This communication is particularly directed to those who are at the absolute greatest risk for a serious adverse outcome should they become infected with the virus causing the current pandemic sweeping our nation and the world, the Coronavirus, but is pertinent to all. It is becoming increasing clear that those who are at the greatest risk are the older generation (above 65 years of age), those who have had or are currently combating chronic illnesses (such as heart disease, cancers, diabetes, respiratory issues, chronic steroid use, immunosuppression use, etc.). This does not mean that those without these preexisting risk factors cannot contact the virus (they certainly can), but it does appear that those without the factors are much better prepared to survive such an infection with relatively minor issues to contend with.
A particularly greater risk undoubtedly lies with those who have Chronic Obstructive Pulmonary Disease (COPD or Emphysema), and it is to those we would expressly urge to monitor their situation closely and to follow recommendations rigorously. If you are one of those patients, we urge you to listen carefully to the recommendations offered by the Public Health Personnel (that is health personnel, not politicians), and practice what has proven to be helpful. Understand also that there is two aspects to this problem, one being an attempt to prevent the spread of the disease (which is largely what you have been hearing on the media to this date) and the other proper management of the disease itself (its diagnosis and treatment, which are medical issues). Please consider the following and implement them in your daily living. Nothing will work to prevent the spread of the Coronavirus if it is not rigorously applied, just as nothing works well for the prevention of other chronic diseases like diabetes and COPD if the preventive measures are not applied.
- Wash your hands well (soap and warm water, 20 seconds or so). No kidding, this works about as well as any single thing you can do. The key is to avoid transferring the virus from your hand to your face (eyes, nose, and mouth).
- Try to avoid touching your face (yes, this can be a difficult habit to break).
- Avoid crowded places (important). Social distancing from people of approximately 6 feet seems to help. This means avoiding handshakes, hugging, and the like for now. Common advice is to avoid groups of 50 or more—we would advise that even smaller groups increase your risk. Use your computer and use the social internet whenever possible—much safer. Cover coughs and sneezes.
- Limit your excursions out of the house to necessary tasks—you will still need food items, gasoline for the car (perhaps), care for your chronic medical conditions, addressing emergent conditions (sick loved ones, heating system malfunctions, sewage issues, etc.) and the like. Just ask yourself, “Do I really need to go out to do this, or can I get along without it and not harm myself or someone else?”
- If you have concerns about symptoms you are currently experiencing that are respiratory in nature (cough, fever, shortness of breath, chest discomfort, sore throat, known contact with a diagnosed case of Coronavirus in the past 14 days, and the like), call the office. We will screen the complaints over the telephone, advise rather or not you need to be seen, and if so, the appropriate medical personnel, or perhaps merely quarantine yourself at home and monitor.
- Stay calm—to date, this virus seems manageable somewhat in the sense the influenza virus is manageable. It will spread, that is a given. Our attempt should be to minimize its spread and to slow its spread as much possible (gives us time to gear up treatment procedures for those who need it).
After practicing these epidemiological recommendations well first, then turn your attention to medical (diagnosis and treatment) recommendations.
- Maintain your current medication program for any chronic illness you are treating. Do not alter a chronic illness treatment program without discussing it with your physician.
- Monitor yourself for the presenting complaints of Coronavirus
- Fever (usually above 100.5°F, often in the 102°F range)
- Cough (may produce sputum, may not)
- Shortness of Breath (beyond your normal shortness of breath if you have COPD, etc.)
- Chest Discomfort (yes, anxiety can provoke this symptom)
- Sore Throat (usually mild)
- If you experience some of the preceding complaints, call the office as discussed above. These complaints, unfortunately, are not unique to Coronavirus. This will be the point that being cultured (screened) will be very important. Screening is currently available at both our labs at the office. We expect that testing will be more readily available with each passing day.
- If symptoms and physical condition are mild to moderate, practice the following:
- Stay inside—self-quarantine! Avoid contacting others. Have people living in the household screened and we would advise they self-quarantine too (keep in mind the virus is transmitted prior to experiencing symptoms, this being a major reason it is difficult to control spread, and is probably most communicable for about 5-6 days, but possibly up to 2 weeks).
- Plenty and adequate rest—very important (7 hours minimum, 8 – 9 better).
- Emphasize fluids—do not become dehydrated.
- Eat healthy foods that help the immune system—fresh and colorful fruits and vegetables are particularly helpful. Consider taking Zinc 50mg daily and Vitamin D 5000mg daily.
- Control fever with agents you personally tolerate in appropriate dosages.
- If you are treating COPD (emphysema), pay particular attention to this advice and follow it rigorously. COPD will particularly increase your odds of a poor outcome.
- Stop smoking if you are smoking (it is estimated smoking increases adverse outcome by about 70%).
- If your condition deteriorates and worsens to the point that the fever is rising, chest pain is becoming worse, and particularly if breathing is difficult, labored, and very short in breath, you must be seen and evaluated, and this will be a legitimate use of the E.R. and hospital (but only if needed, avoid use of E.R. and hospital if at all possible).
- Hospitalization will be necessary for a few and it will be determined by people very capable to both determining if it is needed and, if so, the appropriate measures that need to be taken to assure the best possible outcomes. Our hospitals are very capable of doing all of this, and contrary to much of the political hype being bandied about on the media at the present, there is no reason to suspect shortages or inadequate facilities at this time (stay tuned and monitor this). By practicing good epidemiology measures as previously discussed above, we can all help assure this will not be an issue.
If you are advised to come to our office, FMOM has enacted measures to help minimize the possible spread of the virus to other patients and to our staff within the office. This is extremely difficult to do in an office setting so your cooperation is requested to help by following the above recommendations. We will make it through this, just as we did H1N1 (Swine) flu, SARS, and Ebola. Be confident, be wise, and practice good epidemiology control measures. Working together, we will control this virus! Thank you!