Increasingly, we local healthcare providers are hearing more and more concern from patients regarding Covid-19 (the “coronavirus”). This is understandable-- of March 11th, the World Health Organization has declared Covid-19 a pandemic, and although there have been no confirmed local cases, as more cases are identified nationwide and worldwide, there is a higher likelihood that we will see spread within our community: according to the CDC’s Dr. Nancy Messonnier, “It’s fair to say that, as the trajectory of the outbreak continues, many people in the United States will at some point in time, either this year or next, be exposed to this virus and there’s a good chance many will become sick.” 

Like other healthcare facilities, TCMH--with the help of our providers and staff, and a responsive Administration-- is taking this with appropriate seriousness, and has taken steps to reduce risk to our patients in the community, and continue to provide the best care possible not just for any potential corona virus cases, but for our other patients as well.

At this point, we are well supplied, and have comprehensive plans in place to deal with any eventuality.  However, as we have seen world-wide, significant procedural changes and good resource stewardship are going to be critical to an optimum response. Over the next few days, you will see some of these changes in the form of more visible screening, signage and some restrictions—you should not be alarmed by these, but know that they are evidence based interventions to help keep you safe. Over the next few weeks and months, the TCMH Covid-19 Task Force will be releasing public updates regarding the situation in the community, state and nation, and our community response. I would encourage everyone to keep abreast of these updates through the TCMH web site, social media, and other reputable sources.

But it is not just a health system response that is needed—it is important for individuals to do what they can to help care for themselves and to reduce the risk to their friends and neighbors through adopting simple strategies to prevent the spread of any contagious disease, such as the influenza that we are still seeing quite a bit of in the community.

To that end, as a physician, I am asking people to be cautious, but also realistic.  It is important to remember that the vast majority of individuals that may contract coronavirus will have mild to moderate symptoms, and for them there is no specific care other than the same types of symptom management that have been recommended for decades-- exercise precautions to avoid transmitting it to others by self-isolating when necessary, wash your hands, cover your cough, push fluids, take ibuprofen or Tylenol if needed, and take it easy.

These mild-to-moderate symptoms may resemble those of a common cold or a mild case of influenza (fever or chills, a runny or stuffy nose, sore throat, headache, muscle aches, cough), and there is nothing that professional medical care can do to make you better faster.  Always trust your intuition and follow the specific advice of your personal healthcare provider, but if you have mild-to-moderate symptoms it is probably best just to stay home.  After all, even if you have something like an uncomplicated sinus infection or bacterial bronchitis, antibiotic stewardship and best practices generally suggest that we would not treat those with antibiotics unless you have been ill for 10-14 days, and antibiotics of course do nothing to treat viral infections.  Also, at this point the turn-around time on specific testing for the coronavirus is also not rapid enough to change treatment plans, or community response, in most cases.

If you have severe symptoms such as wheezing or shortness of breath not relieved by any usual intervention that you may use, significant chest pain, high fever or shaking chills (particularly if not relieved by Tylenol or Motrin), symptoms of dehydration, or confusion, you should be evaluated in the emergency department, as there may be a higher likelihood of a more serious problem, including those which may require hospitalization such as bacterial pneumonia.

If you choose to take yourself to the emergency department due to the above symptoms, call the emergency room from the parking lot so that you can be met by a provider instead of going to the waiting room, and thereby reduce the risk of spreading any infectious agent (not just Coronavirus) to those in the waiting room, visitors, etcetera.

It may still be appropriate to visit your physician's office, or a walk-in clinic for more mild or persistent symptoms, or for situations that might point towards something for which antibiotics would be appropriate immediately, such as a child with fever and isolated sore throat, or fever and isolated earache; or if you had a confirmed contact with influenza and you are within the two day window to start Tamiflu.  However, out of an abundance of caution you should still call the office before arrival (or if it is a walk-in Clinic, call them from the parking lot).  Be prepared to briefly described your symptoms, when the symptoms began, and a specific temperature if you have taken it, and then be prepared to answer any further questions the staff may have for you (this may include travel history or potential sick contacts, and it is critical that she would answer these honestly), and to follow their specific instructions about how to proceed.

HOW YOU CAN HELP

"This is an evolving situation, and everyone should take it seriously, but without panic. Those of us in the ER and in the Clinics and on the Wards are doing what we can to continue to provide the best care possible, but we need everyone’s help in order to adapt to this “new normal” as a community," wrote a TCMH physician on Wednesday afternoon.

I cannot stress this enough:  Unless you are gravely ill, at which point you should be going through the emergency department anyway, you should not just walk into the waiting room of the clinic or hospital with a fever or respiratory symptoms, and instead contact them first and follow their specific instructions, in order to reduce the risk of spreading any potential infection to others.

From a prevention standpoint, it’s also important to exercise common sense strategies that you should be using during this Flu Season anyway: If you are sick, a mask may reduce the risk of transmission to others (but generally won’t protect you from someone who is sick) but it’s more important to cover your cough and avoid contact with others until you feel well. Everyone should be washing their hands or using hand sanitizer after contact with others, contact with public surfaces, or hygiene activities. Those with other medical conditions (or those over 60) should stay at home as much as is reasonable to avoid contact with sick individuals, or large gatherings where transmission is likely to occur.

This is an evolving situation, and everyone should take it seriously, but without panic. Those of us in the ER and in the Clinics and on the Wards are doing what we can to continue to provide the best care possible, but we need everyone’s help in order to adapt to this “new normal” as a community.

If you have further questions, please contact your doctor, review information from the WHO and CDC (who.org, and cdc.gov respectively), or contact the Missouri DHSS Covid-19 Hotline at 877-435-8411.

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