Hello Friend, Family, and Community-
It has been a different week here in the Seattle/Tacoma area than any other week in my life.
Over the last couple of years Natasha and I have been working to build community through our email newsletter so that each of you can be at your best (if you don’t already receive it, subscribe here) . The coronavirus/Covid-19 is going to mobilize the nation and the world to act as a community.
I thought I would reach out to each of you and share the tools for managing this epidemic that I have been sharing with my family, Tacoma community, and patients here in the state of Washington, which is ground zero for the introduction of the coronavirus into the United States.
Below, I answer 10 of the most common questions that friends and family are asking and make suggestions on how to prepare. At the end of the post there a link for a ZOOM online meeting to discuss how to help our friends, families, and clients. This is free.
First, this is an evolving situation and the timing of arrival of the virus will differ depending on where you are, so please monitor for information in your area. I would look at your health department website, your local newspaper, and the CDC website.
Question 1: What is the big deal? I am under 60 years old, so I am not at risk. I have things I need to do and places I need to travel. I am healthy, and I don’t care if I have some flu symptoms.
I get the confusion. On the one hand, we hear adults under 60, and children, will have a mild cold with fever, cough, and fatigue - if that. So, what’s the concern? The reason to self-quarantine if you are sick is so you don’t infect other people. Corona viruses are very contagious. Authorities are still deciding if this one is air born. The recommendation is to not be within 6 feet of someone sick for more than 10 minutes (for now, since testing is not readily available, that implies anyone who is ill or if you are ill). The reason we don’t want to infect other people is that most of us have contact with people who are vulnerable to the virus and likely to get pneumonia, such as people over 60 or who have a compromised immune system.
Question 2: This doesn’t sound any different than the flu, again why should I stay home if sick, wash my hands all the time, and wipe down my office between clients? it seems like a hassle, and I still don’t think it is worth it for me.
The reason to follow what health authorities recommend is because we are trying to prevent too many people who are at risk of infection from all needing intense medical care for severe pneumonia at the same time. Since this virus is new to humans, all of us could be infected and get sick all at the same time and overwhelm our local medical systems. This could impact a healthy person if they have a serious medical event unrelated to the virus (e.g., appendicitis, motor vehicle accident or heart attack). If hospitals are overwhelmed by people presenting with severe flu symptoms and needing respirators, others seeking medical care may not get optimal care. Additionally, when the health care system is overwhelmed, more people can die.
Question 3: How do I not get sick?
There is currently no vaccine to prevent COVID-19. The best way to prevent illness is to be as healthy as possible, avoid being exposed to this virus, and avoid spreading the coronavirus or other seasonal flus. Here is the list from the CDC to help prevent the spread of respiratory diseases, including:
Avoid close contact with people who are sick.
Avoid touching your eyes, nose, and mouth.
Stay home when you are sick.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
Follow CDC’s recommendations for using a facemask:
CDC does not recommend that people who are well to wear a facemask to protect themselves from respiratory diseases, including COVID-19.
Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others.
The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).
Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing. Always wash hands with soap and water if hands are visibly dirty.
If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.
As the virus spreads to your community, your local health care authorities will be making recommendations about participating in face to face meetings, groups, and communities. In the Seattle area, at first the message was to wash your hands and stay home if sick. Then, companies like Microsoft, Amazon, and offices downtown said to stay home to work, and all business travel is canceled. Then, it was recommended not to have groups of more than ten people. This is why it is important to find a local source of health updates to learn more about what is being recommended based on the prevalence of the virus in your area. I have found our newspaper, department of health, governor office, and state congress people are good sources of local information.
The way an epidemic is controlled is that we all participate as a community in limiting the spread of the virus.
Question 4: When do you wash your hands?
Wash your hands as a punctuation ritual for meeting people and going outside of my home.
a. Before you leave the house and when you return home
b. Before you meet face to face with people and after you meet face to face with people
c. Before you eat, particularly at a restaurant and after you eat at a restaurant.
d. And let’s not forget, after going to the bathroom, coughing, or blowing your nose… even if it’s just for spring allergies.
Question 5: Is there anything else I should do to prevent getting the virus?
Prioritized sleep. As much as possible, offer your body at least 8 hours of rest in bed with the lights off and no screens. Even if you don’t sleep, it’s helpful to your immune system to rest. As much as possible, go to bed at the same time and get up at the same time.
Walk 10 minutes outside. Spring is arriving - go outside for at least 10 minutes and look for one color—red, yellow, purple, blue… Studies show that being outside supports your immune system, and doing a fun mindful practice by looking for colors will tell you brain that you can step away from any anxiety of the moment.
Don’t increase your use of sugar, alcohol, or smoking (of any product). These will suppress your immune system.
Stay connected to your community through phone and facetime calls. It would be nice to reach out to the older folks to help them stay connected.
Question 6: Do you recommend any supplements for prevention?
Generally, on my website, I focus on helping the body to take care of itself. For this situation, I do think three supplements are helpful.
Vitamin D3 - for adults 4000IU per day and for children over 6 years old 600 IU/day
Vitamin C - 500 to 1000 mg per day or until you get loose stools.
Zinc- 15 to 30 mg per day.
Question 7: I am worried that I am going to get the virus, what can I do?
Let’s make a plan for if you get sick. The Chinese Medicine that I study suggests that if you’re anxious about something, making a plan for dealing with what makes you anxious will reduce your anxiety since you know what your first few steps are.
COVID-19 is a respiratory virus that attacks your lungs; the symptoms are very much like the flu: elevated temperature, cough, shortness of breath, tight or sore chest, muscle aches, and fatigue. Currently, the public health message is, “If you are sick, stay at home unless you are really sick. If you get really sick, call your doctor, hospital, or urgent care. Don’t just go into the medical facility.”
So, I would suggest that you minimally gather the following:
A thermometer
Tissue for nose blowing
Go to your pharmacy and request an extra month of your medications
Food that you like to eat when sick. If possible, it would be good to have enough food for two weeks. Soups are great to overstock in the house.
The phone number of the medical provider or facility that you will call if you think you have pneumonia or need medical care. If you have health insurance, they usually have a nurse’s phone on the back of the card or a telehealth site. Just be familiar with what number you will use and be sure you know how to use it.
Have a support person who you will contact if you are sick, particularly if you live alone. Ask if you can be in regular contact with them in general and especially if you are sick.
Make a list of 10 things that you can do from home to rest and combat boredom (Netflix, read a book, call a friend, start that hobby that you never have time for, go onto YouTube and learn to draw, sing, fold origami to name a few).
If you consider yourself at risk for getting pneumonia, there are two other tools that might be helpful at this moment.
Pulse Oximeter- This is a monitor that you put on your finger, which will show the oxygen content of your blood. If you wear nail polish, it will need to be removed to ensure accuracy. It’s common to have between 95 to 100% oxygen saturation for most people. If you have a lung condition such as COPD, severe asthma, lung cancer, it might be lower. What a pulse oximeter will help with is when you are sick, if you have shortness of breath, you can know that your lungs are still absorbing oxygen easily, and if the number drops, you can report that to who you call to talk to. This is about $14 - $24 on Amazon.
A stethoscope – since it is viral pneumonia that we are concerned with. A $6 stethoscope off of Amazon will help you hear if you have pneumonia. If you need to call a medical professional, you can describe on the phone how the sounds of your lungs have changed since becoming sick. I always have my patients listen to their lung sounds when they have pneumonia, and they all say, “Oh, that sounds bad. No wonder I feel bad.”
Question 8: What should I do if I know that I am getting sick?
Stay at home until you are better plus a day
Rest
Take your temperature
Stay hydrated with water and hot tea
Take lots of hot baths. This makes it harder for the virus to replicate. See our handout for Getting Better Faster on our website
Stay warm
Eat foods that are warm and cooked
As much as possible, keep a distance from family members who need to be out in the community
Question 9: What is really sick? When do I call for support or seek medical care?
First, it is always ok to call your provider if you think you need medical care for any reason. If you call first, rather than just showing up when you have flu symptoms, they can be prepared to help you. Remember, other health events will come up, and if you think that you have a serious medical event like heart attack, please call 911.
Call if you have a temperature over 101 degrees
Call if you have shortness of breath and feel like you are having problems breathing
Call if you are so fatigued that you are struggling to do basic care activities like preparing food, drinking water, changing clothes.
Call if you have a pulse oximeter, and your oxygen saturation is dropping below 95%
Call if your lung sounds have changed since getting sick.
Question 10: I have a high deductible or no health insurance, and I’m worried about the cost if I need care.
Check with your state, in WA there is an order from the WA insurance commissioner that there is no deductible for testing and there is money for care for those without health insurance. You can ask what the policy is when you call.