The Hurricane

Here in Florida, we can handle a hurricane. When Hurricane Michael was looming in 2018, I prepped well in advance. I rushed out the grocery store, bought supplies for the next two weeks, not knowing if the power would be out. We stocked up on water, food, non-perishables. My friend bought a generator. The whole family helped out by bringing in the lawn furniture. After the grocery store, I stopped at the Home Depot to pick up any supplies for openings that weren’t covered. I picked up some sandbags for areas for flooding. We dropped the thermostat down to 70. We closed the shutters. And then, we waited.

Our eyes were glued to the forecaster on the weather channel and waited. On the news and on the social media feeds, I remember seeing gas lines for miles and all the crazy ways some people made due with what they had to board up their houses. Some used tables and even bed cushions to border up their windows. And Michael didn’t even make landfall here. That’s how Floridians roll.

Of course, this isn’t the first hurricane Florida has seen and, truth be told, it certainly won’t be the last. This pandemic, however, is a different beast and Florida has no idea what it’s doing thus far.

Right now, as we watch the news, in very much the same way were watching the forecasters of Michael, we are beginning to feel a panic that I don’t ever recall having during a hurricane. Covid-19 isn’t something we are familiar with and very little guidance has been given by the government.

The CDC guidelines seem to be changing as this crisis evolves. With this coronavirus, the initial recommendation was to wash your hands and stop touching your face. As it became more serious, the recommendation included social distancing. After this guideline was implemented, schools began to shut down. As the numbers of the infected increased, suddenly, nonessential workers were asked to stop working. As the death toll continues to mount, now, the government has issued a stay at home order. And this stay at home order is truly not an order, but more of a recommendation. It still seems like our government still doesn’t understand that asymptomatic carriers of the infection exist and they are likely the super spreaders of this infection. No cough is necessary. No fever. No sneeze or shortness of breath. Just some regular guy that woke up feeling funny, brushed his teeth, got in his regular guy clothes, possibly the same shirt he wore yesterday, and went about his business.

These maneuvers by the government seem to be reactive, rather than proactive. From a medical standpoint, we want to be as prepared for this disaster as best as possible. Since the government hasn’t been as strong as it should be, doctors are stepping to the podium and ringing all the alarms about the seriousness of this. The landscape of medicine is trying to adapt to the crisis.

Now, my clinic is now offering telehealth services. We are trying to reduce the amount of traffic in the clinics by offering this.

Telehealth services allow for all people, not just assigned patients but all people, access to our medical services. Now a doctor is only a phone call/facetime/skype visit away. People simply need to call our office and we try to arrange everything else. I send medications directly to pharmacies. Pharmacies with direct to door services can mail them to the patient. We practice safe social distancing and avoid putting any additional people at risk for the virus. Of course there are still instances where a face to face encounter in necessary, as is the case with blood draws, but we also try to arrange this in the most safe and convenient way for people. Now, more than ever, it’s crucial for patients to maintain a relationship with their doctor in case of a medical emergency.

We are also practicing protocols at hospitals and clinics to try to head off any unneeded exposure. Fever checks are being performed at the door. Patients that need to enter the building, regardless of symptoms, are required to wear a face mask, whether its homemade or provided. The building is also being cleaned off constantly with cleaning solutions every morning, afternoon, and evening, particularly the common areas as well as the door knobs. A tent is now available outside to help triage and test suspected sick patients. This way, we minimize the risk of contamination to the rest of the building, which limits the risk for our patients.

With the expected surge in patients in the hospital setting, we are encouraging patients to use their primary care doctors, whether its for sick visits or other nonemergent concerns. A primary care doctor can direct a patient in the right direction as to minimize any undue burden to the system.

What else can people do to reduce their risks during these trying times? In addition to the CDC guidance on social distancing and hand hygiene, I would also strongly recommend that patients have at least ninety days worth of medication as supply production may be problematic for demand in the future. Shortages in albuterol and other asthma or COPD medications may be problematic in particular, as some of these medications are used to also treat sick patients. Therapies are also being developed for covid-19 patients that may place a strain on existing medications, as is the possible case with hydroxychloroquine. If a patient takes these medications chronically, now is the time to resupply to avoid a possible shortage in the future.

I would also recommend taking zinc as a possible prophylactic measure as this is the only supplement with any proven benefit to reduce the timeline for other viral infections related to the coronavirus.

Masks are now a topic that the CDC is changing positions on. While the CDC is still recommending that the N95 respirator masks are reserved for healthcare workers due to shortages, they are now contemplating the recommendation of using a regular surgical mask or self made mask to limit the spread. As I’ve mentioned in past blogs, surgical masks really do not convey too much additional protection to the wearer other than barrier protection from sneezes, coughs, and blood. The reasoning behind the surgical mask recommendation is to essentially limit the spread of the breath of the wearer, thereby conveying protection not to the wearer of the mask, but to the people present in his or her company. If everyone were to wear a mask, it would limit the aerosolization of everyone’s breath, thereby conveying some level of communal protection. I offer this as a recommendation with some limited reluctance, because it will cause more people to touch their faces and it will become a potential vector of infection with repeated use without washing or cleansing. But it still may help.

Currently, the government guidelines are fairly basic. They read more like suggestions rather than mandates. Please stay at home if possible. Please wash your hands and stay away from others, if possible. The problem is that even if the government puts out the recommendations, what are the actual repercussions if someone doesn’t follow them? Will I be fined? Will I be arrested? I’ve seen footage from other countries like Colombia and the Philippines, where there are serious risks to breaking quarantine and curfew, like physical beatings and public humiliation. Here, we just look at those breaking quarantine and shrug our shoulders. But this is America, and we’re Americans. We have different rights that no one can take away. But please remember, that hurricane is coming.

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