ASHLAND Despite 24-hour media coverage of COVID-19, many continue to have questions. Some of them can’t be answered, because doctors haven’t seen anything like this virus. However, Ashland physician Kimberly Baldock offers her insights to help in understanding, preventing and treating the coronavirus.
Question: Are you still seeing patients in your office? How have you changed the check-in procedure to further protect patients?
Dr. Baldock: I am rarely seeing patients in my office and only for conditions that are not possible to adequately assess or treat via telemedicine. Our check-in process is designed to limit exposure and physical contact as much as possible. We instruct patients by phone prior to their appointments and also via signage on our entry door to remain in their cars and call when they arrive to our parking lot. We then direct them when to enter the lobby where they are immediately given a mask and escorted to an exam room. As much triage information gathering is done on the phone prior to entering the building. We also do not allow visitors to accompany the patient unless absolutely necessary.
Question: How involved are you in preparing the community for COVID-19? Do you have a lot of high-risk patients? Are you working with local authorities to prepare?
Dr. Baldock: As a primary care physician having practiced in Ashland for 24 years, I have quite a few high-risk patients. Many of my patients are now older than 65 and have comorbid conditions such as high blood pressure, diabetes, heart and lung disease. I work closely with our local hospitals and health department to implement practices adherent to CDC guidelines to protect my patients and also the community at large. It is also important that we as physicians work to disseminate up-to-date information to patients and their families.
This has been a fluid situation with guidelines changing almost daily as we learn more so it is vital that we as a medical community provide accurate information and dispel the many myths that are circulating.
Question: Why is this so contagious? Is it more about the rate of transmission or the severity of illness that comes with it?
Dr. Baldock: This virus isn't necessarily more contagious than previous cold viruses, including other coronavirus strains. What makes it so dangerous is the fact that it is novel, meaning human immune systems have never seen it before and, therefore, have no natural immunity to it.
Question: In this area, there are so many allergy sufferers. At what point does one say, “This is more than allergies and I need to be checked out?
Dr. Baldock: Our Ohio Valley is notorious for seasonal allergies and with milder winters come earlier and more robust pollen seasons. The emergence of COVID-19 in spring as well has caused concern that many patients won't be able to discern their allergy symptoms from infection. This is true for any allergy season where we look for cardinal signs or symptoms to differentiate allergies from colds or flu. With an infectious process you would likely feel suddenly ill, have a fever and body aches and feel short of breath. These are not symptoms generally seen with simple allergies, which tend to be more nasal congestion, runny nose and post nasal drip.
If you have symptoms such as fever, cough, sore throat, shortness of breath and are concerned you may have COVID-19, it is best to first contact your primary care provider. Many times with a simple phone call, we can determine if you need further testing and in what environment that testing should be done.
If that is not possible, then all of our local hospitals have drive-through clinics available for testing. KDMC's Access Center is available at (606) 408-8999 and OLBH has a flu clinic at (606) 833-6765. There is also a state hotline for COVID-19 at (800) 722-5725. These clinics allow for testing without having to leave your car and can check for common ailments such as flu, streptococcal infections or other respiratory viruses as well as COVID-19 testing if deemed appropriate.
Question: What happens if you have to self-quarantine and you live with people?
Dr. Baldock: If you have been tested for COVID-19 and are awaiting your results but have only mild symptoms, you will likely be told to return home to self-quarantine. This means not only remaining in your home but also to limit exposure as much as possible to others within your household. Ways to accomplish this include confining the ill person to their own room and preferably to their own bathroom. If a bathroom must be shared, then wiping down all surfaces, including door handles, with a disinfectant spray or wipe after each use is vital. This virus spreads through droplets. This means if an infected person coughs or sneezes, droplets settle on surfaces that another person can touch and transmit to their nose, mouth or eyes unknowingly. These droplets live on various surfaces for different lengths of time depending on the type of material. The droplets are generally fairly heavy and will not travel more than a few feet, which is why the 6-foot distancing rule is so important. Having the infected person wear a mask will also help prevent the spray of droplets into the environment.
Question: What self-care can you do to at least alleviate symptoms? How long can you expect to feel bad?
Dr. Baldock: Self-care if you are infected includes the basic recommendations we give for virtually any respiratory illness and includes rest (believe it or not, sleep has a biologic function in helping your body repair damaged cells), adequate hydration, especially if running a fever, eating healthily and taking acetaminophen (Tylenol) for fever/aches. Currently, there are reports that NSAIDs such as ibuprofen (Motrin, Advil) may worsen the clinical course for this particular virus and should be avoided.
There is no “typical” course as of yet known, as we are learning as we go. We are seeing the spectrum, from carriers who exhibit no symptoms at all to those with typical cold symptoms lasting seven to 10 days to the more serious complications of pneumonia and respiratory failure. Thankfully the latter is rare.
Question: I know it’s different if you have underlying health problems. What underlying health problems are we talking about?
Dr. Baldock: The high-risk population for complications of COVID-19 are (a) age 65 and older (b) chronic lung disease or moderate to severe asthma (c) immunocompromising conditions including those on chemotherapy, transplant patients, smokers, HIV/AIDs patients and those on chronic steroids or other immune weakening medications (d) diabetes (e) severe obesity defined as a BMI of 40 or greater (f) chronic kidney disease on dialysis and (g) chronic liver disease.
Question: If you’re sick enough to be hospitalized, how long might you be in the hospital and on a respirator?
Dr. Baldock: This question would be difficult to answer right now because there are so many variables, so I would defer this one until we get more information.
Question: Why, all of a sudden, did this virus show up? Had it been dormant on Earth and for some reason “went viral?” Can we expect more of that?
Dr. Baldock: The current theory as to the origin of this virus is, like the SARS and MERS strains of coronavirus before this one, COVID-19 likely originated in an animal host. The horseshoe bat has been proposed as the likely culprit. The virus then developed the ability to jump from animal to human host likely through an intermediate animal host. For SARS, that intermediary was determined to be a civet cat and for MERS a dromedary camel. This is still being researched at this time and will take more genetic footprint tracing and animal testing before we can be certain of its origins.
Question: Do we have any idea if coronavirus will be something that will pop up seasonally or be a danger through the summer?
Dr. Baldock: This virus will be circulating for some time among us and we may see a so-called "second wave" once we begin relaxing our social distancing measures. Unfortunately, only time will tell if this particular virus will exhibit a seasonal pattern of transmission. Being a novel virus, we cannot predict its behavior based on other coronavirus strains. Of course, the goal with current social distancing measures is to keep transmission rates as low as possible to buy us more time to develop better and faster methods of screening, treatments and ultimately a vaccine.
Question: What can people who have to go to work in the public do to protect themselves?
Dr. Baldock: If you are considered an essential employee and must work in public places, it is definitely important to follow the 6-foot social distancing guidelines, wash/sanitize hands frequently and do not touch your face unless you have just washed your hands. There are conflicting reports about the use of masks for the general public. Masks are most helpful if worn by those who have symptoms to prevent the spread of droplets from coughing or sneezing. Personally, I recommend anyone with high-risk condition wear a mask in public. For the general low-risk population, it is certainly your prerogative to wear one if for no other reason than it will prevent you from touching your face inadvertently. If you choose to wear gloves, remember they carry the same risk as unwashed hands if you touch contaminated surfaces or money and then touch your face. So changing gloves frequently or washing with soap and water would still be necessary. Alcohol-based sanitizers can break down the integrity of latex gloves. In other words, be cautious that the use of gloves doesn’t give you a false sense of security.
Question: What about taking supplements and drinking hot liquids?
Dr. Baldock: Zinc and Vitamin C have been utilized in many treatment protocols overseas and now in the United States. Vitamin C definitely plays a supportive role in our immune system function. Zinc has been shown to shorten the course of common colds and I have recommended starting zinc at the onset of cold symptoms for many years. Although neither will prevent you from contracting the virus itself, both theoretically can help boost your own immune system's response to it. There is no evidence that drinking hot liquids or gargling salt water will prevent contracting the virus or prevent it from traveling to your lungs.
Question: A physician online recommends disinfecting groceries. Is that necessary?
Dr. Baldock: While it is important to be mindful of washing hands after empyting grocery bags, disinfecting surfaces upon which the grocery bags have rested and discarding grocery bags after unloading them, there is no evidence of a need to disinfect every package. Certainly washing fresh produce prior to consumption is always important, but more so for prevention of ingesting harmful bacteria than viruses.
Question: Is there anything you would like to add?
Dr. Baldock: This situation is certainly scary because the vast majority of us have never experienced anything like this, but God has given us a remarkable immune system. Humans have survived numerous plagues and pandemics in the past without a fraction of the knowledge and medicines we have now. While there are many unknowns about this pandemic, there are a few things I do know. We will learn much about ourselves and our society. We will have more empathy for others. We will see incredible innovations, not just in medical science, but also in technology and engineering. We will be more prepared in the future for outbreaks such as this. And most importantly, we will get through this together.
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