COVID-19 Updates From Dr. Gee

We realize the importance of staying connected and intend to provide weekly updates in this format for some education, encouragement and challenge. Each week is different as our lives shift and change with the complexities we experience personally and jointly in these days. Our desire is to give you the facts as known at the time of these letters and assist in filtering the poignant developments for your consideration and application. As your healthcare team, you can count on receiving authentic communication from us and our remaining a positive force in this journey together.

COVID-19 Updates From Dr. Gee

04/20/2020

A tremendous amount has transpired since our last correspondence on COVID-19. The great news is that we have reached our first benchmark in our new, overused, pandemic lexicon of “flattening the curve” in Idaho. This is based on significant reduction of new cases reported given the profile of patients that have access to testing. Our collective efforts to mitigate the risk of an overwhelming healthcare crisis have worked to date. We can be grateful for this outcome. We have completed Round 1. Each of us has wrestled with our current status and experiences of the past month.  As we contemplate the implication of transitions and new norms of life, we have to focus on what is known and what we can control. I would like to highlight a few of these for perspective and, hopefully, some clarity as commentary, information overload, speculation and misdirection do not empower or encourage us as we face this infectious opponent. We must not add each other or our community to the list of things embattled right now.

Known and important:

*This coronavirus can transmit in the first 5-7 days prior to symptom onset in those who develop symptoms and potentially up to 3+ weeks after symptom resolution. It sheds from those infected but have no symptoms (asymptomatic infections). Any of us may be shedding without knowledge of it.

*Some healthcare supply chain limitations are improving. Others remain restricted such as testing capacity with rapid turnaround time, PPE, and contact tracing. These are core limitations that risk failure of the work done to date in keeping the outbreak contained if we don’t correct them. Idaho COVID-19 prevalence is not known, but if this is currently and speculatively around 5%, over 1.3 million of us would have to get the infection to reach 80% herd immunity for Idaho. (Most community disease dwindles out at 80% immunity  of a population). Not a good approach given net outcomes.

*Successful surge prevention countries such as Japan, South Korea, Taiwan, and Singapore have numerous factors that have led to their success. Mask compliance. Compulsory compliance. Philosophical compliance.  Look at the Daily Case Rate of Singapore, however. They were championed initially for their first 6 weeks of control from early February to mid March. Their easing of restrictions and behaviors to baseline life hasn’t gone very well in the past 1-2 months. Other countries with trustworthy data have succeeded. We need to take heed. Can’t speculate here on all the reasons. Just file it away for consideration. 

*Most current debates on relaxing measures to our new “normal” pit individual rights and collective rights in the realms of health and economic well being. There are critical issues surrounding all of this and they define how we view and treat each other. I would posit a simple stance that the individual and collective outcomes are not exclusive of each other (see below). 

So where do we go from here and what can we control? Fear and denial are not reasonable options as we process all this.  Clarity and simplification of the arguments are needed to act and implement what is possible individually and corporately. Hopefully in the past month, some personal simplifications have cleared your perspective, focused your values, and caused you to contemplate things that remain stable in your life. For many of you, that surrounds relationship with others, ideals, philosophy, or faith. Go deeper in these pursuits. I would encourage each of us to elicit others’ personal perspectives as we struggle with an understanding of where they may be stressed, bewildered or worried; you will be enlightened and better educated on the “facts” of their experience. Walk a mile in their shoes. From that position you can make a substantial difference in your village.

So what about COVID-19 clarity and simplification as our heads spin with perspectives from many directions? How do we jointly act as this virus threatens to create a persistent dystopia? How do we reconcile personal and collective rights? What we need to do for COVID-19 is fairly basic with what we already know. I doubt there will be a date of “all clear” for months at the earliest. Freedom of movement, travel, and gatherings will all have to be addressed as sources of potential flares or outbreaks. We need our community to move forward but this requires everyone’s participation just as we have for the past month. The basics of good hygiene and prevention of respiratory droplet exposure will be the champion in this battle. Wearing a facial covering or mask in public can not be overstated. Social distancing is constantly violated with shared air space when we are out in public. When I run an errand, I only see about 20-30% of people with covered faces. It’s not too much to ask. It’s an act of respect to others, not an ill-informed self-protective maneuver. Humble ourselves and let’s start to transition back to more normal movement and life. In the absence of a vaccine we can’t instantly create herd immunity without disastrous results. We can create a “barrier-herd immunity” while awaiting more options. Absent this joint behavior, we risk undoing our efforts. We don’t have personal or social reserves to do this all over again. Learn the lessons of others and look at the data; Singapore’s graph speaks volumes. Some would argue that compulsion or guilt would be the best way to achieve this; these also destroy. I am idealistic enough to say that we can do it for the right reasons out of respect and care for each other. Encourage others to do the same.

Stay positive. We can do this. Antibody testing on your blood to clarify your COVID-19 immunity status can now be easily provided through our office at Main Family Medical with next day results. We have had barrier methods in place for the past month and believe we can provide you confidence in this area. We are triaging everyone who calls for appropriate coordination of care. Telehealth visits are provided for those active and suspicious of illness; these remote video visits are also available for you who prefer not to come to the office. We have been wearing masks at our practice for the past 5 weeks and will remain in this fashion for some time to come. We are doing all that we can to keep your baseline health needs addressed and out of the hospital system. More than ever we want to be your resource in navigating options as we shift through these phases. Being an independent and small practice allows us to pivot and adapt quickly for your benefit as new developments occur with the pandemic. We are available to further clarify any COVID-19 issues, questions or discussion. Laura, Michele and I remain very committed to giving you evidenced-based recommendations on all of this.

Let us know how we can meet your needs and serve you at this time. Please wear a facial covering. Our mutual success depends on it. Ask others to do the same. Let’s keep moving forward to what we all desire.

Gratefully,

Dr Gee for the whole team at Main Family Medical

We realize the importance of staying connected and intend to provide weekly updates in this format for some education, encouragement and challenge. Each week is different as our lives shift and change with the complexities we experience personally and jointly in these days. Our desire is to give you the facts as known at the time of these letters and assist in filtering the poignant developments for your consideration and application. As your healthcare team, you can count on receiving authentic communication from us and our remaining a positive force in this journey together.

COVID-19 Updates From Dr. Gee

March 24, 2020

We want to encourage each one of you to respect the implications Covid-19 has on your friends, neighbors and loved ones. Compliance with the “6-foot rule” for social distancing will grant better outcomes for all of us. You may have heard that meeting in groups of 10 or smaller is OK at this time; we would discourage this with the current knowledge of the virus. Asymptomatic viral shedding is one nefarious feature of this virus enabling greater spread; any of us in apparent good health can behave with illegitimate confidence because of this viral characteristic. Our opportunity to help the community is contingent on each of us adopting this behavior to flatten the curve of new infections.  It’s not theoretical, it’s not political, it’s real. Thank you for honoring others in this way.

Good news is progressing with the diagnosis and management of the virus:

• March 21st the FDA announced approval of rapid testing tools for same day results. This will help with containment and more aggressive management of the at-risk population for recovery and for healthcare workers to return to work more readily. This will not be available to lower risk individuals on initial rollout due to demand limits.

• There are several, not-yet-approved by the FDA, medication regimens that are under rapid clinical trials for the treatment of Covid-19. These are in our pharmacies BUT are now being dispensed with positive Covid results only as controlled by the State Board of Pharmacy (which is for the benefit of all to prevent the analogous toilet paper run). These will be reserved for the seriously ill with the protocol for the average healthy patient to not receive this regimen.

• Serum from Covid-19 recovered patients is being collected and shown to be promising in a Johns Hopkins’ report. This is really just reviving a very old technique from years ago which we used for decades with the old gamma globulin shots for hepatitis A (Johns Hopkins’ Serum News Article) This is another very realistic tool that will roll out and be added to our options for the very sick.

*Vaccine trials have already begun in Washington state. This will ramp up in the months ahead.

This is all good news in the right direction. Parents, again, take confidence in the data not bearing increased risk in the pediatric population with our knowledge today, but take CAUTION in that your children are significant transmitters of this virus potentially with lower level symptoms while having active viral shedding. They don’t need testing. They need isolation from others until well (exact timing and studies are not clear on this yet). Again, our job altogether is social distancing.

Prevention with healthy diet, good sleep and exercise remain relevant. Turning off the flow of information through electronics and having a good conversation with someone is a very good thing for each of us. Clean a closet, finish a project. A sense of control in some of these more menial things can be therapeutic.

Our office will remain open to care for your many needs. Our team at Main Family Medical has protocols in place to remain compliant with the above recommendations to protect you while visiting our office. The waiting room is not being used and each patient will check in via the phone from our parking lot. Our nursing staff brings each patient in individually and directly to the exam room. Additionally, face to face telemedicine visits with Laura and Michele are being scheduled this week for established patient visits performed from your office or home. Our office will have normal hours to care for those who need to be seen in person. More than ever, we are here to support you and address your health needs in the midst of daily changes and developments. Know that your concerns and calls will be addressed and cared for as we work through logistics with office and remote staffing. We appreciate your patience and want to assure you of our understanding of the personal impact these events have on each of you. Thank you again for entrusting your health needs to our team.

Sincerely and gratefully,

David Gee, MD
Laura Bainbridge, FNP
Michele Miles, PA-C
The full team at Main Family Medical

We realize the importance of staying connected and intend to provide weekly updates in this format for some education, encouragement and challenge. Each week is different as our lives shift and change with the complexities we experience personally and jointly in these days. Our desire is to give you the facts as known at the time of these letters and assist in filtering the poignant developments for your consideration and application. As your healthcare team, you can count on receiving authentic communication from us and our remaining a positive force in this journey together.

COVID-19 Updates From Dr. Gee

03/19/2020

It is important that we maintain communication and connection in these unprecedented times. Each of you undoubtedly is feeling stress and tension for various reasons of altered plans, schedules, expectations, financial loss, inconvenience, loved ones’ health risk, and the list could go on.

I am writing you today to give some encouragement and challenge. It’s important that we remain vigilant with the health recommendations that have been given so far. The separation that has been encouraged and implemented in our community will likely have a significant impact on the overall rate of spread and ultimately allow for allocation of resources to more effectively address the health needs of our community. No one can prognosticate fully on these matters and I am not attempting to do so at this time; I’m only attempting to give a tempered distillation of what is known today. We are fortunate to have the observed lessons from other nations and communities who have been ahead of us in this infection cycle and for that we can be grateful.

In spite of no active cure, several developments are worth noting and may help with some of your individual uncertainty or anxiety:

*combination anti-viral HIV medication and chloroquine, an antimalarial medication, have had some significant beneficial results in a few patients at the University of Queensland in Australia. These are readily available and currently manufactured. However, it could be some time before numerous validated studies can be performed.

*determining more accurate colonization of individuals who have minimal symptoms or are carriers of the virus is being looked at with widespread community testing in Seattle through the Gates Foundation and the University of Washington. They are implementing large population testing with mail in swab samples from home. They then can more quickly isolate carriers and early infected individuals to help with containment. Additionally, this will reflect more accurate data on the rates of severity within our communities by knowing the true “denominator” of infected individuals for more precise rates of morbidity and mortality.

*current testing in the U.S. is based on detecting virus in a patient’s nose or mouth in those who meet stricter testing criterion; many companies are working on point of care blood tests that detect IgM and IgG antibodies to the Covid-19 virus which will help identify in lower level patients if the “cold symptoms they had last week” was Covid-19 or not. This individual knowledge will give personal clarity. These are not readily available but are pending stream-lined FDA approval.

• vaccine for Covid-19 will be the multi-billion dollar holy grail. It will happen but likely on the backside of this unfolding story due to inherent logistics and production. Just as the 2009 Swine flu epidemic (H1N1) has led to the continued inclusion of this flu strain in the most recent flu vaccinations given in 2019-2020, a new vaccine will likely be used widely in vulnerable populations in the future. This will take many months or longer for widespread use.

The points above are given for thoughtful contemplation of where we are as a community and where things will change. The current focus of intervention is to slow the initial inertia of this infection. Higher and more effective level of care may then be given to the 15-18% of the population that do get severe Covid-19 hopefully for better outcomes.

The challenge I give to each of you, along with myself, is in the contemplative response to this challenge and opportunity. Not many times in life is there a “reset” button on what you value and with which you occupy yourself. No gatherings, no sports, no class, maybe even no work. In the midst of this anxiety-provoking condition, we need to give each other the support and “presence” that each of us need in various ways. Make the most of it. How many of us remember the perspective or feeling we had on September 11th, 2001 or Hurricane Katrina in 2005? This time it is in our own streets, neighborhoods, schools and community.  Act and invest in the community you wish to have. A word of encouragement, an errand run, protecting and still connecting with the at-risk population, dispelling anxiety for a friend or neighbor, patience in the midst of inconvenience are all remedies we need. This season will reveal and stress everyone’s character and we should strive to bring out the best in each other.

We have seen the stressful effects of these events on some of you this week at Main Family Medical. We have had no known exposures through our facility at this time. Each of my staff recognize the important role we play presently. Our attention and focus has been to educate, direct, and coordinate those who have concerns about coronavirus while maintaining and meeting all the essential routine care needs that you and your family experience. We have been as strategic as we can to remain present on site delivering the safest care possible. We have protocols in place for limiting and preventing exposure to our patients and team. We are not offering Covid-19 testing at this time due to numerous factors but are directing and coordinating the care of those who need to be tested. We are seeing only healthy patients with routine medication and well evaluations in the morning and those who have any illness symptoms (the vast majority of those ill right now have nothing to do with coronavirus) in the afternoon.  We are getting telemedicine set up this week so we can offer an additional route of care for you as well. This will be for the types of conditions that do not require physical examination.

We hope to be a steady and calming resource in this uncertain time. This is our current mission. It is an honor to be your health care team.

With gratitude and honor,

Dr. Gee, on behalf of our Main Family Medical team

We realize the importance of staying connected and intend to provide weekly updates in this format for some education, encouragement and challenge. Each week is different as our lives shift and change with the complexities we experience personally and jointly in these days. Our desire is to give you the facts as known at the time of these letters and assist in filtering the poignant developments for your consideration and application. As your healthcare team, you can count on receiving authentic communication from us and our remaining a positive force in this journey together.

COVID-19 Updates From Dr. Gee

03/11/2020

Information on COVID -19 (Coronavirus) is rapidly increasing and daily evolving. Your healthcare team at Main Family Medical is continually seeking up-to-date and accurate information from the Center for Disease Control (CDC) and local Health Departments. We strive to provide quality care to every patient while ensuring that we protect all patients and staff as well.
Our information to you is based on what we know as of March 11, 2020. It is currently known that this virus causes upper and lower respiratory illness and ranges in appearance from a simple cold to significant respiratory failure. It is primarily spread through respiratory secretions. The CDC indicated that over 80% of the 40,000+ positively tested patients out of China have mild cold symptoms while the mortality concerns are highest in elderly patients and those with pre-existing conditions. These statistics do not indicate the baseline rate of all positive Coronavirus patients in the general populations as many may not have enough symptoms to have been tested or evaluated. To date, no cases have been documented in Idaho, but this will certainly change given the cases in surrounding states.
Prevention measures for the Covid-19 virus are the same good hygiene practices needed for cold and flu prevention throughout the year. These include the following:

• Wash your hands with soap and water thoroughly for 20 seconds. Use at least 60% alcohol hand sanitizers if not washing your hands.
• Avoid touching your eyes, nose and mouth with unclean hands.
• Cover coughs and sneezes with the crook of your elbow or a tissue and then immediately throw the tissue in the trash and wash your hands.
• Minimize exposure to others if you are ill. Stay home from work or school. Take particular consideration for those with chronic illness and elderly in your spheres of interaction.
• Disinfect surfaces that are frequently touched such as phones, keyboards, doorknobs, etc.
• If you show signs of respiratory illness and must go out, wear a mask. CDC does not recommend that those who are well wear masks.
• Eat, exercise and sleep with good health in mind.

If you or your family member are experiencing any signs of respiratory illness (cough, shortness of breath, fever) and feel you need to be seen by a provider, we will have you speak over the phone with one of our Triage staff. They will ask about recent travel, cruises, and possible exposures to COVID-19. They will also speak with you about what symptoms you are experiencing. WE DO NOT HAVE THE ABILITY TO TEST FOR COVID-19 AT MAIN FAMILY MEDICAL. If there is a possible exposure, we will coordinate appropriate care with your local Health Department.
If you are scheduled at Main Family Medical for respiratory illness, shortness of breath, fever or cough we will ask that you remain in your car and call when you arrive. A staff member will then call your cell phone when we have an exam room available and escort you in through the rear entrance if able. This is to limit exposure to other patients and staff and decrease the potential spread of any viruses.

Please refer to the following websites and phone numbers for more information:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://www.who.int/health-topics/coronavirus
https://coronavirus.idaho.gov/
Central District Health (Ada, Boise, Elmore and Valley Counties): Operates weekdays from 8:30 a.m. to 4:30 p.m.; call the hotline at 208-321-2222.
Southwest District Health (Adams, Canyon, Gem, Owyhee and Payette Counties): Operates weekdays from 8 a.m. to 8 p.m.; call the hotline at 208-455-5411.
South Central Public Health (Blaine, Camas, Gooding Jerome, Lincoln, Minidoka and Twin Falls Counties): Operates weekdays from 8 a.m. to 5 p.m.; call the hotline at 208-737-1138.
North Central Health District (Idaho County): Operates weekdays from 8 a.m. to 5 p.m.; call the hotline at 208-748-0400.