For most of us, we began to self-isolate Friday, March 13th, fittingly enough. Many of you were ahead of the public pronouncements by state authorities, not to mention our laggard federal leadership. We chimed in at that time as to the urgency of establishing a circle of safety and staying rigorously within it. So today is the 4th day of Week 2 of the Covid-19 epidemic self-quarantine. What lies in store?
Circles of safety at least through April
In Massachusetts and New York and many other locales, new cases continue to escalate in dramatic fashion. The clear message of the many predictions of the course of this epidemic is that we will have expansion of infection at least through the end of April. Beyond that, it seems much more likely than not that May will also be a month of expanding infections, but with some hope of leveling off only if the public as a whole practices rigorous social distancing and if we get data about new infections.
Whether that will happen is unclear for several reasons. The most important is our still vastly inadequate testing capability for Covid-19 here in Massachusetts, as elsewhere. We simply do not now know the prevalence of infection within the community and the numbers of people incubating the disease. We still cannot get all suspiciously ill or exposed patients of ours tested promptly. You can’t predict the future without knowing the present.
And second, with our current national leader today pushing to undo social isolation strictures by Easter (April 12), the effectiveness of mutual public protection is suspect and under threat. God bless Dr. Fauci, but his tenure at the public forefront is clearly in jeopardy.
The best advice Dr. Sobel and I have for you is to prepare for continued, rigorous social isolation within your circles of safety through April and likely well into May. Plan your Easter and Passover ceremonies remotely, unless all your family are in your circle of safety. We will update this outlook regularly, and will hope for better (realistic) news.
Office procedures for continued remote care
Our Orchard Health Care office remains open its normal hours, M-F from 8:30 a.m. to 4 p.m. Our nurses, Pat Potenza and Anna Cherkassky, are in every day. They are fielding emails and phone calls and generally directing traffic so that Dr. Sobel and I can answer your questions and solve medical issues remotely by phone and electronically and try to allay your fears. Our admins, Sandra Curtin and Cathy Salvucci help them keep the medical infrastructure working, including arranging referrals (even though most in-person medical visits are on hold at other practices).
We are trying to be organized with remote visits on a schedule. The phones can be overwhelming for the two nurses during the day, so we prefer you to use email wherever possible, especially for anything non-urgent:
- Please transmit your concerns to us by email, using firstname.lastname@example.org for any clinical issue, and email@example.com for any scheduling or admin issue. Include both addresses on the note if there is any uncertainty. Our email is secure.
- You can certainly copy your physician on those emails (firstname.lastname@example.org or email@example.com), but in general please include the staff so they can help follow through and arrange remote conversations. (For Dr. Sobel, you can use the Partners patient gateway as an alternative.)
- Please do not text to Dr. Sobel or Dr. Kanner. Such texts are not secure, not HIPAA compliant, can’t be forwarded easily to staff, and can’t be readily archived.
- Clearly urgent issues will be dealt with urgently by the staff and Dr. Sobel and me.
- Most issues will be set up as remote visits on our schedule, starting late morning. Dr. Sobel and I will then get back to you by phone or other electronic means and resolve the problem as best we can. We will be taking notes, as will the nurses, so we can keep everything straight. There is a lot of monitoring going on of people at risk, people worried, and unanswered and sometimes unanswerable questions. We will be charging insurance for any substantive remote visits, as has been approved, which means you may see copays down the road.
If you have any questions about this, please pose by email. Also please read our blog posts. We are trying to get relevant current information to you on our website and pushing to you by emails. You are welcome and encouraged to comment on the posts. That way many people can get the same (I hope accurate) information most simply.
Personal protective equipment (PPE)
Masks, gloves, and hand sanitizer remain in short supply in the hospitals and nursing homes. This of course should not be, in the U S of A. But it is. So if you are sitting on a sizeable amount of any surgical masks, protective gloves, or hand sanitizer that exceeds what you realistically need, we are trying to help get that back to the hospitals and health care facilities that truly need it today. You have heard of this. Dr. Sobel is coordinating our response. Please email to her (firstname.lastname@example.org) with details about exactly what you have and the quantity and she will work with you about how to get that to appropriate care facilities in short supply.
Using masks yourself
Several members have asked, if you have surgical face masks, sufficient for personal use, is it reasonable or necessary to wear them in public if you are out and about. Such masks mainly protect others from your exhaled air and droplets, but offer some modest protection to the wearer. An occasion to use a mask might be if you go to a supermarket for food or a pharmacy to pick up meds. But much better for all would be for you to arrange for your food to be delivered or for the pharmacy to deliver. Overall, stay at home, walk in the woods or open spaces, but minimize excursions into any commercial spaces where there are potential clusters of people.
A final word for Day 4 of Week 2
Please remember that while Covid-19 can be quite serious and cause death, and is much more serious than influenza A, nevertheless most cases of Covid-19 are mild to moderate and treated at home. We also collectively are now 11 days into serious social distancing. The median onset (50% mark) of disease with this virus is 5.5 days, and 97.5% of disease onset occurs by 11 days, which is where we collectively are. Within another 3 days, if we have truly been self-quarantining in our circles of safety, we should be past almost all the risk of Covid-19 infection from our prior exposures.
Spring is here. We should all be optimistic. Concerned but not afraid. And also resolute to keep to our circles of safety for the next month or until we get reliable, science-based information so that we can begin to mingle more normally again. More tomorrow sometime. Have an afebrile day.