Today marks the beginning of the third week since many of us in Massachusetts truly started to self-quarantine and practice “social” distancing, which may better be called “physical distancing” as others have recently suggested. This means we are likely past the incubation period for Covid-19 from any infected contact before our quarantines. Physical distancing, rigorously staying within our circles of safety and avoiding other physical contacts, and continuous personal hygiene including careful handwashing, will all serve to keep us from future infection.
Let me review a potpourri of practical details of our lives today.
1. How long will we be in “lockdown”?
We all certainly will need to restrict ourselves to our circles of safety at least until the end of April. And very likely through much or all of May. The number of new cases of Covid-19 in Massachusetts continues to jump substantially every day. No medical authority has yet projected anything other than a hoped-for slowing of new infections (not a reduction of total infections) in April. And without widespread community testing for the Covid-19 virus, our ability to make valid projections is limited.
So clearly we all need to continue to protect ourselves through our circles of safety. We need to work remotely, keep occupied, deal with family frictions from confinement, and so forth. And be grateful for spring weather.
2. What would we do if a member gets ill?
If you come down with any significant illness, you should certainly contact our office, at any time. As previously detailed, nonurgent issues can be sent by email to email@example.com with a copy to your physician. If it is more urgent, by all means call the office (781) 684-0600. During office hours the nurses will pick up directly; otherwise the answering service will get you promptly to me or to Dr. Sobel.
If it sounds that you have a mild or moderate respiratory illness, we will first talk to you carefully to get detailed information. In the event a physical exam seems important, for possibility of pneumonia, for example, we will refer you to the Respiratory Clinic at Newton Wellesley Hospital where a physician can examine you, get X-rays, and arrange other testing as well.
In the event that you have a moderate respiratory illness for which physical exam does not appear needed, and where home care with remote supervision is the correct course, and also where Covid-19 seems a real risk or where your own susceptibility factors are high, we may arrange for you to get a drive-through Covid-19 screening either at a Partners facility or another local hospital that is offering the tests on doctor’s orders.
However, if you seem seriously ill with a respiratory illness, we will refer you to an emergency room for evaluation and will work with the ER to assure your information is there and to keep up a dialog with the ER medical staff. You will not be alone.
3. Would we just provide you hydroxychloroquine or a Zpak?
In general we will not prescribe such antibiotics for treatment or alleged prevention of Covid-19. Unverified anecdotal reports do not justify such prescribing, especially when doing so will contribute to another panic shortage that potentially will impair other people who need those medications for other documented conditions. We will of course try to keep you alerted to any substantiated medications of benefit for treatment or prevention of Covid-19. You are welcome to put such questions into Comments on these blogs.
If you are sick with Covid-19 and appropriately at home, we will provide you with whatever antiviral treatment is considered accurate at that time. Recommendations will change in the coming weeks as more data come in and rapid trials are done. We need to be guided by accurate science whenever possible. Should you require hospitalization with Covid-19, the inpatient staff will be in constant contact with infectious disease authorities about the best treatment at the time of your admission (which we hope is never necessary).
4. Sensible personal sanitation details
- The most important protection you have is staying out of public venues. The virus is spread by droplets that are exhaled by people who are sick and coughing, or who are incubating the virus and have minimal symptoms, and some who are carrying the virus and have no symptoms. Physical distancing (over 6 ft) protects you in general. The best protection is staying at home. Get food sent to you or packed by the market. Lots of pharmacies deliver. Amazon delivers all kinds of things. Stay home.
- If you must go out, as to an early morning supermarket run if you can’t get delivery, then by all means use sanitizing wipes on the carts before you use them. And wipe off again when you get home. Wash off or sanitize hard surfaces near your home entries from time to time.
- If you have any plain surgical masks, wear one when you are out. The personal protection may be modest, but it is not zero. More authorities are conceding that masks in public are not a waste of effort. Most foreign countries adopted mask use at the start of the epidemic. The continuing problem, of course, is that no one can readily obtain the masks.
- Cooked food does not support the virus, so hot takeout delivered to you or picked up judiciously should be fine. And remember that the virus is essentially only active if it gets into your nose or mouth or eyes, either by breathing or if we touch something contaminated and then rub our noses.
- So you can rationally pick up and open an Amazon package from your porch, dispose of the box, and then carefully wash your hands (Happy Birthday twice) with good protection provided you don’t touch your face while doing so. You don’t need to attempt to sanitize every cardboard box you open if you wash your hands immediately afterward.
5. What is needed for us to come out of collective quarantine?
As the next few weeks go on, pay attention to public discussion of how we will all safely emerge from quarantine perhaps in May, much more likely in June, and perhaps not till later.
We will need first to have new cases drastically reduced. And we will need to know who has had the infection and is immune, who might still be carrying it, and who is susceptible. That requires testing, not just the nasal PCR (polymerase chain reaction) test for active virus, but serum (blood) tests for presence of antibodies.
At the moment, we are still woefully behind in our ability to get sick people tested with PCR. As an example, today I spent an hour trying to get a PCR test for a suspiciously sick member through the Partners system, and failed. I fortunately was able to arrange the PCR test through another community hospital. If we achieve readily available testing for any sick person by the end of April, we will be lucky and I will be happily surprised.
As to antibody testing for Covid-19 virus, that is not yet available except on a research basis. I spoke to senior Quest personnel yesterday, who indicated their tests for IgG and IgM for Covid-19 (the antibody tests we use for virus exposure) are under development but have no certain availability anytime in April.
And finally, to congregate safely when we emerge from quarantine, we almost certainly will all want to be wearing face masks (not necessarily N95) for protection. This is the practice in other countries who are coming out from under the worst of the epidemic. Given that we are many weeks behind in getting such masks for health care providers, and given the overall public need is at least 100 times more than just the medical needs, we will again be talking well into May before masks are generally available.
So be prepared for a long spring close with your loved ones in your circles of safety.
Amusement during quarantine
Keeping everyone from going stir crazy over the past two weeks has been difficult. And many are appropriately worried. Clearly there is TV and Netflix. But board games and card games can also be a good distraction.
Consider playing Up and Down the River, an easy and engaging card game typically for 4 people (but 3 up to 6 can play) that resembles bridge but is much easier and quicker. Mr. Vin Sahney, a friend who taught us the game along with his wife, Gail, last year, provided the attached written instructions (Up & Down the River instructions). I constructed a score sheet (Up and Down the River scoresheet) that makes it easy to keep track of the rounds, bids and point totals, also attached as a PDF. We all likely have a bit more time on hand at home than usual. Give it a try. A good game may lighten up your evening (or afternoon).