COVID-19: Stuck in stage two of treatment. “How much better can this get?”

Robert Angotti, Lic. Ac. , Herbalist

I have something of a routine at my clinic. When I first meet with a patient I try to explain the stages of treatment. I explain that the first stage of treatment is designed to assess, “Is the treatment helping?” The second stage is then aimed at determining, “How much better can this get?”. And finally, the third stage is, “What do we have to do to maintain those benefits?”

In previous posts, I compared our collective therapy against COVID-19 to the kind of therapy I would administer for a single patient using the three stages as a framework. Back at the outset of this pandemic, my practice was shutdown, (Stage 1 treatment) and I had more time to write. Once we entered Stage 2, with more opening of society, and a slow return to normal at the clinic, I found less and less time for writing. However, we have hovered in stage two through the summer and several areas of the country had to return to stage one in order to stop the rapid rise in cases in their region. Unfortunately, it seems that our upper midwest area is headed in the same direction.

“Right here in the upper midwest we are on the road to following what happened in Georgia, Florida, Texas and parts of California.” ~Dr. Micheal Osterholm

Since the second surge of cases that started in July, I have heard more and more about “cases with faces”. In other words, I have heard of people who know people that have tested positive. My patients, my students, and my family members all now know others that have been infected. Two members of my own family came down with COVID and are slowly recovering. I don’t point this out for emotional impact. Rather, I point it out in order to demonstrate that infections are increasing around us, pushing us closer to a scenario of spread which becomes harder to manage. That spread puts people, schools and businesses at risk.

While the summer surge was happening, the debate over masks continued, along with protests, and the increase in large gatherings such as in Sturgis, South Dakota. Clearly, these things have enabled the spread of COVID, and with schools resuming we can already see a rise in cases.

In my own family, I have seen my boys become more active in social activities, and sports. My oldest son is now in quarantine after only one week back in session at Concordia.

All of these things point to the inevitable oncoming third surge in cases and the importance of highlighting once again what will be required for us to prevent unnecessary death and economic hardship over the next several months.

Surrounded in Cases

When patients and I first enter into the second stage of treatment, things are usually looking pretty good. Patients are pleased to see that the acupuncture works and/or that the herbs are helpful. In some cases they can also see some benefit from lifestyle adjustments we have agreed upon. Generally, things are looking up.

However, my clinic experience usually leaves me prepared for some peaks and valleys in progress as we enter stage two. Often, my suggestions for some of the lifestyle recommendations become harder to get traction on. When I bring those things up, patients aren’t as enthusiastic about engaging in them. When I suggest limiting their use or exposure to some of the problem aggravators, many patients give only half hearted indications that they have heard me. Therefore, I wasn’t surprised that as we entered stage two with COVID back in May, the essential commitments for continued progress against the pandemic were not being embraced nationally. When I see this happening with patients, I usually like to review our goals in treatment. It seems that we should be doing this regularly with regard to COVID both nationally and locally.

COVID-19 Treatment Goals

1. Limit unnecessary deaths. It is interesting to me how we seem to have lost site of this. Nearly every day in August 1000 Americans died of COVID. Just imagine how many bombs we would have dropped on some foreign country if this were the daily death total from terrorist attacks. Imagine the outrage and the patriotic lust for vengeance if our 190,000 dead civilians had been lost at the hands of an enemy we could take up arms against. We must acknowledge, honor, grieve and protect against this tragic loss of life. I have imagined creating a place where those lives are no longer just numbers. Until we see faces, or until we experience the pain directly we may not be able to understand the need for sacrifice. This link serves that purpose.
2. Protect our medical personnel. We have lost over 900 medical providers to COVID0-19. People are showing up to work daily and risking their lives in order to give others a chance at survival. Why we are not honoring that service and instilling a national commitment to self-sacrifice in tribute to these heroic efforts is beyond me. It speaks to the tragic loss of consideration, concern and a shared truth that underlies our struggle with this pandemic.
3. Assure the educational opportunities of our children. Unfortunately, we will likely see area schools return to distance learning within the next months as cases rise. The depth of the effect this will have on families may last decades. Many parents will be forced to either stay home and leave a job, or stay at a job and leave children unsupervised. I have heard from educators for months discussing how hard it is to provide quality education online, and how many young people may not have the nutrition, emotional support, or even broadband access necessary for an online education. I wish more government officials had been considering these consequences when bars were opened back up in May and June.
4. Preserve the economic foundation necessary for a post COVID recovery. Many people weigh the economy against the above criteria and come to a conclusion that protecting the economy must be the primary goal of treatment strategies during stage two. However, this is like the tennis player that comes to see me so that they can keep playing tennis. Sometimes you have to take a break and let the body heal or you will just be back again and again as the unresolved underlying dynamics go unaddressed. We are one of the wealthiest nations in the history of the world. We can afford to put the brakes on the economy for a few months now in order to avoid having to do it haltingly again and again over the next 9-12 months. The economic consequences of the later are likely much more dire.
5. Return to normal. Stage three of treatment is aimed at maintaining progress and resuming normal activities. However, much like a patient that has made it through to stage three of treatment, we won’t necessarily return to the old “normal”. Instead will have to redefine a new normal based upon all that we have learned. I will write more about this when it looks like we have a chance to get there.

Essential treatment during the stage two resurgence

Below I have compiled a list of “treatment strategies” for each of us to embrace individually over the next several months. All indications are that we will be dealing with COVID well into next year. A vaccine may be ready much sooner than expected. Hopefully, no short cuts will be taken on safety evaluations and we will see the administration of a vaccine beginning sometime early next year. Nevertheless, the availability of a vaccine will take many months for most people, and still others will deny getting it. Therefore, we need to prepare for at least another 9 months of challenges with COVID.

1. Limit your exposure to strangers. It’s important that we assertively restrict our social circle. Now that the weather is making outdoor activities less appealing we need to remind ourselves of the danger of enclosed spaces. Being with large groups of people, or varied and unpredictable groups of people is not recommended. Limiting group size slows the spread and assists in tracing positive cases.
2. If exposed – quarantine for 14 days. The importance of this step can not be overemphasized. Nothing is harder than staying away from people and your responsibilities when you are well. Commitment to the importance of this step will be the difference between seeing regional deaths in the hundreds over the next months or deaths in the thousands. We need to publicly honor and celebrate this sacrifice if we are to succeed.
3. Wear masks and make sure you know how to wear them properly. Make whatever case you want about this. Let the science bear it out somewhere down the line if you need to. But.. come on America! If we can’t take on this little inconvenience in order to potentially save lives, what American ideal are we really fighting for. Think about the American’s before us who sacrificed life, comfort and wealth to preserve the ideals of liberty and freedom that many anti-mask folks find offensive. We are better than that. We are more willing to sacrifice for others than that. We just seem to have forgotten it.
4. Trust experts and trust that they are still learning. One of the biggest challenges with COVID-19 is that if we do the right thing, it will look like we over-reacted. I have settled in on listening to a few experts in the field in order to assess the risk for my patients, my family and the community. In addition to the charts and graphs I share here, I listen to national reporting and specific podcasts on the topic including the one with Dr. Osterholm above. The predictions of these experts, or those reporting on them, have proven consistently accurate. I am not an expert. I don’t even really have the time needed to necessarily consider myself a well informed citizen. However, many in our nation believe this pandemic is a hoax. The consequence of this thinking is that the pandemic will only appear real when you, or someone you love becomes sick or dies. It is time to find a shared truth and a shared purpose.