On a recent balmy, pollen-yellow afternoon, I sat down with Dr. Mike McCrady, East Texas primary health physician for 35 years and president of the Smith County Medical Society. We sat six feet apart at the medical society office on Copeland Road, a bottle of hand sanitizer on the table between us.
My conversation with Dr. McCrady covered everything from how coronavirus spreads, to testing in Tyler, to how East Texas is — and isn’t — in a good place to slow its spread. I learned new information and connected new dots as he spoke. I was touched by hearing how Mike and his wife, Anne, said their goodbyes to their grandchildren and Anne’s mother, who is in her 90s, for an indefinite amount of time, which Mike speculates could be “months and months and months.”
Mike’s story is the first in a series, as The Tyler Loop looks at how coronavirus is impacting Tyler and East Texas. Here are his words, edited for clarity and brevity.
“I’m a part Texas Medical Association, and Smith County Medical Society, of which I am president this year. I’m a physician, and I work in [one of] the big healthcare organizations here. Smith County Medical Society is a doctor membership group, a representative body for all doctors.
So this particular disease that we’re dealing with, COVID-19, is a respiratory virus. It is something you catch from other people, and it’s a virus so theres no specific treatment medically that will stop its spread, or stop it invading your body, once it’s there. We can help you deal with it, but we really can’t stop it. And that’s true for almost all viruses. Your body just has to overcome it on its own. And we almost always do.
You catch [new coronavirus] from person to person if somebody sneezes on you or in your face and it gets in your eyes, nose or mouth. It can also land on surfaces, and it will live there. You can give it to yourself off of that surface. The virus may persist up to several days on surfaces and up to three hours in the air.
Being outdoors is probably the safest place you can be now, just to be on your own outside. Being indoors where people are touching, breathing, coughing or going to the bathroom — all of those things are where it spreads. Social distancing probably needs to go on for a long time, months and months and months. Six feet is considered a safe distance between people. It’s gonna change people’s behaviors.
Now, this virus is new. It’s in humans now, and it’s not going away. It’s going to be in the human population probably from now on. The problem with that is, nobody in the world — all seven and a half billion of us — is immune to it. You don’t have any antibodies against it. So the speed at which a whole bunch of people get it is what’s scary. In certain people, it will then go on to the next phase, which makes you really, really, really sick. When nobody is immune, one person that gets it on average will spread it to four people. That’s about twice as fast as flu is.
At some point, there will be a lot of people who caught it and nothing happened, they just had a bad respiratory illness and they got over it. They’ll be immune to it, they won’t get it again. We don’t know if the immunity we get will be lifelong. It may last a year, five years, 10 years. We just don’t know because we’ve never seen this virus before.
We have good tests for it now, but there aren’t very many. We have a lab at UT Tyler, and they can do 25 a day. We can also send it to the CDC (Center for Disease Control) lab, and that takes a couple more days. The turnaround at UT Health is supposed to be 24 hours. It’s getting better. But that’s the only machine in East Texas. That’s why we’re only doing tests on people that have already gone to the ER, gotten in the hospital, been admitted, have been in the hospital for a day or two and ended up needing to go to ICU. We haven’t tested them up to that point because we don’t have enough tests. We’ve already isolated them, just like they have the flu, so we don’t catch it or take it to their neighbor next door.
The test is a viral culture. You take a tiny swab and stick it up your nose about that far [three to four inches] way into the back of your nose, and you twirl it around and then take it out and put it up the other side and twirl it around. It’s very uncomfortable. It’s uncomfortable for the person doing the test, too, because the patient usually coughs or sneezes on you. That’s why we wear protective equipment when we’re doing it. That’s the most dangerous time for the medical provider, doing the test on someone you think is sick. And that’s why we don’t want to do it on 10,000 people. You’re going to get lazy after 10,000 people. And you’re really supposed to change your protective gear every time. That’s why it takes 15 minutes. And then you have to go down their throat, too, and swab it. It’s a two-part test because it can be in one or both places.
Everybody’s mad, saying ‘why can’t I have a test?’ It’s a very complicated piece of laboratory equipment. It’s a gigantic machine that costs a couple of hundred thousand dollars. You have to order it, put it in, get it tested and train people to do it. You don’t just go get one. It’s not like a lawn mower.
The best science right now says that when you get exposed enough to catch it — and that would be day zero — that sometime within zero to five days, you will become infectious, which means you could spread the virus. That’s probably at day two or three. You’ll probably start having symptoms slightly after that, up to day five. The rules right now are that we want to wait for 14 days to be real sure, before you circulate back in.
If you have the virus, you’ll be sent home and told to avoid contact with household members. Stay in your own house, one room and one bathroom. Nobody else goes in there, and wait it out. If you’re just coughing, having fever, having aches and pains, you’re uncomfortable — we don’t have anything to offer to make you feel much better, besides what you can get at home, over the counter. You’re supposed to wait three days after your symptoms have resolved, with no fever, no significant cough.
We’ve got three big health systems here in East Texas. There’s UT Health, Christus Trinity Mother Frances and Baylor, Scott and White. All of them are actively engaged and very professionally dealing with this. We’re well staffed with doctors and ICU beds, with all of the things within our control. But nobody can handle a huge influx of really sick patients in any community.
So far I’ve been going to the Emergency Operations Center meeting down at the fire house. There’s a debrief every morning. I feel really good about that. Every single organization is in the room or on the phone. They are sharing new facts and hearing what every organization is doing and what their needs are, without any idea that somebody is hoarding information.
[Another] important thing is the population doing what they can. I think it’s remarkable that we switched so quick, and we didn’t have a riot when people said we’re gonna shut this stuff down and you shouldn’t go to a restaurant. I’m pleasantly surprised that people are not freaking out and not going crazy that they shut school. I’ve had very few people who say ‘it’s a hoax.’
Keeping people apart [who are medically vulnerable] is really hard. It’s very close to home. I’m in the age group that’s pretty close to the high risk group and my family members are. I’ve also got six grandchildren. That’s where the population’s got to be strong and be consistent and not get tired of this in a week or two.
We have several elderly people in our family beyond my wife and myself that we’re worried about. We’re proactive and went and visited them with the understanding of ‘we can’t go back.’ In 80-year-olds, 10% can have a bad outcome. We don’t want to be the one that gives it to them.
We’ve got all these grandkids. We visited them all and said we won’t be back until all of this has passed. We’re getting really good at Skyping with them. So (my wife and I) are going to be on our own desert island for a while. We’re gonna let the kids come and play in the backyard, but we’re going to keep distance from them. We’re lucky, we have our own house, so we are able to isolate ourselves.
East Texas is starting off from a difficult spot. We’re starting out with a very vulnerable population. We have a population of older people, we have statistically very high heart rate, of diabetes, hypertension and renal disease. And there’s still way too much smoking and way too much obesity. Our statistics are nothing to be proud of.
And we have a low physician-to-population ratio, particularly in primary care. A lot of our patients don’t have really good, intact primary care relationships so they can just pick up the phone and get advice from a trusted medical professional. We’ve got really good medicine. We don’t have unlimited capacity.
If you look at the population of primary care doctors in Texas, well over a third of them are close to retirement age. A bunch of us are in the age group that we want to slow down. But we don’t want to catch coronavirus to make us slow down. That’s not the way we planned it.
The principle we work under in medicine is that if you can do something early that has a really good payoff later on, you better do it. If you wait until the last minute, that’s a really bad way to practice medicine. Dr. Fauci said the other day that the best thing that can happen is a couple of months from now, that people say, ‘Gosh you just blew that all out of proportion. Nothing happened.’ That would be the best thing that could happen.”
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