Here in central Vermont we enjoy relative isolation.
Most of us appreciate the lack of traffic, quiet, and the neighborly feel of our communities.
It’s why we live here.
Despite that, every now and then a new concern arrives on our doorstep.
Anyone following any sort of media has likely already guessed that I am referring to coronavirus.
Given the amount of stress this is generating among friends and neighbors, I wanted to take this opportunity to reach out and hopefully offer some reassurance and guidance.
First and foremost, what is coronavirus?
Coronavirus is the name for a family of viruses known to infect birds and mammals, including humans.
These viruses are well known and common. Some members of this family even contribute to the common cold.
Every now and then, animal coronaviruses will mutate and jump to humans. Sometimes this is quite severe, sometimes quite benign.
COVID-19 is the name of the illness caused by this particular coronavirus when it makes a person sick.
The next obvious question is, do I need to worry about coronavirus? The answer to that question is a bit more complicated.
There is a lot that is unknown about this particular virus. It appears to be new to humans and, as such, new information is coming out almost daily.
What we know thus far is that a large percentage of individuals who become infected with this coronavirus really don’t get sick, or at most develop a mild runny nose and cough.
This is a really important aspect of the behavior of the virus, as it makes the spread of COVID-19 almost impossible to control.
Anyone who is feeling absolutely fine is going to go about their day in their normal fashion while unknowingly spreading the virus, and people have been doing just that.
Meanwhile, infection control agencies around the globe struggle with who to quarantine, as there are many people with coronavirus that they can’t identify.
There was no system in place for general screening prior to this outbreak, as it was unknown in humans.
What does that mean in the long term?
Well, among other things, it’s highly likely we will all get coronavirus sooner or later.
Going back to the reality that most of us won’t feel sick or will shrug it off as a common cold, for the bulk of us that’s not too big of a problem.
Why did I suggest this is complicated?
As I’m sure most of you are aware, there are some people who are becoming quite sick and even dying of COVID-19.
Epidemiological data has made it clear that the older and sicker you are, the higher the risk.
That’s true with most diseases, and it’s true with coronavirus.
The fatality rate in China at this point is reported to be 0.2 percent in people ages 10-39, but 14.8 percent in people age 80 or older.
It’s worth noting that children appear to be less likely to contract the illness in the first place.
Thus, we’re honestly not worried about schoolchildren, but we’re very concerned for our nursing-home residents.
How are we, as a community, going to handle this? Answering this question, it’s important to keep in mind the context that we have been through this before, and we will go through it again.
To greater and lesser degrees, our health care system experiences this situation with influenza annually.
As we do every year, we worry a lot when our senior citizens come down with the flu.
We will focus our efforts on the elderly with coronavirus in a similar fashion. How is this situation different and more challenging? A big part of our problem is going to be the potential for public panic.
The unknown scares people, and that’s to be expected. At the same time, I expect that most of us understand that panic rarely helps a situation.
We want to avoid situations where our Emergency Department and clinics are swamped with the worried well, making it harder to identify those who require emergent intervention.
So what can you do?
• Expect to get sick at some point. Almost all of us are going to get this eventually, and if you don’t get coronavirus, you will get a cold that feels exactly the same.
• Practice good hand hygiene, as this is more likely to protect you than any other measure. Use sanitizer if you have it, but handwashing is just as good if done well. Hum the song “Happy Birthday” in your head twice while washing with soap and warm water. You should not be done washing your hands until the song is over the second time.
• Regular medical masks that you might find at the drugstore do not stop coronavirus. Don’t waste your time or money looking for or stockpiling masks.
• Stay home if you can afford to and you are worried about coronavirus. Reducing your exposure reduces your risk of contracting the illness, at least in the short term.
• Be careful about your media consumption. Regular news media and social media posts tend to be full of errors and can mislead you and you may end up wasting your money or contributing to the problem.
• Understand that there is not a medication or vaccine that can currently prevent or treat coronavirus. Tamiflu does not work for coronavirus. The only prescriptions you might receive would be to alleviate symptoms, such as Tylenol for fever.
• Understand that you cannot go to your doctor to be tested for coronavirus. Currently, all testing is being managed by the Vermont Department of Health (VDH). VDH tells us who they want samples from, and decides when to test. (Please call your healthcare provider if you develop symptoms and have been in contact with a person confirmed to have COVID-19, or if you recently traveled from an area with community spread of COVID-19. Gifford will work with VDH to determine if you need to be tested for COVID-19.)
When do you need to go to the doctor / ER?
• If you are age 65 years or older and have a cough and temperature greater than 100.5 degrees F.
• If you are experiencing shortness of breath and/or chest pain.
• For other emergencies or severe symptoms that would have prompted you to seek care beforehand, such as a cut that might require stitches.
When should you stay home or not go to the doctor / ER?
• If you are worried about coronavirus and just want yourself or a family member to get tested. Remember, we aren’t able to do that at Gifford.
• If you are hoping for a medication such as Tamiflu to prevent or treat coronavirus. Remember, there aren’t medications that work for coronavirus.
• If you have a mild cough or runny nose, but otherwise feel OK.
What if you have additional questions? Feel free to give us a call at Gifford! Kate Walker is our infection control specialist and can be reached at 802-728-2329.
I’ll close by noting that this community has weathered challenges in the past with dignity and a measured approach, ranging from the anthrax scare after 9/11 to H1N1 in 2009. It makes me proud to live here and be your neighbor. I expect that we will handle this situation with aplomb as well.
-Joshua T. White, MD, MBA
Chief Medical Officer