Updated on: March 24, 2020

COVID-19: Social Distancing is Critical, Now

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Original story posted on: March 23, 2020

These are scary times for those working in healthcare.

EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesday. The following is an edited transcript of her reporting

These are very challenging and scary times for us, especially among those of us who work in healthcare. I was skeptical of the practice of social distancing at first, thinking it was just going to prolong the inevitable, but I was mistaken. I recommend that everyone take a look at a piece the Washington Post allows us to access for free – https://www.washingtonpost.com/graphics/2020/world/corona-simulator/. It very explicitly lays out the case for social distancing.

Everyone should be practicing social distancing to the best of their ability. Social distancing means limiting your physical contact with other individuals, with the intent to slow down the transmission of the virus throughout the population. This goal is to prevent the healthcare system from getting overwhelmed, enabling everyone who needs medical care to receive it.

The particular coronavirus (SARS-CoV-2) that causes COVID-19 is quite contagious, and since it was novel (new), no one had immunity to it. Until very recently, we didn’t have the ability to test patients. We still do not have the capacity to test people who are not considered to be of high risk. Patients who had mild or no symptoms, or who have no known exposure, may still have had COVID-19, but will never be counted in the denominator. The expectation is that there will be significant morbidity and mortality, although the precise rates are unclear, and may never be elucidated.

Social distancing is keeping six feet between you and other potential carriers or victims (in case you have it). You don’t have parties unless they are virtual. You don’t go to the store on a whim. Spring break had become a break from normalcy before, but in the new normal, post-COVID-19, it’s not an excuse to congregate on the beach. You can go outside and take a run or walk for exercise, but don’t cluster together with other people.

People need to take this seriously. I myself cancelled a nail salon appointment, asked my cleaning service to not come, and, one by one, my spring speaking engagements are being cancelled. My son’s college semester has gone remote. My father’s assisted living is on lockdown, and they are all eating in their rooms to avoid congregating. I am not going to discuss my great concerns over the societal and financial implications of social distancing.

I basically venture out only to grocery shop. I used to shop for tonight’s dinner today. I stocked up my freezer and fridge so that I don’t have to do that anymore. Now, I keep a running list and go out only when it is necessary. When I go out to buy essentials, I do so as expeditiously and hygienically as possible, often bringing my own wipes.

I am not only doing this to try to prevent myself from becoming infected, but, since my husband is a radiologist and may bring home the coronavirus, I am trying to prevent exposing other people to me. Since many infections are mild or subclinical, we may be unwitting vectors.

Many of you may normally work remotely, and some of you may be doing so temporarily, in response to the pandemic. This week I am going to give you some medical pointers.

If you get sick, don’t panic. Just having aches and pains and fever is not a reason to go to the emergency department to get tested. We don’t want to inundate the ED, and you don’t want to needlessly expose yourself in the waiting room. Seek medical help if you are having trouble breathing. Other non-COVID reasons to present to an ED include chest or abdominal pain, bleeding that can’t be stopped or is coming from an orifice where blood shouldn’t be coming from, severe confusion or inability to rouse, and difficulty speaking or moving arms or legs.

If you have underlying medical conditions or are older than 60 and have respiratory symptoms, contact your healthcare provider for advice. Many are offering virtual visits. If you think you have COVID-19, call your doctor’s office first to allow them to advise you what to do. They might not want you to come in, to avoid exposing their personnel or other patients.

Cover your mouth and nose when you sneeze or cough, even if you are alone. Your family may be exposed to your germs hours later. Lather your hands for 20 seconds with soap and dry them, or use hand sanitizer with at least 60 percent alcohol, after doing so. My environmentally conscious nephew informed me that flicking your hands and fingers 12 times into the sink can result in only needing to utilize a single paper towel.

If you are out, clean off the grocery cart with a wipe, and avoid touching your face until you have washed your hands thoroughly. Clean any keyboards or electronic equipment you share (and don’t share keyboards or mouse if you can avoid it!). Routinely clean all high-touch surfaces, such as counters, drawer pulls, doorknobs, handrails, grab bars, and phones.

Don’t let other people handle your cell phones (#SelfieTime, and use your speaker phone), and don’t set them down on any surface when you are out. Apple now says you can use disinfectant wipes or spray a microfiber cloth and wipe off a powered-down, unplugged phone.

Masks are not part of the solution. Most people don’t have access to the right kind of mask and don’t wear them properly. I can’t tell you how many people I saw in the airport on my return from Hawaii only covering their mouth and leaving their nose exposed. I think masks give a false sense of security, so limit their availability for healthcare personnel who really do need them.

Next week, I am going to have some advice on how to maintain our general health and sanity while cooped up at home for two months. Until then, socially distance and wash your hands. Stay well.

Programming Note: Listen to Dr. Erica Remer every Tuesday on Talk Ten Tuesdays, 10-10:30 a.m. EST.

Erica E. Remer, MD, FACEP, CCDS

Erica Remer, MD, FACEP, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. She was a physician advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, and denials management topics. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is a member of the ICD10monitor editorial board, the ACDIS Advisory Board, and the board of directors of the American College of Physician Advisors.

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