, we all need a specific strategy to address our mental health. If we are able, trying to get outside daily and go for a walk for at least half an hour is a great simple rule to institute for ourselves. Even seeing other neighbours at a distance and saying “hi” can do wonders. Other safe activities include hiking, skating, or tobogganing. We must be mindful, however, that getting too close to others, even while outside, can be a risk. With the new variants, transmission occurs more easily. We must distance ourselves when outside and even wear masks when needed. This is not the time to take chances. We are so close to the end of this pandemic and I can just feel it. Better days are within our grasp.

November 18, 2020November 17, 2020

Winter is Coming: How to Best Protect Ourselves from COVID-19

We are still learning about transmission of the virus, SARS-CoV-2, that causes COVID-19. We have come to learn that the way this virus spreads is a bit more complicated than what we initially understood. Thankfully, the main mode of transmission is still felt to be through direct exposure to respiratory droplets that carry the infectious virus. These types of respiratory droplets are larger and heavier in size and rarely travel farther than six feet. They fall quickly to the ground or land on surfaces. If you are around someone who is infectious, your highest likelihood of catching the virus is if you inhale respiratory droplets that they have exhaled while you are in close contact with them. Hence the importance of masks, particularly in situations when you cannot adequately physically distance.

The comfort in knowing that this is the main mode of transmission is that it offers us a mode of control. If we keep at least six feet away from others or wear a mask if we cannot always do this, then we can substantially lower our risk.

We can also be exposed by touching surfaces that are contaminated with the virus and then touching our eyes, nose, or mouth. However, what is interesting is that we have come to understand through careful study that this mode of transmission is a less common route. We should still be careful about it, though. Regular hand-washing and avoiding touching our face help to minimize the risk of exposure through this route.

However, it is unfortunately not so simple. There have been some rare case reports of people getting infected when they have kept to these rules. There have been outbreaks of cases when people were far away from infectious individuals, in indoor settings. How could this happen?

The CDC has recently amended its guidelines on transmission to reflect our new understanding. This link explains the new understanding in detail. Basically, the new guidelines state that there are rare circumstances where you can become infected when you are far apart from others, beyond the six-foot distance. This can occur especially if you are in an enclosed space, with inadequate ventilation. Infectious people in such a location who are breathing heavily, such as when singing, shouting, or exercising, can produce significant amounts of smaller respiratory droplets that are light and can stay suspended in the air for longer periods, sometimes for hours. These suspended droplets have the capability of travelling longer distances and, if there are enough of them, can lead to infections in those who are far away. When we are outdoors or in an indoor area with good air circulation, such small droplets are blown away and don’t have the ability to stay suspended in air and become concentrated. But given the right circumstances, they can. It’s vitally important that we are aware of this in order to fully protect ourselves.

The new and improved guidance is simply to avoid crowded indoor settings, especially enclosed spaces with inadequate ventilation. Stay away from people shouting, singing, or breathing heavily. There is a small chance of becoming infected in these situations, even when physically distanced. Of course, the wearing of masks helps to reduce these risks, and in that regard, there is now an update on that subject as well.

The Public Health Agency of Canada has now revised its mask guidelines in anticipation of most of us spending more time indoors over the winter. The use of 3-layer masks has now been recommended as additional protection. This link provides more details on the ideal mask. An optimal mask contains two layers of a tightly woven material fabric, such as cotton or linen. The third (middle) layer should be ideally a filter-type fabric, such as a non-woven polypropylene fabric. You can use a craft fabric, or even a folded paper towel or coffee filter. But be sure to not use plastic as this will make it difficult to breathe. A more robust mask such as this is felt to be much better protection now that we will be spending more time indoors.

The changing of guidelines and recommendations can be quite confusing for many of us. It can sometimes make us question the validity of what we are being told. Ultimately, it should serve to increase our trust in the experts issuing the guidance. The science is changing, and our understanding is always growing. Public health recommendations must also change to reflect this situation. We don’t want to keep to rigid rules and regulations when it comes to keeping ourselves and our loved ones safe. As we move into winter, we need to adapt to the new knowledge about the transmission of SARS-CoV-2 and tweak our approach. Stay safe, everyone!

July 13, 2020July 13, 2020

Battling COVID-19 Episode 8: Staying The Course by Dr. Michael Szabo

Summer is officially in full gear now. Isn’t it great? Warm weather is here! Backyard barbeques, long walks outside, swimming and picnics. But we all know it isn’t completely like old times, there’s still a little something different, right? COVID-19, the pesky little virus we’ve come to know all too well, is still around.

In Canada, we’ve done very well to minimize the spread of this virus. The majority of us have done an excellent job at following the public health guidelines to physically distance, wash our hands, avoid others if we are unwell and to wear a mask when appropriate. We look to our neighbours in the south and can see what occurs when the guidelines aren’t followed, and we don’t want that to happen to us. However, it’s tough to believe that we need to be vigilant when most of us don’t know people who are getting infected and we hear that only around 200 new cases a day are occurring across the entire country.

One of the truths about human nature is that it’s very hard to believe something is real unless we see it.

One of the truths about human nature is that it’s very hard to believe something is real unless we see it. I often think that what is even more powerful than seeing something bad happen, is to feel something bad happen, as experienced when a loved one or even, we, ourselves, endure a health-related crisis. We rarely can look at life in the same manner after that. Emotions are powerful.

As health care workers, we never lose sight of this. We all see and feel the reality of this virus and what it can do. We look at the chest x-rays, review the blood work, monitor the oxygen levels and experience the anxiety and fear of a patient who cannot breathe due to this infection. We place people on life support when they require it. We see the blood clots, strokes and heart attacks that COVID-19 causes. We see the kidney damage. We see the patients who have recovered from the virus but months later, are still unwell, struggling with debilitating fatigue, joint swelling and breathing problems. We also see that the vast majority of patients recover completely and are well again. This makes it easier to deal with because we know it’s certainly not all doom and gloom. But we know bad outcomes still can, and will, happen.

We need to remain vigilant about this highly infectious virus. It hasn’t disappeared and is still very much among us. We must accept some uncomfortable realities here. This virus doesn’t care about us – it just wants to spread. It doesn’t care about our economy or our mental health. As long as we give it the opportunity to jump from one of us to another, that is exactly what it will do. This isn’t “fair”, but whoever said the universe was always a fair place? At this time, it’s extremely important that we focus on what we CAN do to combat the spread of this virus, because we now know plenty on how to do that. And the good news is that much of it is pretty simple.

The simple things are the most powerful right now. Avoid close contact with others, especially indoors. This is one of the most important facts that has come to light recently. The virus seems to spread best indoors where people are in prolonged close contact. It also spreads outdoors where large numbers of people are close to one another, particularly when close talking, shouting or singing is involved, such as sports events or bar patios. Avoid those situations ideally. If you can’t, then wear a face mask, as scientific evidence shows that it reduces the likelihood of spread in those environments. One of the most common situations for all of us is visiting a store. We should all wear a mask when we go inside any building open to the public.

We need to wash our hands repeatedly and avoid touching our face and continue to develop that habit. Stay six feet away from others as much as possible and avoid being around anyone if you feel unwell, even if you just feel tired and have muscle aches, as these could be early or mild COVID-19 symptoms. We are still trying to understand it, but it does appear that the virus can be transmitted from asymptomatic people. At this time, it remains prudent to assume anyone you come into contact with could transmit the virus to you.

Fortunately, the measures we can take to protect ourselves don’t mean we need to be socially isolated. We can get out into the world and interact with family, friends and loved ones. We just need to be cautious about it and do it under the correct conditions. The public health measures we take can actually help us open up society. It’s incorrect to say that these measures keep us locked down, they’re our toolkit for getting out into the world. We’re in a good position in Canada right now. Let’s stay the course.

May 25, 2020May 25, 2020

Battling COVID-19 Episode 7: Being Patient in a Challenging Time by Dr. Michael Szabo

Remember back in early to mid-March when the reality of COVID-19 was sinking in? Before that point, we knew it was an issue of concern, but we didn’t think it was much to stress over. However, we slowly began to realize that the virus was spreading in the community in North America. We heard horror stories from hospitals in Italy, where health care staff were overwhelmed. We began to see the same thing happening in New York City. All of a sudden, it changed, and our lives were altered dramatically.

We immediately went into lockdown. We didn’t leave the house unless absolutely necessary. March Break vacations were cancelled. Restaurants and stores were shut down. Schools were closed. We started working from home. We carefully wiped down our groceries and washed our hands obsessively.

I listened to a podcast recently where one of the speakers likened it to what happens when someone drops a glass on the floor of a crowded house party. I really like that analogy. The glass shatters everywhere, all among everyone’s feet on the floor. The first instinct in these situations is for someone to shout, “Nobody move!” We say this because everyone knows that the shards of glass can go everywhere in these situations, in places you would least predict; places so far away that you are dumbfounded at how they got there. It’s also amazing how so many tiny pieces of glass are produced from such a smash, some so small you can barely even see them. But those small ones can often prove to be the most damaging as they can become embedded in the bottom of your feet and be almost impossible to get out later. With everyone standing still, someone then gets a dustbin and a brush and tries like the dickens to clean up all the pieces of glass, looking in all possible places they think they may be hiding. Then, people slowly and carefully start moving around again, realizing that surprises can still happen, and they may end up standing on a piece of glass. So, we take our time. Eventually, people start moving around normally with more confidence. But we all know what can happen: a few hours, days or even weeks later, another small piece of glass is discovered in the strangest of places. We can never be truly confident that we are out of the woods for quite some time. However, at the same time, we cannot be paralyzed forever. Life and the party must go on.

We are coming out of that initial phase right now. We are much more aware of what is happening. We have a better grasp of where the virus is in the community and how it spreads. We know how to prevent ourselves from being exposed, with face masks and hand washing now a part of everyday life. Staying six feet away from others is common practice whenever we walk down a sidewalk or take a trip to the grocery store.

The challenge right now is deciding how confident we feel in resuming our regular lives. Should we start having friends over who we feel are “safe”? Should we allow our kids to play with the neighborhood kids in small groups? Should we send our kids to day camps this summer? Can we visit our elderly parents? These are some of the questions many of us have.

I think what is required from us is patience. Patience with an imperfect process that must take time and be dictated by science, data and expert opinion. We need to trust our expert decision makers, who are tasked with the impossible job of devising a plan to optimally protect us. The process cannot be rushed because we are in the midst of a complex and new situation. As we all have noticed, experts haven’t always gotten it right. First, they said no face masks, then they reversed their opinion. First, they said not to worry about asymptomatic spread, then they said to be concerned about it. First, they said not to worry about children because they are only rarely adversely affected. Now we are discovering that may not be true. These things happened because we learned more. The virus has affected more and more people, so with that increase in the number of infections comes more and more understanding. We are so early in the process of comprehending every nuance about this new virus. In three months, we have come a long way, but at the end of the day, it is still just three months. Our ability to be confident in making big decisions like allowing all children to go to overnight camp for the summer has to be tempered with the humility of what we actually know to be true right now. We may overcall some things in this process but understand that we may undercall some things and live to regret them dearly. It’s a tough position to be in. When do we walk around freely after a glass has been shattered on the ground? When do we risk getting pierced by a wayward tiny shard of glass? No one has all the answers. Let’s not be paralyzed by fear, but let’s not be overconfident. A tough line to walk, but here we are. Let’s be patient, trust the process and we will overcome this.

May 11, 2020May 11, 2020

Battling COVID-19 Episode 6: Wearing masks properly by Dr. Michael Szabo

The decision by public health authorities on whether or not to recommend the use of face masks was a difficult one. One of the biggest reasons was that educating the public on how to safely wear a face mask is challenging, because of the many details involved.

During my recent forays into the public, here are the top 5 issues I have seen with people wearing masks:

Pulling the face mask down over your chin. This is probably the number one mistake. After wearing a mask while outside for a walk or going to the grocery store, you may need to talk to someone more clearly, eat or just “want a break” from it – so you pull it down over your chin. By doing this, you effectively contaminate yourself with any virus particles that were on your mask prior to that. The rule is once you put your mask on, don’t pull it down. It’s either on or it’s off and there is no in between. Minor adjustments to its position can be made but only if done safely (see below).
Not covering your nose. We breathe through our mouths and our noses. Many people cover only their mouth with their face mask, which means they can easily breathe in the virus through their nose. They can also transmit the virus to others through their nose. Always cover both your nose and your mouth.
Touching the mask. Never touch the mask once it’s on your face. You can transmit the virus that was on your hands onto your mask that way. Before putting on your mask, wash or sanitize your hands. After putting the mask on, you will need to wash or sanitize your hands again. Do not touch the mask again, unless you just need to make a minor adjustment to its position. If an adjustment is needed, wash or sanitize your hands, adjust your mask slightly, and then wash or sanitize your hands once more.
Wearing the mask upside down. If you are wearing a medical grade mask, the metal piece on the mask is to be worn around the bridge of your nose and adjusted to fit. The folded edge of the pleats on the mask itself should be on the bottom.
Wearing a moist mask. Once a mask is worn for a period of time, it can become moist. A moist mask no longer acts as a protective barrier and is dangerous to wear. While running the other day, I observed a lady doing heavy gardening and lawn work with a face mask on, which had obviously become sweaty and moist. For the same reason, jogging with a mask can be problematic. It would be best to practice physical distancing measures when participating in such activities rather than wear an essentially ineffective mask.

Wearing a face mask is a public health measure that is likely to be helpful at this time of the pandemic. However, doing so requires a careful understanding of how to wear one properly. Remember, once you arrive home, wash or sanitize your hands, then remove your face mask. Immediately place it in the wash or dispose of it, and wash or sanitize your hands again right after. Please stay safe, everyone!

May 5, 2020May 8, 2020

[Battling COVID-19 Episode 5] A Vaccine for Coronavirus: Are We There Yet? By Dr. Michael Szabo

The current COVID-19 pandemic has led to an unprecedented effort by scientists around the world to develop a vaccine. Vaccines are important to protect us where the risks of natural infection are significant.

COVID-19 is a more deadly and dangerous virus than the flu. While we still do not have definitive data on the true risks of infection with COVID-19, one can safely say that places like New York City or Italy have never seen a flu season similar to what they are currently going through. Since mid-March, more than 60,000 people have lost their lives in the United States due to COVID-19.

It is important to note that this has happened despite the institution of public health measures like physical distancing, quarantines and self-isolation. If not for these, thousands more would have died.

Is Allowing Natural Infection a Good Option?

One way to protect the population is to allow the infection to spread so that most of us successfully fight it off and become immune. Once that happens in a significant percentage, the virus has a reduced ability to spread and we can better contain it. Scientists currently estimate that around 60% of the population needs to be immune to COVID-19 in order to considerably reduce its ability to spread. We call this herd immunity.

The problem is that if we allow COVID-19 to infect that many of us, the loss of life and the impact on the health of many individuals would be too great, even if we allow only “low risk” individuals to become infected.

Experts have estimated that the COVID-19 infection fatality rate (the ratio of deaths divided by the number of actual infections) is approximately 0.5%. That’s lower than the case fatality rate (the ratio of the number of deaths divided by the number of confirmed cases) of 5 to 8%. Why is this? Because it considers all infections, including those that are asymptomatic or with minimal symptoms where individuals did not see a doctor to get tested.

If we allow 60% of the population to get infected, the estimated deaths could run as high as 1 million in the United States and 111,000 in Canada.

That’s unacceptable. We must find another way.

The Safest Route

Vaccination is a way for most of us to become immune, while not placing our lives and health at risk.

But developing a vaccine is not easy. We must be able to prove that we can create a significant immune response with it. That immune response then needs to be shown to be protective when exposed to the virus.

We must also demonstrate that the immune response lasts for a considerable length of time; it wouldn’t be useful to have a response that only lasts for a few months. It should last for at least a year, and longer, to be helpful. More importantly, it must also be shown to be safe.

Patience is the Key

Vaccine development requires following a very careful and sound scientific process that takes time. It is estimated that it will be at least 12 to 18 months before we can develop a vaccine that is acceptable for use in the mass population.

The World Health Organization (WHO) currently reports that there are five candidate vaccines being studied in 71 preclinical studies. From here, there will be clinical studies where they will be tested in small groups and then larger groups of patients.

We must be patient with this process. The last thing we need is for it to be rushed. A good example is what happened in 1976 when a vaccine for swine flu was fast-tracked for development. When rolled out to the mass population, it was found to cause a significant number of cases of a serious neurological outcome called Guillain-Barré syndrome.

What to Do While We Wait

In the meantime, public health measures like physical distancing can lessen the spread of infection. Many clinical trials are also looking at the use of different medications to improve outcomes in those who have been infected. It goes without saying that optimizing our health with good diet, exercise and sleep as well as reducing stress likely helps the ability of our own immune system to fight off an infection.

All these interventions act as a bridge until we are able to develop a safe and effective vaccine that will hopefully protect all of us and allow us to return to a more normal life.

April 24, 2020May 6, 2020

Battling COVID-19 Episode 4: Why we need to keep physical distancing By Dr Michael Szabo

In Canada, our efforts to flatten the curve are going well. Thankfully, we haven’t seen the same surge of cases that hit New York City, Italy and Spain. Don’t get me wrong, those of us on the front lines here have seen a lot of cases, but so far, our health care system hasn’t been overwhelmed. While our good fortune has much to do with our heeding of public health guidelines, collective uptake of physical distancing rules and staying home as much as possible, I’m still a little worried. There is something about our human nature that concerns me.

At times, public health strategies can become the victims of their own success. Vaccines are a great example. The incidence of diseases that were once part and parcel of everyday life has been greatly reduced, and in some cases, eradicated completely with the advent of vaccination. As we don’t see these diseases much anymore, we don’t learn to fully appreciate their potential severity. With time, we begin to think that the diseases are nothing to worry about. Some may begin to think that it would be acceptable, and perhaps even beneficial, to get these diseases naturally in order to build “natural immunity”, which can sometimes be more robust and lifelong. With time, some people begin to fear vaccinations themselves, focusing on the associated tiny risks, rather than the risks of contracting the diseases they prevent. This loss of perspective plays a large part of the anti-vaccine movement.

We must stay the course right now. Physical distancing has reduced the impact of the infection we are seeing in Canada, but this does not mean that we can breathe a sigh of relief and head back to a normal life anytime soon. Our success with public health measures should only harden our resolve to keep it up even more. We need to look at hugely impacted areas of the world for a harsh reminder of the truth as to what this virus can do – a good place to start is hearing stories from front line emergency doctors and nurses in New York City.

There is a good reason why doctors and nurses who treat critical illnesses on the front lines believe whole-heartedly in public health measures like vaccines and physical distancing. It’s because we are immersed in the reality of what can happen in life and we never lose that perspective.

Committing ourselves to continue physical distancing is even more important than ever. We have seen success and that should spur us all on to continue. Our success should not lead us to think that it was unnecessary to institute preventive measures in the first place, or that we don’t need to follow them anymore. The outcome we have seen is a result of the actions we have taken thus far – let’s not forget that. If a house were on fire, and the fire department was called to extinguish it, would we then argue that the fire department wasn’t needed after the fire was put out? Or similarly, if someone with a serious blood infection were admitted to intensive care and put on intravenous antibiotics, would we look back and declare that the antibiotics weren’t needed because the patient recovered?

Physical distancing is working. We should all be proud of our collective efforts that have saved thousands of lives and eased the burden on our health care system. Success should breed more of the same, and not be used to deny the seriousness of the situation. With time and a better understanding of this virus, we will be able to slowly and safely return to a more normal life. One thing is for sure: we will get through this together!

April 9, 2020May 6, 2020

[Battling COVID-19 Episode 3] Face Masks in a COVID-19 World: To Wear or Not to Wear? By Dr. Michael Szabo

Should we wear a face mask when out in public right now? It’s a question many people have since the Centers for Disease Control and Prevention (CDC) issued its new recommendation that people wear face masks when leaving their homes. Canada’s chief public health officer has echoed the recommendation.

There is confusion because the CDC and the Public Health Agency of Canada had initially suggested that face masks not be worn in public. The flip-flop in recommendations has triggered many questions.

It’s important to understand that, in a complex and evolving situation as this, it can be quite difficult to set a firm policy. As the situation changes, the risks and benefits of recommendations are constantly re-evaluated. In a way, it’s reassuring that agencies aren’t being rigid and are revising their guidelines based on the best available information, with the goal of keeping us all safe.

However, the reason behind much of the change in face mask recommendations is the increase in community spread of the virus. We now believe that there is indeed some community transmission from people with no symptoms (asymptomatic), or minimal symptoms (pre-symptomatic), before they realize that they are sick. This occurs when these individuals are breathing, sneezing or coughing in close proximity to others (within 6 feet). At first, transmission of the virus in these circumstances was thought to be unlikely but we’re now reconsidering that possibility. The CDC wants to err on the side of keeping people safe, particularly in areas of the world that have seen high levels of community transmission and where physical distancing measures can’t always be optimally practiced.

While wearing a face mask does have some risks – it must be worn properly or it can increase the risk of infection, for example – experts believe that the benefits likely outweigh the risks at the present time.

We should consider wearing a face mask when venturing out into the community where it may be difficult to maintain social distancing measures. In other words, if you’re likely to get within 6 feet of others despite your best efforts, wear one. This includes visits to a grocery store or pharmacy where groupings of people are common. However, individual interactions such as going for a jog or a walk don’t necessarily require one.

In addition, you don’t need a medical grade face mask (surgical or N95, for example). In fact, you can make your own cloth mask at home. The CDC provides useful information on how to do just that: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

Wearing a face mask safely is of the utmost importance. The cardinal rule is to treat it as if it’s covered with the virus. Remember to wash your hands before putting the mask on, making sure it covers your mouth and nose. Never touch the mask itself while wearing it. Be very careful to not let the mask touch your face when removing it. Wash your hands immediately upon removing it. It should not be reworn until it has been fully cleaned in hot water in a washing machine.

Lastly and perhaps most importantly, don’t fall victim to the false sense of security that a mask can provide. No mask can provide 100% protection. Continue to practice physical distancing while wearing it.

April 9, 2020April 11, 2020

Battling COVID-19 Episode 2: From the Front Lines with Dr. Michael Szabo

With the increasing number of COVID patients presenting themselves to hospital emergency departments across Toronto, it’s a regular occurrence for me to come across several suspected cases while I’m working. Most are well enough to go home, but some are so sick that they need to be admitted. I find myself checking in on the test results of patients I have sent home, breathing a sigh of relief with each negative and feeling a knot in my stomach with each positive. The challenge with being an emergency doctor is that we see a lot of the bad outcomes. They are our reality. During a pandemic, it begins to feel to us like “everyone is dying” – but not everyone is. In fact, the majority of people recover from the virus. The increase in positive results will not only usher in a new reality but hopefully will reduce my own anxiety about a positive test result and its implications. A positive result is not a reason to panic and most of the patients I discharge won’t ever come back to the emergency department. I will likely stop checking their results after a while.

One of the things that is true about life is our ability to adapt. Once the new ‘normal’ takes hold, we adjust. Life just keeps moving. We’re living amid a pandemic and simply put, we can’t will it away. To accept this harsh reality, or modern-day Twilight Zone, is a process we’re all going through, in our own time and in our own way.

Some of us may need a bit more help and time to acclimate to this new ‘normal’. Getting help is not a sign of personal weakness but rather an expression of our own humanity. Reaching out shows self-awareness and strength of character. Sometimes we need help to talk through our concerns. Sharing our deepest fears with others is powerful, particularly with those trained to help navigate the complexities of human emotion. Using technology, it’s now easier than ever to

connect with a mental health provider, or family doctor, to discuss our emotions and secure advice to get the help we need.

This is a difficult time that poses a tremendous challenge for all of us. Let’s remember to do the little things to boost our mental health as much as possible. This means eating well, getting fresh air, exercising, connecting virtually with others and getting a good night’s sleep. Over time, we will adjust to our new circumstances. And if you need a little help along that journey, then please reach out for mental health support and at the same time, pat yourself on the back for having the strength to do so at such an arduous time.

April 3, 2020April 11, 2020

Battling COVID-19 Episode 1: From the Front Lines with Dr. Michael Szabo

Recently, I’ve been working quite a bit in the emergency room of the hospital where I’ve served as a staff physician for the past 20 years in downtown Toronto. There are many positive things happening at the hospital: Everyone is working together to prepare for all the challenges that lie ahead. We’re all connecting with co-workers in ways that are meaningful and inspirational. The strength of the human spirit is alive and well. And we know that we will get through this difficult time and be better for it.

We’re starting to see a number of cases of very sick patients with COVID-19 at the hospital. Yes, most of them are older folks over 70, often with chronic health problems. But I’m going to be real with you. We’re seeing some young and otherwise healthy people becoming very sick – sometimes, critically. It’s important to realize that these cases are rare when compared to all the people likely infected – much less than 1%, but we are still figuring that out. The overwhelming likelihood for those of us who get this virus, and are under 60 with no chronic health problems, is that we will be able to fight it off and recover. But one thing that we’ve always known about infectious disease is that a very small number of otherwise healthy people can become quite sick. While it’s true for the flu, this is much worse. We don’t fully understand why and we’re unable to predict to whom it could happen. A nerve-wracking tidbit of information, I know.

This won’t be easy. It’s okay to say it aloud because it’s good to be honest. Being honest can diffuse the tension we may feel inside by getting our feelings out into the open. The most important thing is to remember what we CAN do to help get us through this time. We have the power to lessen the impact of this virus and reduce the chances of becoming infected. We’re not powerless here.

For example, we’re all doing an EXCELLENT job with physical distancing. So, let’s keep that up. Remember to stay home as much as possible. Avoid any close contact with anyone other than immediate family. By all means, go out for walks, breathe some fresh air and get some exercise – but stay at least 6 feet away from others. That’s about the size of a pair of skis!

We must remember to wash our hands and not touch our faces. If we’re sick with any kind of cough, runny nose or sore throat, self-isolate at home and avoid close contact with anyone.

These are all simple things but sometimes the most powerful things are the simplest. We’ve got this. If we all do the right thing, we can greatly lessen the impact of this virus. The power is in our hands.

Dr. Michael Szabo

January 14, 2020January 13, 2020

Let’s Talk about the Real Flu

I saw a post on Twitter the other day and it really made me laugh. It truly hits the mark on the reality of having a bad case of influenza (“the flu”).

The flu is nothing like a typical cold or mild upper respiratory infection. It is not a stuffy nose, sore throat, and some mild muscle aches.

You are sick. And I mean really sick.

You can feel like you were hit by a train, or the other analogy I hear all the time is feeling like you were hit by a transport truck. You have a bad cough. Your muscles hurt so much you can barely walk. You just want to lie in bed all day and you begin to feel like you will never be “normal” again! I have even heard people tell me they think they are dying.

Misconceptions about the flu

A big problem is the public’s use of the word “flu.” People say all the time that they have the flu, when in fact they don’t. They have a minor other type of respiratory virus that is not the actual influenza A or B virus. As a result, there becomes confusion over what a true case of flu is. People don’t think there is anything to worry about when in fact there should be some concern, particularly when you are at risk of complications.

The actual flu is predominantly a respiratory or lung infection. A dry cough is a very prominent symptom. You often become sick rather quickly with a high fever, severe muscle aches, headache, and feeling generally unwell, that “hit by a train” feeling. Most of the time, you feel terrible with influenza but get better after 7–10 days. It’s not fun and people often miss a lot of work or end up having to forego a vacation they were looking forward to.

Others are not so lucky. The main complication of influenza is pneumonia. Sometimes this is a viral pneumonia: inflammation to the lung tissue caused by the influenza virus itself. Other times, pneumonia, caused by bacteria, can set up shop in your lungs when they’re raw and inflamed. In that state, they become an easy target for any other infection that normally wouldn’t affect you.

I have seen plenty of previously healthy young people develop these complications and end up in respiratory failure in the intensive care unit. No one can believe that “the flu” could do this because they thought “the flu” was nothing to worry about, it’s just the sniffles and some aches. This kind of thinking needs to be addressed with better public health education and perspective.

People at risk

Luckily, most people with true influenza get better. Those at extremes of age, the young and the old, are at higher risk; and so are pregnant women, even if they are otherwise healthy. Anyone with a compromised immune system, such as a cancer or organ transplant patient, is particularly vulnerable.

It needs to be emphasized, though, that many healthy individuals can and do die from influenza. It’s rare but it does happen; I have seen it and it’s devastating.

What you can do

The best defense is to avoid exposure to others who are sick. Wash your hands a lot when in public spaces. Eat and sleep well to keep your immune system strong. Get the influenza vaccine to protect yourself and those around you who are at higher risk. The flu shot is not always effective for every flu season, but studies show that even if it doesn’t stop you from getting the flu, it may reduce the severity of your illness.

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