I was wondering what everyone was doing as far as precautions.
So far, in a state where this is around 100 cases, we have probably seen three patients with a slight possibility of Coronavirus. Otherwise, even though you can't be sure, no one has had symptoms. I always wear an N95 mask when I am with a patient; goggles and gloves when I will be examining them.
Gloves are always questionable. Before and now, I would go through a bottle of hand sanitizer a day. I wash/clean my hands five to ten times per patient. Now the same. With the gloves, while I read you can use sanitizer on the gloves, I don't. So, technically, I am probably more at risk with the gloves. Then, if I remember right away, I remove them, but that just gets my hands on the gloves temporarily. So, I have to wash my hands with soap and water rather quickly. I have always thought of gloves of being a barrier when there could be body fluids like blood or something, not so much viruses.
I only take off my mask in my office. I certainly can't change to a new mask.
My biggest question is my staff. While they are slightly concerned about the virus, they don't seem to worry otherwise. They will put on a mask when triaging a patient, but the rest of the time they don't even in the front area. I am talking about the blue surgical masks. I believe those work better at stopping transmission from the person wearing them than from their getting it, although I don't know.
I think if they wore them, it would also send a message to patients about the need for precaution.
We instituted this a few weeks ago, and I wasn't sure how patients would react but probably one of the best things we have done. We have a nurse sitting out in the hallway and screening everyone coming into the office, by checking the temp and screening questions, such as fever, cough, shortness of breath, travel and will turn patient away to their car or home or have them put on a mask and enter depending on consulting with doc. Also we check twice daily temps on all of our employees. Personally, I wear a mask at all times when I leave my office, and it is an N95. I wash my hands or hand sanitize before and after every patient encounter, and swab my stethoscope with alcohol pads after each encounter. My nurse wipes all surfaces too after each patient encounter, and if I swab patients for COVID-19 I do it out in parking lot all gowned, facemasked, gloved, N95 upped. Also this study I saw earlier today was a bit disconcerting. https://www.medrxiv.org/content/10.1101/2020.03.23.20039446v2.full.pdf
we have rescheduled about 1/3 for 2 months from now, we have done telemed either phone or video chat on another 1/3, and have seen the other 1/3 in the office. Cleaning the doorknobs, contact surfaces, armrests between patients seen(wonder if the bleach wipes will kill the brass of the doorknobs?) only doing visits by appointments no walkins 1 person in waiting room at a time. Sick patients given a mask(I only have plain old surgical masks can't get N95's) I wear a mask and wash before and after patients. Respiratory sick patients are doing drive-by through the car window cultures so far 1 Flu A + only finding am down to 18 swabs labs refuses to give me more. 3-4 weeks ago I was sick for 3-4 days with a viral ST to chest thing wonder now if it was it? Also a few weeks ago lots of a GI bug going around everyone recovered in a few days but now some data says 40% of cases have GI sxs? damn On the other hand I am liking the telemed and being able to charge for my time and recommendations, how much free-care have we all given away, hope the insurance companies keep it ongoing after 90 days.
Yes if staff develops fever, gets tested and sent home, if test negative and gets better ok to return to work. If positive out till symptoms resolve and two negatives 24 hours apart.
I have the option to keep working from home on my chromebook, to do secure video chats and if it really heats up may work on weekends if the need arises, or if I get sick but well enough to work, plan to as well.
There is still so much confusion. For instance, if a patient you swabbed tests positive, are you now considered a contact? Do you have to put yourself in isolation or check for fever or symptoms?
One thing I haven't heard much about, but I am pretty sure it is true is how long a person is contagious who has the virus. The definition I heard is three days without cough or fever as long as the number of days has been at least seven days.
I know you can do the two negative tests as well.
I applaud both of the above measures. I am torn between doing so much and maybe missing steps and picking the most important ones and doing them diligently.
Also while some are doing testing in the parking lot, why shouldn't those be done in designated drive-through places. Those healthcare workers have all the needed respiratory equipment needed. Again, if the CDC would give us the equipment necessary, we could help the EDs and drive-through testing sites.
They will supposedly have an antibody test soon. So many people who were aymptomatic who had the disease already. The thing to pray for is that being infected gives immunity if at least for that year.
Another thought. If they do come up with a vaccine, it would be great if it were only available in a flu vaccine. Then we would have > 99% flu vaccine rates.
Koby, are you saying that YOU, yourself, do not have an N95 mask? I have one extra I could send you.
Bert, I don't think so, when I swab I have a facemask, N95 mask, gloves, full body gown, head gown, and use hand sanitizer before and after putting on my gloves. I watched multiple videos on how to don and doff PPE and the doffing process is more difficult than donning. So I feel quite good about being protected during the nasopharyngeal swab collection, but nothing is perfect, thus the reason I wear a mask all day long when I see patients.
Yes don't have true certified N95 although my sons respirator masks for painting cars are in the garage so gonna don that suspect better than N95 efficiency
The only place by us doing drive-by swabs is associated with Hartford Hospital and they will only do it with an order from a Hartford Healthcare provider, us regular docs aren't smart enough to write the orders. WTF.
Again, I applaud you. I just wonder if it would be best to let the government take the risk until they fully send us the number and right materials.
@koby,
Most paint masks that you can get from Lowe's or Home Depot are N95. Another place where our government screwed up. It would be common sense to immediately make it unlawful for any vendor of N95 masks both offline and online to only sell to those who could prove they were healthcare workers or first responders and resalers be approved by a government agency.
The only place by us doing drive-by swabs is associated with Hartford Hospital and they will only do it with an order from a Hartford Healthcare provider, us regular docs aren't smart enough to write the orders. WTF.
Well, I was kinda happy I wasn't able to do swabs. Now the director of our lab says she is approved to do in-house testing, which means same day to one day turnaround. She did 120 tests on Friday. It will still be done by tier. So, she will run all tier 1s first, and if there are any left over will do tier 2. Right now, she says she has enough. But, how long will that last?
@jimmie You should make a YouTube video on this stuff especially donning and doffing. Does your staff watch you do both? Do you watch the staff?
OK, now this would be cool as hell. Now, I am not sure how you are doing it, but I am guessing for those who may require testing or want testing, you are doing a telehealth visit first. After all, they have a CPT code for Covid-19 testing, but a) you should be reimbursed, and b) you should screen, correct. I mean a 24-year-old with one day of light cough and no fever or S.O.B. or close contact doesn't need to be tested in the parking lot.
BUT FOR ME IT WOULD BE SO COOL:
Right next door we have a self-serve car wash. If we could have one bay, we could put all the equipment we needed there, do the test, then hose ourselves down with the power water hose. Soap, foam and clorox could be extra.
This is on my twitter feed but this is from Duke and one of the better donning and doffing videos I have watched https://cepd.warpwire.com/w/gR4AAA/
Yes my nurse helps me get all the stuff on right and looks me over and I look in the mirror too, and helps tie my ties.
Yes I do a secure video chat first and then either have them go out to our parking lot or send them to either the Great Falls Clinic testing area or Benefis Hospital testing area, and call ahead so some patients prefer those other areas because right now the results are 24 to 48 hours turn around time at the other places and about 72 hours or more with Quest.
well looks like hell but filters are clean and cinches up tight, tomorrow I have a patient coming for a swab, + exposure 8 days ago now fever and cough
Oh come on, that respirator and the welding faceshield have years of great protection experience. The welding gloves might pose a bit of a problem with dexterity however.
The patient was supposed to mail them anonymously. I sent them to you. I didn't want you to think you owe me anything. But, if you do send me a gift, I will take three things:
1. A case of Heinekens. 2. A boat load of Plaquenil. (I am actually taking them) 3. Zithromax which is harder to find.
Good news is I haven't contracted Malaria yet. It is pretty big in Maine in the 25 degree weather.
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