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By Lori Rabe, RN MSN FNP-BC CPNP—
CHILDRESS – Coronavirus is a battle I hoped I would not have to fight.
In rural America, we heard of the 2003 SARS-CoV outbreak, but it was quickly contained in 2005. Then, in 2015, MERS occurred in the middle east. Again, not in rural west Texas. And who can forget EBOLA in 2014? Then, in December 2019, the WHO noted the first cases of what is now COVID-19 in Wuhan, China.
On Jan. 5, it was coined as a “public health emergency of international concern.” Feb. 11, the name “COVID-19” was officially adopted, then exactly one month later, March 11, COVID-19 was declared a pandemic.
At that point, I realized I would likely not be able to “watch this one” from afar in my rural Childress home. We had to be smarter than the virus.
As you know, being rural has its benefits. We are 110 miles from a large city. By nature of rural, we have more room to spread out, six feet is not a problem. However, our rural medical center did not sit and wait; we prepared. Medical staff meetings went from monthly to twice a week. Masks became mandatory inside our doors for everyone. We immediately planned to take care of “our” population when or if we could not send them to a higher level of care.
Equipment and supplies were being ordered and secured. Training on new guidelines, protection and treatment modalities were being attended by all staff. Administrators, physicians, nurse practitioners, physician assistants, nurses, respiratory therapists, radiology, housekeeping and all departments were changing their duties and tasks daily to prepare and care for our patients. Medical guidelines, evidence for treatment and recommendations for patient care were changing almost hourly. We prepared to be smarter than the virus; it was exhausting. That was March and April.
Then we had cases here and there in our area. We were still preparing. Today, as I write this, it is here. You can see it in the raw numbers. On July 7, CRMC reported positive results at 18, total since we started tracking in late March. In a matter of nine days, this number was sitting at 51, an increase of 294%. On July 10, our area active case count was 27, on July 17, this number had almost doubled to 52, that is one week.
Some of these folks are very sick, sadly some have died, but most all have had symptoms that range from mild and moderate to severe. Medical science tries to predict who will have severe disease and who will not. High risk people include the elderly and those with chronic health issues, but it is not 100% predictable as to who will get sick with a mild versus severe case. That is perplexing.
So, it is here, what now, you ask? Be smarter than the virus. First, it is not a hoax. It is as real as any illness, physical or mental, that is present. The virus is transmitted person to person through exhalation of respiratory droplets from the nose and mouth via talking, coughing, sneezing, singing, breathing and close contact.
People can contract the virus if they breathe in droplets from an infected person, with or without symptoms. The droplets can also land on surfaces and be transmitted by touching these surfaces then touching your eyes and mouth (frequent hand washing and sanitizing helps here). People with NO SYMPTOMS can spread the virus. For this reason, if someone in your home has the virus, you will stay home as well. The virus spreads from people that DO NOT know they are infected. Be smart, avoid close contact and wash your hands. (JohnsHopkins: www.jhsph.edu/covid-19/questions-and-answers/index.html)
Remember, “close contact” with a person who is positive for the illness is defined as “within six feet of that person for 15+ minutes”. Also, if you had direct physical contact including “hugging, touching or kissing” with a positive person, you shared eating utensils with a positive person or they cough/sneeze on you, you are a close contact and will need to stay home for 14 days following the last contact with the person. Walking by a positive person at the store, especially if both have masks in place or going into a room a few minutes after they were there does not currently qualify exposure. If you were in close contact (see CDC definition above) with a confirmed positive person, it is recommended that you stay home for 14 days, regardless of any test result. (CDC: www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html)
So, you had a close contact two days ago, and you tested negative today (on day three), do you still have to stay home? YES! This virus is tricky. You may be exposed on Monday, have a negative test on Tuesday, develop symptoms on Wednesday and then test positive on Friday, but all that time, you are spreading the virus. If you have close contact with a positive case, stay home for 14 days since the last contact with that person, regardless of your symptoms or tests. If you have any symptoms at all (fever, chills, cough, difficulty breathing, fatigue, muscle aches, headache, sore throat, loss of taste/smell, nasal congestion, runny nose, nausea, vomiting, diarrhea) STAY HOME. Do not go to work, do not go to the store and call your local healthcare provider, be smart and protect your fellow community members.
At this time, CRMC is testing those who have symptoms. They are not testing if you were exposed and have no symptoms. Unfortunately, there is a limit to the number of test supplies and equipment. If you feel you have been exposed, be smart, you need to isolate and QUARANTINE. If you develop symptoms, call Fox Clinic or your local provider for an appointment. As a part of the preparation and adaption to the current guidelines, CRMC has developed a drive through clinic to serve the region for anyone with any symptom or exposure to COVID-19.
Masks, when did that turn into a political word? On June 12, our fellow Texans, the Aggies of Texas A&M released a study that states, “not wearing a mask dramatically increases a person’s chances of being infected by the COVID19 virus.” The study authors go on to conclude that “wearing a face mask in public corresponds to the most effective means to prevent inter-human transmission; the inexpensive practice, in conjunction with social distancing and other procedures is the most likely opportunity to stop the COVID-19 pandemic”. (TAMU: https://today.tamu.edu/2020/06/12/texas-am-study-face-masks-critical-in-preventing-spr ead-of-covid-19/). The CDC recently released a study where 139 people wearing masks were exposed to hair stylists who were symptomatic, wearing masks and later tested positive for COVID-19. NONE of the hairstylists’ clients developed symptoms or tested positive for COVID, none. This is evidence for prevention of spread. An ounce of prevention is worth a pound of cure. Masks work! (https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e2.htm)
One more thing, protect those in our community who are most vulnerable. If you have a tickle in your throat, a sneeze, a little runny nose or a cough, and you are sure it is allergies, please do not go see grandma, grandpa or your elderly neighbor. Be smart, you could have a few mild symptoms of the same virus that has an exponentially increased chance of being life changing and/or deadly for those over 60.
In conclusion, welcome to a living science class. It is time for our community to be the top of the class. The basic hygiene practice of frequent hand washing is highly recommended along with social distancing and covering the nose and mouth with a face covering when in public. The changing nature of treatment guidelines is nothing new to medical providers, but now the influence of mainstream media and politics has added to the dynamic.
If you have questions or concerns regarding your health and treatment, the best source of information is your healthcare provider, not social media. Please be kind to your medical community and know they are staying on top of the medical data, not mainstream media, regarding trends and treatments for this disease as well as any other processes they treat. It is what they do, it is their passion and they know you and care for you, and they are prepared.