Insights and Priorities Related to COVID-19 shared by an Arizona Emergency Physician and Legislator

Amish Shah, MD is an emergency physician at Dignity Health and a member of the Arizona House of Representative elected by the people of   LD24 – Central Phoenix and South Scottsdale.  On Friday at 5:17 PM, Dr. Shah shared the message below via Facebook.  With his permission, we are sharing it with you. 

Emergency Physician and Arizona Legislator, Dr. Amish Shah, was honored as an AZBio Trailblazer in December for his leadership at the state legislature in 2019.

Emergency Physician and Arizona Legislator,
Dr. Amish Shah, was honored as an AZBio Trailblazer in December for his leadership at the state legislature in 2019.


As an emergency physician with a Masters in Public Health and your State Representative, I’ve been closely monitoring the crisis that has unfolded, including reviewing medical information and media coverage. I’ve been in meetings with many of our elected leaders offering my thoughts and questions as a physician and a public official. I want to share the latest news with you, so this post will be very long. I have been working hard to gather all the rapidly changing information and help mitigate the crisis.

The coronavirus COVID-19 has come to the United States, and to Arizona. It is like nothing I have seen before in my life or my medical career. This is a global public health emergency. Governor Ducey and President Trump have designated it as such.

If the experiences of other places such as China, Italy and Seattle are any guide, we are about to face a deadly, once-in-a-lifetime threat. 2020 will be a very difficult year for all humankind. All of our lives will be changed and disrupted. This will continue to cause massive social and economic disruption for many months.

But we will get through it together, and we will get through it BECAUSE we have each other. We have no choice. This situation demands much from us, your elected officials, and it demands much from all of you. While we take all necessary steps to provide the earliest and most aggressive response, we will need every person to help us support one another by knowing what to do and what not to do. Let’s all get in the right mindset – We will be prepared, not panicked.

Coronaviruses often cause colds and upper respiratory infections. The flu comes every year and kills thousands. But this virus is up to 30 times more deadly. Typical symptoms are dry cough, fever and shortness of breath. 80% of people will have only mild disease, 15% will be moderate, and 5% will be critical.

Children do NOT appear to be severely affected and are generally safe, though we don’t know why. Young and healthy people under 50 are very likely safe. The death rate is around 0.5%. This is overall very low, but high compared to similar diseases.

Meanwhile, the real toll here comes from our seniors over 60, those with chronic conditions, and smokers. The virus hits them very hard with high mortality rates increasing with each decade. This makes the hospitalization rate about 20% and overall death rate approach 3.5%, according to all the data from around the world. We don’t really know why some people die and others survive.

The disease is highly contagious by airborne droplets, person-to-person contact, and on contaminated surfaces. Most of us will get it, and it is impossible to fully contain. No vaccine will be available for 12-18 months. As of now, there is no drug that will help. Research efforts are underway at a furious pace, but will take weeks or months to bear fruit. If you are hospitalized, oxygen and supportive care will help.

Testing is a complicated question. As of this writing, we don’t have enough test kits for everyone, though this week kit production has been ramped up rapidly. In the meantime we are reserving testing for only certain people who are high risk. Your doctor’s office or ER will determine whether you are eligible. This will change as test kits are produced by the millions in the next week.

So what can we all do?

During my emergency medicine residency, we learned a basic principle of disaster medicine: flatten the curve. If everyone shows up in the hospital or ER at the same time, the system becomes overwhelmed and we cannot take care of them all. This leads to bad outcomes. On the other hand, if we space the disease out over time, we can treat many more and save as many lives as possible. In Italy, a surge in patients meant there were not enough ventilators to serve patients in need, and people died unnecessarily. We can’t let that happen here.

As you’ve probably noticed, we are starting to practice social distancing. Large events and gatherings have been canceled and will continue to be for months. At restaurants and movie theaters, people are spacing out from each other. Unnecessary travel should be avoided. Work from home, cancel meetings if you can, and use teleconferencing. These measures among others will slow viral transmission.

Meanwhile, you should:

  • Wash your hands
  • Wipe and disinfect if you are coughing or sneezing
  • Cough and sneeze into your elbow, not your hands
  • Elbow bump or wave instead of shaking hands, fist bumping, or hugging

So what happens if you get sick?

If you have mild symptoms, are under 50 and healthy, stay home. DO NOT GO TO THE ER. Stay hydrated and manage symptoms with over-the-counter medicine such as Tylenol or Motrin. Self-quarantine and do not make any unnecessary contact with other people for 14 days.

If you have shortness of breath or significant tiredness or weakness, go to the ER or your doctor. If you are older or have chronic medical problems and have moderate or severe symptoms, you should also go to your doctor or the ER.

What are we doing to help?

The public response as of today, March 13, has kicked into higher gear with the declaration of a National Emergency as well as a State Emergency. This means the government can take extraordinary steps to stop this crisis and mobilize a lot more resources. All hands are now on deck to protect our people.

We are working to address the two main spheres affected by this crisis: Public health measures and economic rescue.

Public Health Measures.

Most of the responsibility for managing such a pandemic falls on our executive branch, meaning the Governor and the President. At the Legislature, we authorize expenditures and pass or amend laws. In this regard, we have allocated $55 million to the Governor for use by the Arizona Department of Health Services (DHS) to combat the pandemic. Meanwhile, President Trump has allocated $50 billion federally. More money is likely coming, but these are a start to help us get resources mobilized.

Specifically, DHS is ramping up testing and coordinating with groups such as health care workers and hospitals to increase capacity and prepare for the surge that is expected over the coming weeks. This includes opening up more beds and possibly more hospitals. The President has said that we will open an Emergency Operations Center here in Arizona. We continue to push for more personal protective equipment and other supplies to deal with the critically ill, such as ventilators. Further, we will advocate for money to make sure elderly and disabled populations continue to be supported with caregivers as needed.
The medical system will also need to be protected. We will need every available doctor, nurse and health care worker to get through this crisis. We will help DHS make sure they are supported throughout.

Economic Rescue.

Because of the social distancing measures crucial to prevent the disease from spreading, many of our people will be hit hard economically due to loss of work or loss of their business. We continue to push for economic relief measures to make sure that people will always have access to food, water, utilities, and their homes. At this time, the food supply does not appear to be in any jeopardy. We will push for business relief as well for those affected, especially our tourism, retail and hospitality sectors, among others. Ultimately, this will require a very strong federal government response.

School closures are a complicated question. On one hand, we do not want children infecting one another and taking the illness home to elderly people. On the other hand, many parents are single and would be forced to stay home from work, including health care workers that are vital to the intervention efforts. This matter will be handled by local jurisdictions.

My personal role and my commitments

Finally, I want to talk about my personal involvement. As you know, I am an emergency physician. Tomorrow and each week, I will be working in the Emergency Department as scheduled. This is a job I have done for over 15 years and I am very proud to serve patients. Some have asked whether I would cancel my shift, and my answer is a resounding “No.” I simply can’t allow some other doctor to become exposed to this virus while I am relatively young and healthy and therefore at lower risk.

But given my work in the ER and the risk to the other elected officials, I will no longer be able to attend the Arizona House of Representatives in person in 2020. I have informed Democratic and Republican leadership of my decision. I hope to be able to resume as soon as possible. I will continue to fully participate by telephone or conferencing as much as I can.

Also, I will be offering my medical services as much as possible to our local hospitals throughout 2020 because they will be in need of doctors who can manage critical patients.

To all of my fellow health care workers:

I am so honored and proud to be on the very front lines of this working alongside you. I know it’s scary. I’m scared too. Some of us won’t make it through this alive. But in your commitment to our patients, I consider every one of you to be my brothers and sisters, and my heroes.

In closing, I am asking each one of you to bring out the best of the American people this year. Show each other kindness, comfort and support. Be smart and learn what to do to protect yourself and others. Politically, I know we have many differences. In the Democratic Party, I know many disagree vehemently with or simply dislike the President and the Governor, but this is not the time for acrimony. Vote how you like in November, but right now, we must support them. Keep your suggestions constructive and positive, and please do not engage in personal attacks. If I don’t respond to all of your messages, please understand that I am working hard medically and politically to serve you.

Here we go. Let’s fight this virus and win.

Source:  Republished with permission

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Posted in AZBio News, COVID-19 News and Info.