REIDSVILLE — Dr. William S. Luking worked on very little sleep Wednesday morning, but felt compelled to spend his rare break from patients outlining to reporters the urgent discipline and sense of civic responsibility required to manage the COVID-19 threat in Rockingham County.
The coronavirus, which is particularly lethal to people over 60 and individuals with compromised immunity, will put the county’s citizens and a short supply of health care providers to an extreme test, the longtime local family practitioner cautioned.
A rural county of nearly 91,500, Rockingham counts senior citizens as 20.5% of its population, well above state and national rates of 15.1% and 16.3%, respectively.
And plenty of these 17,708 community elders are among the county’s chronically ill and its 19% of food insecure residents, statistics show.
Folks are hustling cheerfully to prepare meals for needy school kids and displaced workers, but he COVID-19 threat has begun to bewilder this red clay county where manufacturing jobs and tobacco farming dried up over the past 20 years.
The poverty rate is nearly seven points above the national average at 17.9%, and for decades, it’s been hard for the county to attract family doctors.
In fact, for every 10,000 people in Rockingham County, there are only 4.7 family practitioners, a stark ratio compared to the state average of 7.6 such practitioners per 10,000. The urgency of the COVID-19 pandemic brings this shortfall into ever sharper focus as doctors assume “wartime footing’’ against a pandemic, Luking said.
Luking, who with his brother, Dr. Scott Luking, treats nearly 4,000 patients, counts seniors as 25% of his 27-year-old practice. Of that group of roughly 800, around 20 percent battle chronic illnesses, such as COPD, diabetes and other immune disorders, he calculates.
Such diseases erode those patients’ immune systems, Luking said Wednesday as he rushed through a peanut butter sandwich lunch after a morning of treating patients in his new open air office — a pop-up tent in the parking lot at 520 Maple Avenue. “About 30-40 percent of my patients, because of age or chronic illness, are at increased risk for COVID-19.’’
“It’s a test run for how we’re gonna have to be doing things two weeks from now,’’ he said of protecting vulnerable patients by bringing them outside, away from confined waiting and treatment rooms. And segregating high risk patients is critical, he stressed with a caveat:
“A 6-year-old with a runny nose feeling puny is going to be sitting beside an 80-year-old on seven medicines, and that 80-year-old may very well catch a virus that might take him outta this world while the 6-year-old goes home and ... gets better. That’s the terrible nature of this virus.’’
Luking’s seen disease ravage the vulnerable before.
Volunteering 30 years ago at a rural hospital in Zimbabwe, he watched measles rob the lives of hundreds of children.
“Folks were unprotected, and kids were dying left and right. It was a terrible experience,’’ he said. “But it fortified me and prepared me for what’s coming here. We have this virus busting in … no known immunity, no vaccines, no therapies, and this will be striking the older folks with chronic disease unless we do our best as a society to protect them.’’
The former chief of staff for Annie Penn Hospital and member of Cone Medical Group’s Executive Council, a 15-member group that pens policy for the medical system’s hundreds of physicians, Luking says his worst fear is that younger generations will fail to heed social distancing guidelines and place the county’s elderly in peril.
On what to expect:
“The answer is going to be changing day by day, week by week. It’s already changing and it will continue to change in the weeks ahead. Never have we had a scenario like this in our country — at least not for 110 years with the Spanish Flu. Right now, (there’s) a high likelihood that the prevalence of coronavirus in our community, specifically Rockingham County, is extremely low. There have been zero cases identified with testing, however testing here has sadly been very minimal. Therefore, we have to deal with the potential, and even probability, that there are folks in the Greater Greensboro Area that are carrying the virus and are unaware that they have the virus and have never been tested.
“So right now, there’s a high, high likelihood if you’ve got a sniffly nose, cough and congestion … you’ve got a greater than 99.9% chance it’s just a typical springtime virus and not the coronavirus. But, literally, two weeks from now, my advice could be extremely different and it could have life-saving implications for the older folks in the community.’’
On the unique risks to the county’s older population:
“I’ve been studying this for weeks and weeks. Typically, the risk of this virus starts going up around age 60 or higher,’’ Luking said. In children, COVID-19 can present as “a relatively mild virus, runny nose, mild fever. Some kids, you may not even know they have the infection,’’ Luking said.
Others might have flu-like illness, but the high majority of kids are not going to need to be hospitalized. And the vast majority of kids who get this will survive to tell the story. That, as a father and a family doctor, has allowed me to get back to sleep when I wake up in the middle of the night,’’ said Luking, dad to 24- and 26-year-olds.
On the younger generation’s civic responsibility to the elderly:
“From age 20 to age 40, the incidence of death is around two or three out of a 1,000. That is still relatively good news in a pandemic. But those from 20-40 with mild illness may be saying, ‘What’s the big deal?’ The big deal is a mild virus that knocks you down for a few days and makes you feel puny, might just kill your grandmother. This is my message and it’s a huge message.
On why some people aren’t complying with restrictions suggested and mandated by the CDC, the World Health Organization and state and local authorities:
“I have a number of patients who think this is all overblown … I even had one doctor in the community … who basically said the same thing. But the vast majority of doctors I know totally get that this is an extremely dangerous situation. Some of their (patients’) thoughts apparently come from the political side of this discussion, and I am so sad that with a pandemic that can kill so many … to look at this through a political lens … I think that’s ridiculous. I think we have to put that behind us, unify as a country to go on a war footing. Because this is a war with a virus that could kill more Americans than WWII and WWI put together.’’
“Another group of my patients are very faithful and very religious in how they conduct their lives, and I admire that. I support that. And I believe in prayer. And prayer will help sustain folks through what I think will be a really challenging time. But what I’ve been telling my patients who believe that the power of prayer will defend them is the following: If you’re standing on a railroad track and a train is coming at you at 80 miles an hour, by all means pray, but also step off the railroad track! I completely honor and support and deeply value my patients’ perspective regarding the power of prayer and their often deep religious convictions. ’’
On the time frame of the pandemic:
“In my heart, looking at ... the behavior of the virus, looking at the slow spread in the community, looking at lots of kids with relatively mild disease, lots of old folks with deadly disease ... I’m thinking months of great challenge, maybe more. I hope I’m wrong, but I’m afraid I’m right.’’
On the stress COVID-19 means for the county’s medical personnel, possible reinforcements:
“This is a very challenging and fluid situation, also. The current standard of care is if a staff member is exposed to someone who is known to have the virus, the entire staff has to be pulled offline for 14 days to self-quarantine … That current recommendation … is going to go out the window at some future point ... When, potentially, things are blowing up around us, we’re not gonna be able to afford taking folks off the lines if they’ve just had known exposure. I think the high likelihood is that all health care professionals who care for sick people, will be exposed at one point, sooner or later, if this goes the way it’s looking.’’
Luking noted that North Carolina is allowing retired physicians to return to practice during the pandemic. And medical schools around the nation and in Europe are granting early privileges to their most senior medical students.
On how many people likely are already infected, rate of spread:
“You have to understand that for every one case identified, there’s probably another ten out there who have not been ... This thing could double every two to three days. Maybe by next week, my answer to you could be much more concerning. Right now though, I 110% endorse the idea of us staying a safe distance from others and extremely quickly talk to our older relatives, church members, older members of the community, telling them to shelter in place while the younger folks go get the groceries for them or run … errands.’’
On adjusting distance from the elderly as risk of exposure increases:
“There will come a point … in the coming weeks … when it’s even unsafe for young folks to drop in their old folks’ houses. We’re going to be needing to drop groceries off on the porch, keep a 10-foot distance, give them a virtual hug, tell them we love them and get them back in the house … to stay safe.’’
On precautions to slow the infection rate, prevent overwhelming small rural health care systems:
“You don’t want this all happening at once. Folks my age, in their 60s and older — 5% of us will die, 10-15% of us will need hospitalization — 20% maybe (will need) protracted hospitalization. For the 5% that die, 10% will need ventilators. So we have to slow this,’’ “Imagine ... we ignore the danger. Let’s say the young folks with their runny noses just casually go about their business. People just say, ‘Ah, this is just overblown, forget about it.’ What happens is a bunch of young folks get the virus, they carry it to their grandparents or loved ones ... If we suddenly get this peak what’s gonna happen is we’re gonna have hundreds of our older folks with disease presenting to our emergency room needing intensive care but only 50 intensive care beds.
“When that happens, we practice … wartime footing. I’ve never done that as a doctor … You decide who gets the ventilator, and who doesn’t … Young folks respect that even though their likelihood of being alright is higher, they respect that they love their elders and they wanna keep ‘em around. So they maintain their social distances, they don’t go to unnecessary gatherings, they practice awesome hygiene ... and this thing doesn’t explode on us, but rather stretches out.
“If you love your grandparents — look at what they’ve done for us down through the years. And we would dare expose them to a virus that could take them right outta here just because we think it’s not gonna be that big of a deal to us? Shame on that.’’
On new evidence that young adults are at risk for serious lung damage, too:
“... CDC reports out of Europe and New York City show a higher than expected hospital and intensive care admission rate for young adults. Fortunately, their overall death rate continues to remain relatively low, but young adults need to be aware they could ... suffer .. permanent lung damage, after a hospital admission with this virus.’’
On increased risk for patients with chronic lung disease.
“What’s killing many folks with this virus, is it moving into the chest and causing a viral pneumonia. When that happens in folks who already have a chronic lung disease or asthma, their likelihood of needing to be hospitalized, needing a ventilator … it increases their likelihood of dying. We as a country are gonna surpass our supply of ventilators. We’re gonna have lots and lots of folks with chronic lung disease needing ventilators to stay alive.’’
On compromised immunity:
“Lots of folks’ immune systems are not as good by virtue of being (60) or older or having a chronic condition that compromises their immune system. That could be something as simple as diabetes.’’
“Current CDC guidelines (are) that we should reserve our very short supplies of testing for those (who’ve been in) a high risk area and are exhibiting symptoms or have been around someone with known coronavirus and are exhibiting symptoms. For every one identified (as having COVID-19), there are likely 10 or more out there.
“If you have a cough, fever, feel puny, feel free to call your doctor. Probably the best thing to do may be to stay home and take (fever reducer). If you feel like you’re getting in trouble, go to the ER. Shortness of breath is one of the hallmarks of this, and that’s a dangerous sign.’’ Any persistent illness should be reported to a doctor, Luking stressed.
On hospital response to the virus:
“The leadership at the Cone system is taking an admirable and an aggressive approach to what I think is a pending public health and public safety disaster.
They are taking super aggressive (measures) to do all they can to deliver good care to the community.’’
On behavioral health during stressful times:
“All of us have mental health issues. That is part of the human condition. We are facing a very difficult situation. People are going to die. And likely people we know are going to die. I hope I’m wrong, but I seriously feel I am right. Anxiety, sadness fear … we’re all going to experience this more in the coming months as we get past this. We need to take some solace that the vast majority of kids and young adults are gonna do ok with this. But it is gonna be a wrenching society event … unlike anything we’ve ever seen in this country probably since the Civil War.
“We need to rely on our faith, our love for others, the younger folks need to really step up, and those of us who ... committed to service … need to soldier on and deliver the goods as long as we can.’’