A doctor answers coronavirus questions

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by Thomas Moseley, M.D., S.M.Hyg. FAAP, retired pediatrician speaking for himself, not as an official spokesman

Amidst the flood of information about coronavirus (COVID-19) we’ve been hearing recently — hand washing, social distancing and school and business closures — there have been some very local questions which I have heard discussed at markets, schools or other gathering places.  I’d like to try to answer a few of these as well as I can with special reference to the state of affairs at North Country Hospital in Newport.  Comments I have heard fall into two categories:  denial and fear.  First the denials:

“It’s a nothing special.  It will run its course.  I’m not sick and don’t know anyone who is,” remarks which are followed by discounting “social distancing,” school closures, restaurant closures and other demands we change our habits. 

Let me join the experts who are pointing out that while we have no vaccine and no specific treatments for COVID-19, our best tools are prevention and lightening the peak load of the disease.  Our best similar case is the 1919 influenza epidemic: cases and deaths in Philadelphia (where parades, social gatherings continued and bars, restaurants and pool halls did not close) were eight times, at its worst, those of St. Louis where strict regulations prevented public gatherings

Source: Center for Disease Control.  Nonpharmaceutical interventions include social distancing, closure of public facilities, ban of large gatherings etc. and personal hygiene measures.

The bottom line:  Our best tools to fight coronavirus are those we use outside of the hospital.

Then the fears:

“Can’t I just go to the emergency room if I want to be tested?  I have a cough and fever.” 

No, you shouldn’t; you should call your primary care clinician and together decide if you should be tested.  North Country Hospital is collecting specimens for testing and is providing a drive-through testing service (with a doctor’s order) with follow-up by a local caregiver.  Why?  Because in the ER, you may expose others over the much longer period of time it would take to perform an evaluation than getting a curbside test, and many common cold symptoms won’t need the test, still in short supply.  You can’t be tested as a walk-in.

Won’t I get sick if I visit the hospital’s clinics?   Well patients and sick patients are being seen in separate areas and at different times.  Sick people who must be seen are provided with masks, hand washing is being intensively stressed, and best practices recommended by the Center for Disease Control are being followed.

Can North Country Hospital take care of me if I do get COVID-19? 

Despite the horrifying stories we are hearing about how deadly the virus is, especially for older people, in reality in a study published last week, of 1099 patients admitted to hospitals in Wuhan, China, only 6.1 percent were admitted to an intensive care unit, and 2.3 percent required a respirator.  Most patients can be cared for safely and appropriately at North Country.

Yes, but what if I need that kind of care?  Shouldn’t I just go to Dartmouth or UVM?

Itis possible that every ventilator and intensive care bed in those hospitals will fill rapidly with the very sickest, and the resources of local hospitals will be needed.  North Country is preparing for that need and has doctors, associate clinicians, nurses, therapists and technicians who are the equal of any in Vermont.

So what is North Country Hospital doing that hasn’t been reported?

 The restrictions on the number of beds that NCH, a critical access hospital, has been lifted by the federal government, so more patients can be accommodated as necessary.  Extra critical care space can be provided by using operating room recovery areas, emergency isolation beds in the emergency room and rescheduling elective surgeries.  A team of clinicians, administrators, nurses, and respiratory therapists are meeting daily to respond to changing conditions.  I am sure that more information will be forthcoming publically as the hospital responds to this emergency.

Let me take this opportunity to thank the health care workers at North Country for their untiring and gallant efforts to help our community weather this crisis.  If you know any of them personally, please tell them that their work is appreciated.

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