COVID19 (short for COronaVIrus Disease 2019) is in our community and spreading. Since it is a novel virus we are all susceptible and many of us will likely eventually become infected. There is mounting evidence that many who do become infected may be asymptomatic.
The elderly and those with underlying health problems are at greatest risk of severe disease or death. Infants seem to be at some increased risk of more significant respiratory problems but are at much lower risk compared to at-risk adults. According to early studies from Washington State, children are far less likely to contract COVID19 and are less likely to experience complications when compared to adults. Most people will recover on their own but individuals of any age can unpredictably experience severe disease.
Symptoms range in severity from mild to severe including cold symptoms, cough, fever, body aches and even gastrointestinal upset. Not everyone who becomes infected with COVID19 will experience fever or symptoms worse than a common cold. Medical attention should be sought for severe symptoms including persistent, well-localized pain (chest pain, ear pain) or breathing difficulties.
There is currently no antiviral therapy that is proven to be effective and it is very unlikely that there will be any time soon. Similarly there will not be a vaccine available in the near-term.
This virus is spread via respiratory droplets (coughing, sneezing) and probably from contaminated surfaces as well. Viral shedding can occur before symptoms are noticeable but it is less likely to be easily transmissible at the pre-symptomatic stage without very close contact (such as exposure to saliva).
There are always many viruses circulating in our population many of which can manifest somewhat similarly to COVID19. In our present situation, in order to prevent spread, anyone with any viral symptoms should operate under the premise that COVID19 is the cause.
Covering coughs and sneezes, regularly cleaning of contaminated surfaces with a hypochlorite solution, and frequent hand washing are effective measures of preventing spread of the virus.
Anyone with symptoms who is out in public should wear a mask to prevent spread of respiratory droplets. (These individuals should generally STAY HOME. Wearing a mask at home may help prevent spread of the virus to household contacts). The CDC and Vermont Dept of Health are now recommending that all individuals in public wear a cloth facial covering. The rationale for this recommendation is to prevent spread of the virus from individuals who may have an asymptomatic infection.
Physical distancing is key. We should be staying home or only frequenting places where we won't have contact with people who aren't household contacts (for example a walk in the woods -- but do a tick check afterwards!).
In person visits with friends or family who aren't regular household contacts puts you and them at risk of contracting the disease.
(Do stay in touch with family and friends but do this over the phone or "virtually").
It will take a minimum of weeks of us self-isolating at home in order to break the chain of transmission. It may take months.
The more people who stay home and self-isolate, the slower the spread of the infection will be. Many of us may eventually contract this illness. The goal is to prevent the majority of us getting it at the same time (which is what is meant by "flattening the curve"). If many of us do get it at the same time there will not be the medical personnel, resources, ICU beds etc to support those who become gravely ill. Deaths will result which could have otherwise been avoided.
Testing for COVID19 is becoming more available though we aren't necessarily recommending it for all symptomatic individuals.
At this point in time, testing may help with isolation measures and prevention of spread, but is unlikely to impact treatment decisions. Obtaining the specimen is uncomfortable for the patient. Results are not 100% accurate. There is a small risk of exposure when going to a test site. All of these factors should be considered when deciding if an individual should be tested.
We are not providing in-office COVID19 testing for individuals unless also demonstrating symptoms in need of in-person medical attention. This is in order to preserve PPE (personal protective equipment) which is in short supply, and to prevent doctors in our office from becoming ill (which would preclude us from taking care of our patients).
Testing requested by patients or by parents for their child will take place at drive-by operations at the Fanny Allen campus or the Essex Fairgrounds (operated by UVMMC). This should be prearranged and the test must typically be ordered by the primary care physician. In the near term, if you or your child have symptoms, the advice will be the same regardless of test results: STAY HOME AND SELF-ISOLATE.
As usual, we will be on call 24 hours a day to help with questions and to see patients in need of in-person care. In efforts to prevent spread of the virus, staff support in the office will be less than usual.
We will continue to provide care for infants and toddlers needing check-ups and their immunizations. We are trying to return to seeing all regularly-scheduled check-ups, but this may be limited by the number of nurse hours available. We will call to confirm appointments several days prior.
We will schedule such that different families will not be in the office at the same time. Cleaning of surfaces will take place between patients.
(Please be aware that if you or your child have any viral symptoms, including simple cold symptoms, you should reschedule your appointment for at least a week later - and after all symptoms have resolved - in order to help prevent exposing others).
We will also continue to provide care for other illnesses and injuries as needed. These will be scheduled en bloc at a time of day separate from well child visits (usually late in the day). Any patient with potential COVID19 symptoms will be instructed to enter a side entrance and will be evaluated in a room reserved specifically for that purpose.
If you have an appointment at the office, please minimize the number of individuals coming, ideally to only the patient and one parent. This minimizes potential exposures. Initially we were requesting that anyone with any viral symptom (nasal congestion, cough, fever, sneezing, diarrhea) needs to wear a face covering (where age-appropriate) but based on and in order to be compliant with changes in recommendations, we now request that all parents and older children wear face coverings.
Please do not walk-in for a visit as this puts others at risk. Anyone with viral symptoms needs to talk with us before entering the office.
Anyone with significant symptoms potentially related to COVID19 disease needing attention (with the obvious exception of anyone needing emergency services) will be seen at our office by accessing a side-entrance and directed to an adjacent room reserved for individuals with potential COVID19-related illness. This will be by "appointment only."
Please do those things needed to stay well. As a community, with common sense and caring for one another, we will get through this crisis.
Paul Parker MD
A useful website that includes known symptoms, a "Coronavirus Self-Checker," information on testing, and information to raise awareness on how "fear and anxiety about a disease can lead to social stigma toward people, places, or things."