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"Preventive Medicine"
We are doing relatively well in Massachusetts. Wearing masks, frequent handwashing, and keeping social distance combine as an effective barrier against Covid-19. We need to maintain these practices and stay vigilant. Certain normal activities like going to the supermarket or Costco are low-risk, as is socializing outdoors. Cleaners and service-people are low-risk in your home. But indoor activities including in your living room or a restaurant remain high-risk to all concerned.
We are now doing in-office visits for patients with urgent problems. Most visits will continue via remote video links. We have reconfigured our procedures to include previsit screening for remote or office visits. We will ask people to wait in their cars. We will minimize the number of patients in office and keep the visit itself to essentials. In addition, we now have ability to test every patient for active SARS-CoV-2 virus by a nasal swab and get results in 15 minutes. We expect to integrate this in all our visits now.
We are beginning to leave quarantine. Covid-19 risks are much lower, but still present. We have to keep up our self protection appropriate to the risk, where greater intensity and duration of exposure increase risk. Use of handwashing, appropriate masks, social distancing, avoiding lingering in groups indoors, and home sanitization are all self-protection techniques. It is summer. Enjoy the outdoors, which is overwhelmingly safe.
During May, we saw a steady decline in daily new cases and deaths in Massachusetts from Covid-19. Masks, social distancing and staying at home largely worked. All good news for a change.
I explain multiple and sometimes complex issues with the Covid-19 epidemic, starting with where we are in the infection epidemiology (new infections in Mass. are leveling off but are still high, deaths are growing). Then I explore the types and efficacy of biological tests (PCR and antibody), and why different people have different personal Covid risks and may make appropriately different responses in behavior and personal protective equipment. I tried to keep it short, but ultimately chose clarity over brevity.
Today is Day 2 of Week 6 of the epidemic. We need to maintain rigorous self-quarantines and personal protection when outside, but there is hope and some data that the rate of new cases in Massachusetts is slowing. What we need most to get ourselves out of quarantine is an effective drug treatment, so that an infection does not carry high risk of hospitalization and ICU care or death. PPEs are still problematic and testing is not yet up to the need. The real bulge of cases here certainly seems likely to extend through May. Happy birthday, Happy birthday is still the key song.
The next six weeks will be risky for all of us as the Covid-19 epidemic continues to extend its reach. Nevertheless, I am convinced we can all stay safe with a high degree of probability during this time, whether by keeping in our circles of safety, or by careful use of personal protective gear, providing we are rigorous in our self-protection. I present and explain a graphical model of how and why the number of active cases will likely increase and by how much over April and May.
Covid-19 cases in Massachusetts are expanding exponentially, which will continue through this month. Later in April we pass a peak, or just reach a high plateau. Which is not known. Hospitals, physicians and nurses are struggling still without fully adequate equipment. We have no proven drug treatments nor vaccine. Almost all of our members are safe in their circles of safety, which work. Stay in yours. Do not see others in person regardless of the holidays upcoming.
Today marked beginning of the third week of our collective quarantines. Our practice has had just several possible or likely cases of Covid-19. We will be in “lockdown” certainly through April and most likely through May. We are not providing any off label treatments at this time. Much more testing of active and past disease is needed to enable us to eventually come out of quarantine safely, as well as face masks for all. These of course are not available as yet. But a good card game to try is.
OHC Office Visits This Summer
We have begun in-office visits for appropriate urgent problems that are best handled with direct doctor-patient contact. We will continue to use primarily video visits through July (which are effective), but are considering offering some in-office checkups and routine follow-ups in August if allowed by the state, though such routine visits may not happen till after Labor Day. We all need more experience handling in-person care, which is now much more complex because of sanitation, separation and PPE requirements during this epidemic.