COVID-19 Update 3/20/20

We are grateful for our community and the excellent work of our local and state governments.  From Nurses Jen and Cortney finding ways to hold things together at the office to our patients’ efforts to keep themselves and others safe - I am hopeful that we are in better shape than we would otherwise have been.  Indeed, the mayor and county commissioners have done a fine job of acknowledging the crisis while Governor DeWine and Health Director Acton have been courageous in making hard decisions to slow the spread of this virus and that will save lives.

Hickory is investing in an easy-to-use program that will let us communicate with you by video when you simply click on a link on a laptop or telephone.  We hope that this will allow us to keep connecting to you throughout this time and to offer you appointments and personal care without the risk of asking you to come in to the office

As the media and federal government is catching up in taking this seriously, I would like to spend the majority of this letter addressing the three questions we get most regularly:


1. We are here and you can always call - the advice for all fevers, coughs, and congestion is the same: taking care of yourself at home unless/until you cannot control the fever or you have trouble breathing

From Dr. Ryan:
If you have respiratory symptoms such as runny nose, congestion, cough, sore throat, or fever, these are the symptoms of coronavirus or just a regular cold.  There are currently not tests available except for those who have a known exposure or who are hospitalized.  If you have any of these symptoms you should stay at home, keep your distance from healthy family members, push fluids, and get plenty of rest.  If you have fevers, use Tylenol (acetaminophen).  There was one study that suggested that ibuprofen use might lead to worse outcomes, but it is not yet clear if this is really the case.*   If your fever is not controlled with Tylenol, it would be reasonable to use ibuprofen, but I would not start with ibuprofen.

2. What’s the worst-case scenario:  We do not want to focus on the worst case because it is not acceptable - we can avoid it and we are doing all that we can to make sure that we do.  The most likely scenario that we see right now will require about 18 months of social distancing at least at the levels that we are currently at, likely there will be times where the isolation will need to be even more intense.  I am basing this on the findings of the Imperial College in London. The report is sobering - to read a summary of the findings, click here.

3.  What you can do right now:

  • Stay home as much/if you can...from work, from shopping, from everything.  Every week we hold-off the spread of the virus gives us a better chance to have a better solution.
  • Plan for what you’ll need.  Schedule a quick (10 minute) setup visit with Hickory so we all know how the technology works and you can reach us when you need us (there is no charge for this).  Connect to your family or friends (by phone or computer, not in person), begin working out plans so that one or two young-healthy people with the fewest regular contacts shop for the group, know how to share lists, where to deliver drop-offs, and how you’ll work out payment.
  • Look out for one another.  Whether the American frontier, London in the Blitz, or just surviving middle school, resilience is built on grit but far more on good community than individual heroics.  Learn the skills you will need to make the next year good, even if it is under these circumstances.  Share what you learn and keep reaching out to find the folks who need help.  A large web of small acts of kindness will do far more to strengthen this community than figuring out how to cast the perfect votes, give the perfect speeches, or enact the perfect policy.

We will continue to share everything that we can about how to make the most of what lies ahead.  We are getting to the end of messages designed to convince you that this is real - within the next ten days reality will cut through the other noise and it will be obvious.  At that point my job will become to comfort rather than warn you.  Even so, I want to take a moment now to offer some words of comfort as many of us are starting to see a challenging picture moving forward.  We have strong leadership and committed professionals all around us.  This town has cared for me and my family since we arrived from Alabama in 1980.  The three of us boys in my generation have all settled in this area and we are raising seven children here.  We are here because we are convinced that this is a good place with good people.  In hard times the solutions will come from these community as we find ways to shop for each other, manage children, learn new skills, and ultimately make it through to the vaccine or larger eradication of this virus.

Please stay in touch by email or phone (937-404-2489).  We look forward to serving you through this time.

 
Rudi
 
* Today’s extra nerdery comes in laying out the story behind the acetaminophen/ibuprofen question.  It’s a quick read from NPR: https://www.npr.org/sections/health-shots/2020/03/18/818026613/advice-from-france-to-avoid-ibuprofen-for-covid-19-leaves-experts-baffled

**Double bonus - a tale of two approaches. This set of readings will help you understand the call for more testing (as well as our gratitude for Governor DeWine and frustration with the federal executive branch.)
With adequate testing: How/why testing can make a real difference (from Italy): The story of Vò
Without adequate testing: When leadership minimizes risk early: Another Italian story: Bergamo