Hello All,

This has been a trying time for all of us, especially knowing the impact that this ongoing pandemic will have on our holidays. As many of you know, Governor Kate Brown has recently placed a 2 week ‘freeze’ on social activities that will be in place throughout the Thanksgiving weekend, asking everyone to work diligently to reduce their potential exposures.   This is happening because we are seeing a significant increase in the number of active cases, hospitalizations and deaths from the COVID-19 virus. I believe we are all feeling the strain of isolation, but the idea of losing a loved one to this seems much more daunting than searching for other in-house and nature driven activities.

At our clinic we recently experienced our first ‘exposure.’  We had a patient come in for a visit who was completely without symptoms (asymptomatic) but later that day tested positive for COVID-19.  Thankfully, the procedures that we have in place limited the exposure within our clinic to her primary care provider.  Throughout this experience, we were in contact with the county health department, the Oregon Health Authority, and reviewing current CDC guidelines. While we have constantly been researching the most current guidelines, there is a difference between reading and experience. Below I have put together an update on how things are currently defined, how our clinic will handle exposures, how our clinic will continue to work to prevent exposures, and what each of us can be doing to help ourselves remain healthy. 

Current Definitions:

What are currently counted as “symptoms?”

Fatigue, headache, and muscle aches (myalgia) are among the most commonly reported symptoms in people who are not hospitalized, and sore throat and nasal congestion or runny nose (rhinorrhea) also may be prominent symptoms. Below is a full list of symptoms that are currently believed to be caused by COVID-19.

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

What is Exposure?  Currently the CDC is stating that a person is contagious and spreading the virus for the 48-hours prior to when symptoms first start presenting. We start looking for a combined time of 15-minutes within 6 feet of the person in any 24-hour period from 48-hours prior to his/her/their symptoms starting through when the person begins isolation/quarantine. This is regardless of whether or not the individuals were wearing a mask**.

So if Sally tested positive for COVID on Thursday and her symptoms developed on Wednesday, anyone who spent a total of 15-minutes with Sally on Monday or 15-minutes with her on Tuesday  (within 6 feet) would need to quarantine.

What is Quarantine? This is a 14-day period where a person who has been exposed to someone with COVID-19 stays at home, monitors symptoms and avoids any contact with others.  Quarantine occurs whether or not that person has any symptoms.  Isolation may be warranted if symptoms develop.  During isolation, the person further restricts their contact with others,  staying away from even those within his/her/their household.

How will we as your healthcare team respond to exposure:

1.) Any employees who were exposed to a patient with confirmed COVID-19 will immediately leave the clinic and go into quarantine for 14 days past the date of exposure.

2.) If it is a physician who has been exposed, the doc will continue to see patients via Telehealth as long as they are able.  All scheduled patients will be notified to transition appointments to Telehealth or to reschedule for after the quarantine period as soon as is possible. 

If the visit needs to be in person, such as a procedure, a wellness exam, or a blood draw/injection, the patient will be offered an appointment with another provider at our clinic.

If an employee is confirmed to have COVID-19, he/she/they will remain out of the office for a minimum of 10 days and until at least 24-hours have passed since last fever without the use of fever-reducing medications and other symptoms have shown sustained improvement. 

3.) We will determine if any other patients had potential exposures but generally this should not be an issue since we keep all of our patients physically distanced by at least 6 feet throughout their time in the clinic.  The only exposures that could potentially affect patients would be through a provider, and if this occurs, we will contact any affected patients within 24 hours of finding a positive case within our team.

Our Current Procedures:

1.) All patients and visitors entering the clinic are required to:

• Wear a medical grade mask (these will be provided)
• Take temperature to confirm no fever
• Confirm no current symptoms or exposure to others with symptoms, regardless of whether or not they tested positive/negative  for COVID-19.  If there is any risk of exposure, a provider will confirm whether or not the patient can be seen in person or must be seen via telehealth or rescheduled.
• Use the hand sanitizer provided by the clinic prior to entering the welcome area.

If you have any concern for possible exposure (including sick family members) or have developed symptoms, PLEASE (pretty please with a cherry on top)- do not come into the clinic.  This includes any symptoms within the 10 days prior to your appointment or any COVID exposure within 14 days prior to your appointment.  You will now see reminders of this in your appointment reminders and confirmation emails/texts.

We are happy to transition your care to Telehealth or reschedule your visit.  There is no fee for canceling/re-scheduling/changing appointments for this reason.  

WE DO TREAT COVID-19 PATIENTS– we just do so using Telehealth options and isolated lab collection in our parking lot to avoid any contamination within our clinic or exposure of other patients.

2.) We are currently adjusting our schedule to reduce the amount of hours each provider spends in the clinic to help reduce potential exposure to patients and to other employees. These hours will be transitioned to telehealth visits to maintain availability for our patients.

3.) Physical Distancing:

            – Even within treatment rooms, the spaces where patients/providers sit will be clearly marked    to ensure 6 food distance is kept in place.  For the majority of visit, close contact with any staff will be <10 minute at a time.

            -During appointments where close contact may occur, such as with body work or injection therapies, providers will be wearing N95 masks, which serve to reduce potential exposure by blocking the viral particles from going into the providers respiratory tract as well as blocking potential germs from spreading to patients.

4.) Sanitizing:

We will continue to use medical grade sanitizer on all spaces in the treatment rooms between each patient visit and clean our welcome area and check-in/check-out stations regularly throughout the day and between patients. Our providers wash their hands regularly with hot water and soap and use 70% alcohol-based hand sanitizers frequently throughout the visit.

We will soon have our new Electrostatic Foggers which will provider even more thorough sanitation to our spaces using the most advanced technologies.

What can you do to protect yourself?

1.) Continue to engage in physical distancing, limiting your close exposures to your immediate household/family members and limiting your exposures to non-household members to a core group of folk that are all in agreement that they will continue to participate in risk reduction (physical distancing, masks, hand washing).  If you are going to have a “pod” of folk outside your house, all have to agree they will not have close contact with others outside of this “Pod” without letting others know or it defeats the purpose of the pod.  In other words, keep those you are in close physical proximity with to a select, pre-determined few you trust.

2.) Continue to wear masks when in public.  Remember- masks are only mildly helpful in preventing you from getting exposed to a virus, but masks are incredibly helpful in preventing you from accidentally spreading the virus to others (such as during that 48-hour window before you have symptoms).  Medical masks remain the most effective at preventing the spread, but many cotton masks work great.  Here is a cool video showing comparisons of protection: https://www.cnn.com/videos/health/2020/06/30/different-types-of-masks-effectiveness-covid-19-gupta-lead-vpx.cnn

3.) Wash Your Hands & Use Sanitizer:

• Use hot water and soap regularly, especially before eating and right when you get home if you have gone in public. 
• While out of the house, use a hand sanitizer that is at least 70% alcohol regularly and consider wiping down any touched surfaces (ie cart handles) with the provided sanitizing wipes or your hand sanitizer.  You want to let this completely dry for it to be effective.  These can be drying to the hands so consider using a lotion on your hands at night.
• Clean commonly touched surfaces regularly, such as door handles, light switches, countertops, faucet handles, etc.

4.) Get a Flu Vaccine: Even if you have been hesitant to get a flu vaccine in the past, this year it is important that as many as possible do so.  By getting vaccinated, we reduce the risk of getting influenza.  This doesn’t protect against COVID-19 BUT it does keep thousands out of the emergency rooms and hospitals, leaving more availability for those who do have COVID-19. If you have questions or concerns about the flu vaccine, please reach out to your provider or schedule an appointment.  Folks over 7 years old can easily get a flu vaccine at your local pharmacy.

5.) Focus on Healthy Living:

• Continue to get regular exercise, ideally 30 minutes outside in the fresh air daily.  If you are able to continually keep a 6-foot physical distance from others and you are ok to go without wearing a mask.
• Eat plenty of fresh fruits and vegetables as these contain vitamins and minerals that support your body in staying healthy.  Specifically focus on vitamin C rich foods: broccoli, cantaloupe, cauliflower, kale, kiwi, orange juice, papaya, red, green or yellow pepper, sweet potato, strawberries, and tomatoes. If fruit and veggies aren’t currently a part of your regular diet, make it a goal to increase fruit and vegetable intake by 1-2 cups per day.
• Consider Vitamin D supplementation to support optimal levels of Vitamin D.  Consult with your physician to determine the right dose for your body and health needs.
• Stay Hydrated! Shoot for half your body weight in ounces of water (ie if you weigh 100 lb, the goal would be 50 oz/day).
  • Increase your current intake by one glass/day every 3-4 days.  For instance, if you have been drinking 2 glasses of water per day, today drink 3 glasses.  Drink 3 glasses/day for the next few days, then boost your intake to 4 glasses a day.  Keep increasing your intake until you reach your goal.  
  • Using electrolytes can help you boost your body’s hydration more effectively and usually they add a nice taste to your water.  Great options are Emergen-C packets, Nuun Tablets, Coconut Water, and Vitamin Water Zero.  Avoid Gatorade/Powerade drinks as these have a lot of sugar that isn’t needed. 
  • You can count all non-caffeinated, non-juice beverages like herbal teas  in your tally of water intake.

6.) Don’t Forget your Mental & Emotional Wellbeing

• Stay connected with others! Just because you cannot be physically close to others doesn’t mean you have to feel isolated.  Use your technology to stay connected.  Set up virtual lunch or coffee dates.  Reach out to your friends and family with a phone call or text message.
• Focus on the controllable aspects of your day- see this great post from Dr. McLendon- https://nwim.org/adapting-to-new-routines-amidst-constant-change/
• If you are struggling with low mood or anxiety, reach out to a friend or schedule an appointment with a physician.  We have 4 physicians at our clinic who have a particular focus on mental health support and we can typically get you in within 1 week.

Wherever you plan to be this rainy season, may you go in safety and health & happiness.  We are here to support you!

~Dr. Maeghan Culver Cook

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

https://www.covid19treatmentguidelines.nih.gov/