A sweet, gentle, honest, tender and nice soul is gone. COVID-19 hits home very hard.

For the last three or four months our world has been facing unprecedented challenges. We have been significantly changing the way we live and interact with each other. We will certainly have to keep those changes that recently happened in our habits, behaviors and lives if we want to seriously address this pandemic.

It is very unfortunate that some people have chosen to talk about all kind of conspiracy theories to try to minimize the impact of the coronavirus disease 2019 (COVID-19). Some folks are even attacking Dr. Fauci from all possible fronts. I can understand why they are attacking him. He, so far, has done an amazing job to counter-balance the craziness, lies, confusion and to some extent stupidity that is coming from the White House. Therefore he doesn’t sound like those crazy loyal White House staffs or officials who are willing to do everything to protect the president even at the expense of the general public.

Since the beginning of the pandemic we have been told all kind of lies:” ohhh it’s like the flu”, “it’s going to go away very soon”, “we will pass from 15 cases to 0 cases in a matter of days”, “coronavirus is a hoax”, “just another witch hunt”, yadi yadi, yada, yada. Those completely irresponsible statements were verbalized, tweeted, and boosted by the mainstream media minutes after minutes, day after day. It is really a shame to see how partisanship is playing a central role in the way we address a serious public health threat which is killing hundreds of amazing human beings everyday. Is that the best we can do? Really?

I am not a conspiracy theorist. I, actually, pay very little attention to what people have to say about the subject. I know, as humans, we never want to accept and deal with the predicaments that happen in our lives. It is just human nature. No matter what we are going through, we tend to feel better when we are told, or when we know that what we are experiencing is because of someone else who did something wrong, someone else who does not like us, or someone else who is the devil. Even if COVID-19 were the product of a conspiracy, one thing is factual, very clear and undoubtedly true: there have been more than 2 millions people infected world wide and about 165,000 who have passed away. If someone can prove to me that those numbers are fake, then I ‘ll decide to sit around and listen to those conspiracy theorists. I know that the number of deaths are real, and as a Medical Doctor and Public Health Specialist, my role and mission is to do whatever I can to care, protect and preserve human lives. I have always been paying attention to what is happening in my environment, I have always talked about what I like and what I dislike. I think that in respect to the COVID-19 pandemic I will be doing my best to be more vocal because there are a lot of people who are talking and providing misinformation and disinformation to the general public and to me that is really irresponsible and to some extent criminal. When someone say that COVID-19 is not an issue, it is an hoax, or just another way that a certain political party is trying to undermine another, I think that this whole situation is becoming extremely dangerous. I say so because we all know that there are family members who have been crying to the death of their loved ones who were not taking COVID-19 seriously enough because in the mainstream media and even the president of the USA told them not to take it seriously and everything is under control.

I think that being more vocal is the easy, straightforward, normal and understandable next step to take because COVID-19 has claimed the life of one of the nicest, more gentle, more tender and genuine human beings that I have known. COVID-19 has hit home. It’s one thing to be looking everyday at the number of cases and number of deaths and see how they are changing minutes by minutes, but it’s a completely different scenario when the numbers that you are looking at stop being statistics and become real life experience when your loved ones or people that you have known and valued for many years in your life are the ones reflected in the numbers. Yesterday was a terrible day for me. I received two bad news in about two hours. First at around 7:30 AM I received a text message from a friend who informed me that one of our former classmates in med-school in Haiti, who has been living in New York for a couple of years has passed away due to COVID-19. He was so young, only 43 years old. He was diabetic. Then, about two hours after I was informed that another former classmate from the same class and very good friend of mine, someone that I consider as a brother, was in the hospital (unrelated to COVID-19) with a blood clot in his brain. I was literally asking why, why, why and why? Why so much bad news for me in such a short period of time?

My friend who died of COVID-19 didn’t have to die. No one who died had to die. I don’t think that everyone understands the seriousness of the times that we are currently living. My former classmate, colleague and friend passed away in a hospital in New York all by himself. His family members could not even be with him. There might not even be funerals because of the constraints of the times we are living. Someone told me that the hospital might even refuse to give the body to the family. I am wondering if it’s a dream or nightmare that we are facing those times. My friend who is currently at the hospital is also all by himself. Even his wife could not be there with him. Where are we heading in this world with those new realities. We all should make an effort to take more seriously COVID-19. Regardless of where it came from, it is infecting and killing thousands of people and it is our duty and responsibility to care for everybody infected and affected by coronavirus.

I was watching on television some people protesting yesterday to force some governors to open their states. While I understand that many people are suffering financially, they are losing their homes, cars and other materials assets, I don’t think that we should let those material assets and to some extent literal greed blind us and lead us to make the wrong decisions. Until now not many tests have been done (just about 3 millions of tests were done for a population of about 330 millions inhabitants in the midst of pandemic whose infectious agent is extremely contagious and somehow quite virulent), out of all the people infected very few have been declared recovered. If we look at the numbers world wide, the mortality rate is about 6%. Out of those diagnosed only 25% recovered. What about the remaining 75%? We know that about 6% of them died, but where are the rest. Where are they? There is so little that we know about severe acute respiratory syndrome coronavirus 2 (SARS CoV2) [the virus that causes COVID-19] until now. Do the people who recover has immunity against the coronavirus now? Can they get re-infected? By refusing to take this very seriously are we setting ourselves up for a second wave of infections that can potentially be disastrous?

My former classmate, colleague, and friend is already gone. There is nothing that I can do about it. However I know that I can talk and act to try to convince as many people as possible to be more responsible and serious in the way that they approach and address the pandemic. If we are going to open everything is New York for instance, are we ready to manage the subway system appropriately? Usually in the train cars there are way too many people and there is absolutely no room to even breath. Are we really serious. That’s the way we want to move forward? What is the plan to re-open? What is the plan to prevent what happened to my colleague from happening again, and again. Until we can adequately answer those questions, I think we should just simply and humbly remain in lockdown because we know that the lockdown has prevented thousands, let alone, millions of infections. Let’s stop the greed so that we can save more lives.

In The Fight Against COVID-19, The Stay At Home Orders Do Not Apply To All of US.

We are currently living unprecedented times. If we are lucky enough to survive this scourge, many years or even decades from now we will be able to talk about those immemorial times to our grand-children, perhaps great grand-children and explained to them how we survive the scourge with stay-at-home order, shelter-in-place order, social distancing and all those other terms that are now part of our lexicon. For the majority of us, not a day passes by without referring to at least one of those terms. Our lives will have been for ever changed in a significant major way. We will be obliged to leave in 2019 all those habits or gestures that are believed to promote the spread of Coronavirus Disease 2019 (COVID-19). Besides handshake that I mentioned in an earlier post, I have been thinking of how in Europe people enthusiastically kiss each other on the cheeks when they meet. Sometimes Italians or French people get lost in the number of kisses that they should give each other ( is it one kiss, two or three?). Myself, I usually get lost in the number of kisses when visiting family members in Europe: when I think it’s just a kiss, they would say oh no, one more or even two more.

In order to considerably limit the spread of COVID-19, in many parts of the world the governments have been very firm and strict on preventing people from being in the streets if they are not essential workers. Depending on where you are living, the orders have been enforced with various degree of rigour. That observation in itself can explain to some extent the difference that we see in the data coming from various countries, cities, and counties reporting on the pandemic.

While in several parts of the world, many are respecting the stay-at-home orders and others have the responsibility to enforce these orders, we need to recognize and acknowledge the fact that for some of us the stay-at-home orders do not apply. In the midst of the complete chaos caused by COVID-19, there is an homeless population that is fervently and ardently fighting to stay away from the virus, stay alive, and stay warm. For those individuals, the home is a sidewalk or a space under a bridge. They are way less likely to get access to healthcare services if they were to be infected with the coronavirus.

In the USA, in New York particularly there is approximately 70,000 homeless people (including children). While there are some shelters trying their best to serve this population, every night there are about 5,000 to 6,000 people who sleep literally in the streets. At the onset of the COVID-19 outbreak in New York many shelters that were serving the homeless population closed their doors because there were a couple of cases diagnosed in those shelters. Therefore, there is now a higher number of homeless people sleeping in the cold, on the sidewalks or under the bridges every night. The stay-at-home order definitely do not apply to those amazing human beings. Besides the shelters being closed which cause more homeless to be in the streets, there is also the fact that in the USA 70% to 80% of people are just one of two paychecks away from being homeless. The economy has been hit severely by COVID-19, millions of people have lost their jobs, they don’t have any savings, and are forced to get to the streets. The stay-at-home orders do not apply to those folks either.

In my work implementing harm reduction programs in New York to serve people who use drugs, and those who are involved in sex work, I have come across some really interesting, very smart, and compassionate human beings who just happened to be homeless. Despite everything that is going on in their lives, despite all the negativity that constantly surrounds them, they always find the strength to put a great, beautiful smile on their faces if a provider is kind enough to make a nice joke.

I find it mind-boggling that in a state as rich as New York, in a country as wealthy as USA there are that many people without a place to call home. I find it despicable that in a nation considered the wealthiest in the history of the world there is such a high proportion of workers who are literally just one or two paychecks away from being homeless. Those are major issues that should be talked about more and more and ultimately addressed. I do not understand how many folks can be proud to talk about how strong the economy was before COVID-19 whereas those major issues have been around for too long. How do you define strong economy when there are so many that cannot even satisfy their basic needs. Those without a place to call home are not less human than the rest of us. They deserve quality healthcare services like anyone else so that they can tested and treated for COVID-19. Any plan being discussed on re-opening should include them. What are the steps that will be taken to re-open the shelters that are closed. On a larger scale, what is the plan to address the housing crisis that the “wealthiest” nation in history is currently facing. As states will be re-opening one major component of the public health approach to continue combating COVID-19 will be contact tracing in order to identify all the people that someone who is tested positive for coronavirus might have been in contact with. However, the conundrum is: how do you contact trace homeless people who, in the majority of the cases do not even have a phone whey they can be reached.

It is clear that the stay-at-home orders do not apply to the homeless people, nevertheless any plans to apply the lessons that will have been learnt through this overall situation should apply to them. Quality healthcare services apply to them. Having a place to call home is such an important determinant of health. To my knowledge, health is still a human right. Right?

Social Media, Social Network In the Era of Social Distancing: What Does The Future Hold?

We are currently living some new days, some new moments with their share of difficulties and challenges. No matter who you are, no matter where you live, you cannot deny this statement. Because of the novel coronavirus (Severe Acute Respiratory Syndrome [SARS] CoV2) that has been causing a pandemic of coronavirus disease 2019 (COVID-19) across the globe, our ways of life are changing significantly and perhaps definitely.

The very first case of COVID-19 was diagnosed in China, in a 55 year old patient who apparently got infected in the Hubei province back in November 2019. That is about one month before the first case in Wuhan was identified in late December 2019. Since then, there have a lot happening and changing almost at the speed of light. It is thought that the virus originates from bats and was transmitted to humans in the many wet markets in China. Regardless of where the infection was initiated and how it is transmitted from bats to humans, the facts are: now there are close to two (2) millions of people who tested positive for the coronavirus world wide and about 127,000 deaths. The United States of America (USA) remains the country most affected by the pandemic with over 600,000 people who tested positive, and over 25,000 deaths. The projections for potential number of people who will be infected and the number of deaths are terrifying. A significant part of the world is in lockdown. The economic systems in the richest countries of the world are crashing. There are fears of economic recession, and even economic depression.

Unfortunately at the beginning of the pandemic, in many parts of the world the situation was not taken seriously. Many influential public personalities minimized initially the seriousness of the pandemic and because of that many people are paying the price with their lives or the lives of their loved one who passed away already or who are in the process of passing away. It is a very scary, sad, mind-boggling, frustrating and depressing that our world is currently living.

So far, the 1918 influenza pandemic is considered as the most severe pandemic in recent history. It was caused by an H1N1 virus with avian (relating to birds) origin. Despite the fact that there is no universal consensus on where the virus originated, it is well recognized that this H1N1 virus spread in 1918-1919 like wild fire world wide. It is estimated that about 500 million people or one-third of the world’s population, at that time, became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States. The mortality rate was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality rate in healthy people, particularly those in the 20-40 year age group, was one of the key aspect of the pandemic. Until today the properties that made the 1918-1919 influenza pandemic so devastating are not completely well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly. Those are non-pharmaceutical interventions that are also promoted and enforced nowadays as an effort to prevent the spread of the coronavirus and promote health for the well-being of the communities. Even if some people are complaining because such measures are crashing the world economy, I believe that it’s the way to go. The more people who die of COVID-19, the less people will be available to help make the world economy recover. It is really important that public health trumps economic wealth. When the economy is strong, the people make it strong. Without people we cannot have a strong economy. Also, in the majority parts of the world, the economy has always been in limbo. Many people had already been suffering with all kind of inequity and social injustice, that now they are not afraid of the consequences that COVID-19 can bring in their lives because somehow they believe that they have already seen all kind of predicament that the world had to offer. Nevertheless, it is crucial that public health officials continue educating community members and continue identifying the positive cases by implementing massive testing activities. The treatment of COVID-19 is still not clear. There are some anecdotal stories about the success of hydroxy-chloroquine combined with azithromycin and zinc, but there is still no convincing evidence supporting the effectiveness of those drugs in treating the diseaes. Nevertheless, if we don’t have anything reliably established and we hear of stories of what is potentially working, we should definitely not hesitate to give what is believed to be working a try. Hopefully those medications will help us save as many lives as possible.

There is something that has been intriguing me. I have been thinking of what possibly those non-pharmaceutical interventions looked like back 100 years ago. I have been curious to know what social distancing looked like in 1919. How did people survive remaining in quarantine or in lockdown? What kind of activities that they did in their homes to kill time? How did they engage with their loved ones that were leaving under the same roof as them and how they engage with other kins who were living hundreds or even thousands of miles away? Today we have social media, which started only back in 1997 with “Six Degrees” as the first recognizable social media site. Since then we have had some notable social media site or platforms such as “MySpace”, “Hi5″, ” Facebook”, “Twitter”, “Instagram”, “Whatsapp”, etc. No matter how scary is the current situation that we are living, we have found ways to remain connected with our loved ones, to work from home while being in constant contact with co-workers and customers, and to even have shows and other activities on TV that are presented like there is absolutely no lockdown. All that is due to the magic of the new technology of information. Today even if we are practicing social distancing, we do remain connected via social networks, social media. In the era of tiring, and depressing social distancing, social media give some senses to our lives. There are online classes where pupils and students continue learning everyday. There are shows streaming live online. There are even some concerts organized for online public. There are Netflix and Youtube TV who are getting more and more people subscribing and using their services and watch as many shows as possible. We are finding more and more creative ways to stay in touch with each other. At household level, social distancing is, in some cases, reinforcing the bonds between parents and kids and couples but in other cases there have been alarming reports of domestic violence. We can easily understand that while social distancing is to some extend enhancing bonds between family members, in order cases there might be an escalation in the number of divorces cases once the lockdown is over. Definitely in a couple of months from now (approximately nine months) there will be a considerable number of new babies in the world.

Should we start getting ready for another baby boom after all this time that the couples of the world will have spent in lockdown? we probably should. It will take time before businesses, schools, work, etc can reopen the way they were before the pandemic. We want to be very prudent and demonstrate great care or foresight in the way that we will reopen the communities that were literally shutdown to prevent a significantly dangerous level of spread of coronavirus. We certainly do not want a second wave of infections that would be due to the fact that the non-pharmaceutical intervention that are being implemented now will be completely forgotten in a couple of weeks from now. No matter when we reopen our communities, I strongly believe that the lessons that we are still learning from this COVID pandemic will stay with us forever. This pandemic will certainly force us to change the way we greet people, the way that we interact with them, the way that we serve them. Handshake might be on its way to becoming gesture of the past. Online school or classes might progressively establish themselves as a more reliable and more promising new market. Live online shows, and live online concert might be a tremendous part of the future. In conclusion, I have to say that we don’t know for sure, with certainty, what the future hold for our world but we know that across the globe there will be some damaging effects of the pandemic and people’s life will forever change. In the era of social distancing, social media might help us redefine the way we live.