COVID-19

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COVID-19 UPDATE
by Vance Lassey, MD | Updated April 20, 2020

On march 31, I wrote a big article with information and reflections about COVID-19. It was published on the front page of the Holton Recorder. You can download the article HERE if you haven't read it yet.

As The Novel Coronavirus "COVID-19" gets closer and closer to our community,  here is what you can expect from us over the next few weeks to months. PLEASE read ALL of this page, as it should answer most questions you have. We are happy to answer questions, but reading this first will help our staff out tremendously.

First: For God's sake, don't panic. I have been watching the infection statistics, and I run epidemiologic numbers daily, and the numbers simply DO NOT JUSTIFY any of the extremes of panic the country is seeing. Sure, limiting person-to-person exposure etc, is smart during any pandemic (including the current influenza pandemic that nobody will talk about) but this thing is not anywhere near as deadly as the reaction we're giving it, in my opinion. SO RELAX. Enjoy all the cancellations. Play a game, watch a movie and chill. This is the most important thing I can tell you.

From a scientific perspective, in my opinion which is not widely shared amongst my peers, some of the big social distancing measures have seemed extreme after looking at the math. We must always ask "Why?". If a pandemic claimed 1 of 4 citizens like we saw 100 years ago, then yes. Full containment is paramount for survival. But if the 1918 Spanish Flu was a tornado, this is a mere sneeze. For this reason, nothing that happens from here on out will surprise me, and I'll be as ready as I can for every possibility I can think of. So no matter what the government says we should do or why we should do it, we must above all, refuse to panic, resist fear, be courageous, remain rational and make common sense decisions, and remain in prayer to our God who is above fear and hatred. Love conquers everything and we must remember that.

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So be a good neighbor. Don't hoard stuff, chill out, and we'll get through this together. Small town Americans are particularly good at this, so let's practice. Go out and buy something from a local business/restaurant. They're all hurting from this, and we need to support the economy.

You probably have enough toilet paper and water! If you want to prepare and stock up, it would be reasonable to grab a couple weeks’ worth of non-perishable food items (in case you’re asked to self-quarantine or are caring for someone who has to quarantine) and to make sure you’ve got enough of the staples like ibuprofen/acetaminophen and your prescription medications to last a few weeks (Holton Direct Care has plenty of these in stock for our members).

But Seriously, don't hoard basic staples, it not only makes it difficult on the market, it hurts other people. I only have 6 rolls of TP at home and if we get quarantined, we'll soon be looking for unmatched socks, because these jerks keep buying 5000 rolls of TP and the store is always sold out. 

I’ll discuss precautions you can take a bit more along with Coronavirus facts below my signature (at the end of this message-click HERE to jump there now).
 

Thank you to all who have donated N95 masks.  We're well stocked, if this pandemic gets to town.

We are fully committed to caring for our patients in the most evidence-based, safe capacity possible. In this vein, we’ve instituted a few policies to protect our patients, ourselves and our staff, all with an aim to keep you as healthy as possible.

We are using the most evidence-based triage algorithm, which comes from what the world's scientific community knows about the infection. IF YOU ARE SICK, and IF YOU BECOME SICK, read and understand the following, remembering that the clinic is where the sick people go. You probably don't want to be here.

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• Don't panic! Panicking has never helped anything, ever.

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• If you have isolated, upper respiratory symptoms (cold symptoms such as cough, runny nose, etc.) and no fever, we will recommend home care and that you not come in for an in-person visit. Remember, almost everybody who gets COVID-19 only have the symptoms of a common cold. For what to do for these symptoms, please refer to our Upper Respiratory Infection patient education form, easily downloaded from the Patient Education section of our website.

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• If you have lower respiratory symptoms (shortness of breath, significant trouble breathing, and/or fever), Sharon or I will recommend a telephone visit to ascertain if an in-person visit is warranted.​

• If we determine that you need an in-person visit, the visit will occur in your vehicle in the parking lot of our clinic so as to prevent potential spread and exposure to others. Seriously. IN THE PARKING LOT. This is the current guideline, and although it’s not how we usually do things, it’s the most effective way to prevent the spread in the clinic. It's common sense to not bring all the sick people into a building where other non-sick people regularly come and go. And if we get exposed, we can spread it to others, and would have to close, and we're no good to anybody if we can't work.

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• If you have severe symptoms, we may refer you directly to a hospital. From what we know thus far about COVID-19, symptoms severe enough to require hospitalization occur approximately 9-12 days after symptoms first appear, and are usually in patients over the age of 60. Hospitals may fill up. This is why our country is taking extreme measures to limit gatherings and interactions, so as to slow the spread of the virus and prevent hospitals from being overrun. EXTREME. Like, NCAA-Tournament-Cancellation Extreme!

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• Testing is now available from Quest. I only have 14 test swabs (4 are expired but should be fine, if I need them) from our lab (they're rationed, this is all we can get). Obviously, we'll have to limit testing to those who are very sick. The hospital is in the same situation. This afternoon's website update will include a "who should be tested algorithm". I have no idea how much these tests are going to cost us, I've heard $200, I've heard $65, and I've heard "Free" but nobody seems to know, we're waiting to hear from the lab, who, of course is overwhelmed. The following COVID-19 testing algorithm was developed by a colleague of mine, and is the same algorithm we'll be using here at Holton Direct Care unless circumstances change.

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• I cannot be more clear than this: If we come into contact with someone who tests positive for COVID-19, and develop symptoms of illness, Holton Direct Care will close and be forced to quarantine for 14 days. We are a small business, we would have to close for all in-person interactions, prescription pickups, etc. for up to (and potentially longer than) a 14-day period. If this were to occur, we would attempt to still offer telephone triage and telemedicine visits. There isn’t any safe way around this.

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• Avoiding the clinic: Again, this is where the sick people tend to come. Of course as you read above, when/if COVID-19 gets to Holton, we'll be seeing patients with possible infections out in their vehicles, but the bottom line is we don't want to be a party to spreading this infection. Many clinics have made aggressive moves to minimize patient contact, cancelling all in-person visits of non-urgent nature. They have cancelled all wellness visits, physical exams, and other non-urgent appointments. I am NOT going to go to this extreme...yet. If you do have a non-urgent need, you might consider these facts and consider getting as much of that care as possible via e-mail/phone as possible. By now, you are used to one of the big benefits of the Direct Primary Care model: our alternative types of visits, done by phone, email, or even text. It is wise for us to use this technology to its full capacity during this situation. And yes, you might consider postponing that appointment to remove your benign mole that's been there for 3 decades for a time when we're not looking at impending quarantine.

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• Across the country, patients voice fear that they will have limited access to care because of quarantine procedures, cost, and telemedicine access concerns related to insurance issues and limited telemedicine availability. Most US practices are not set up to do this. We are blessed that all this technology was built into the Holton Direct Care system from day one. And you NEVER have to pay extra for access to care no matter how it comes to you. Through this difficult situation, when others panic, we'll show our country what value-driven, patient-centered, middlemen-free authentic health care looks like!

• Avoiding the ER: Remember, the ER is where the sick people are. Remember, the E in "ER" stands for emergency. So don't go there unless you really have an emergency. ERs will follow strict CDC protocols, and will NOT perform on-demand testing for COVID-19. Unless you are having a real emergency, you would be wise to avoid the ER at all costs. Overburdening our hospitals is BAD. The doctors and nurses are working extra hard, long hours, and doing so in harm's way, and we need to do everything we can to help them out. Not to mention, exposing yourself to lots of sick people due to media-fueled anxiety about COVID-19 is just stupid.

Again, we’ve put these guidelines in place to prevent the spread of this illness to the most vulnerable around us. We very much appreciate your understanding, patience, and effort to keep everyone in the HDC family healthy as we all see our routines upended to some extent by this virus.

Feel free to reach out via e-mail if you have questions I haven't addressed.

Vance Lassey MD

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CORONAVIRUS INFORMATION

The novel Coronavirus started in China in late 2019 and was given the name COVID-19 by the WHO shortly thereafter. The virus eventually spread regionally and in February 2020 we saw cases extend to every continent but Antarctica.

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Here’s what we know so far:

• Every single one of us has had a coronavirus infection in the past — it’s one of the viruses (along with rhinovirus, adenovirus, etc.) that causes the common cold. This novel Coronavirus (COVID-19) is just a variation (or mutation).

• This new coronavirus can cause anything from nothing to a mild cold to a potentially lethal viral pneumonia.

• Those who seem to be most affected by COVID-19 thus far are those who are more at risk to begin with: those who are older, those with multiple chronic health conditions, etc. Remember, most people, especially younger than 60, just get the symptoms of a regular, common cold with this.

• The evidence out of the initial outbreak in Wuhan, China revealed: Median age = 59 years of age, 56% male, No cases in children under 15 years of age, estimated basic reproduction number (the number of people an infected person infects) is approximately 2.2, the incubation period (time from infection to onset of symptoms) is 5 days, and the average length of time from the onset of symptoms to hospitalization for those with severe illness was 9.5 to 12.1 days.

• Widespread testing in South Korea revealed positive COVID-19 in only 2% of symptomatic people tested. The rest of symptomatic individuals had other cold viruses, influenza, etc.

• There have been new coronaviruses in the past — most notably the SARS (2002, 2003) and MERS (2012 – Present) epidemics. These epidemics had mortality rates of 9-10% and 36% respectively. The mortality rate of COVID-19 is well below 2.0%, and very likely to be much lower once widespread testing is done.

• Therefore, it is not the mortality rate of COVID-19 that has public health officials scared, it's the fact that even with the small percentage of major illness that comes from it, our hospitals and intensive care units could be overwhelmed if this spreads fast. (It's going to spread everywhere no matter what- but if it were to spread all at once, overwhelming hospitals, many who could have been saved could succumb to the illness. THIS ALONE is the cause of all efforts at quarantine and social isolation--to slow the thing down).

• This virus spreads from person to person, though we aren’t exactly sure how. Our best hypothesis is that it is spread via bodily fluids and droplets from speaking, breathing, coughing, sneezing, etc (and potentially through the GI tract).

Here’s what we don’t know:

• We don’t know if this virus will "peter out" as the warmer months kick in; we also don’t know if this is a one-season thing or if it will come back strong again next cold & flu season.

• We don’t know when or if we’ll have a successful vaccine to prevent against this new virus.

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Testing: 

• Antibody testing is very much in flux.  We were about to get a shipment, but it was recalled because it had a very high (nearly 50% false positive rate after confirmatory testing, based upon current prevalence estimates.) I can order it from our reference lab, but it has a large cross-reactivity with other cold viruses, and thus is largely useless.  This test suggest, but not definitvely tell you if you had coronavirus in the recent past or if you have it now, as long as you've been sick for at least a week probably. It's mostly worthless to test if you didn't have the symptoms of coronavirus because if you didn't, the odds of you having false positive results are very high, which could give you false security about possible immunity.

How to protect yourself & others:

• Just like any other respiratory virus: stay home if you’re sick!

• Just like preventing any other respiratory virus: take good care of yourself! Exercise regularly, eat nutritious, balanced meals, practice stress mitigation techniques, and get a solid 7-9 hours of sleep a night, etc.

• Just like preventing any other respiratory virus: wash your hands! A lot!

• Just like preventing any other respiratory virus: don’t touch your eyes, mouth, nose, etc., and get into the habit of washing your hands before eating.

• If you can, avoid contact with those who are sick or are caring for the sick.

• If you are not actively sick (or caring for someone who is), surgical masks are not likely helpful. Healthcare workers will wear masks (and often higher-rated ones than the ear-loop masks), as they have a much higher likelihood of caring for someone with the disease and don't want to spread it to others.

• Those who are exposed to someone with COVID-19 or who are being tested for COVID-19 will likely be asked to self-quarantine (currently not mandatory). If your job permits, start asking your employer about work-from-home opportunities; if your job doesn’t permit work-from-home, ask your employer what their plan is to keep you safe!

• Because of the real possibility of a quarantine, stock a couple weeks' worth of non-perishable foods items in a pantry. Also make sure you have the basics — like medications, OTCs like ibuprofen, acetaminophen, diphenhydramine, and pseudoephedrine, and (a rational amount of) toilet paper, facial tissues, etc.

Be smart. Be safe. And God bless you all.