by Houston Criminal Defense Attorney

Save a Life.

I am not a doctor. I am lawyer and despite popular belief, i am a human being. Like you, i have family, friends, and colleagues i care about and want to protect. I am also a Houstonian, born and raised. I have recent accounts of Houstonians putting aside differences and laying it all on the line to band together for the greater good; for the well being of this great city. It’s time to do it again. Distance yourself. Be prepared, not panicked. Quit buying hundreds of rolls of toilet paper. Be a human being. If you’re young, help an elder. Support local restaurants and businesses through gift cards. Urge county commissioners to encourage county employees to work from home and pay them. Short of potential meds or a miracle vaccine, it is incumbent on us to do what is necessary to flatten the peak; to bide our doctor’s time. Take it personal; save a life.

In an effort to assist, i have compiled information gathered from various sources written by folks who know much more than I when it comes to infectious diseases. I’ll update as I can. Hope it helps.

Social Distancing

Below are some practical social distancing tips from a physician at the Harvard School of Public Health.

I know there is some confusion about what to do next in the midst of this unprecedented time of a pandemic, school closures, and widespread social disruption.

What I can say as a physician and public health leader, is that what we do, or don’t do, over the next week will have a massive impact on the local and perhaps national trajectory of coronavirus. We are only about 11 days behind Italy and generally on track to repeat what is unfortunately happening there, as well as much of the rest of Europe very soon. At this point, containment through contact tracing and testing is only part of the necessary strategy. We must move to pandemic mitigation through widespread, uncomfortable, and comprehensive social distancing. That means not only shutting down schools, work (as much as possible), group gatherings, and public events. It also means making daily choices to stay away from each other as much as possible to Flatten The Curve.

Our health system will not be able to cope with the projected numbers of people who will need acute care should we not muster the fortitude and will to socially distance each other starting now. On a regular day, we have about 45k ICU beds nationally, which can be ramped up in a crisis to about 93k. Even moderate projections suggest that if current infectious trends hold, our capacity (locally and nationally) may be overwhelmed as early as mid-late April. Thus, the only set of interlinked strategies that can get us off this concerning trajectory is to work together as a community to maintain public health by staying apart.

So what does this enhanced form of social distancing mean on a daily basis, when schools are cancelled?

1. No playdates, parties, sleepovers, or families visiting each other’s houses. This sounds extreme because it is. We are trying to create distance between family units and between individuals across those family units. It is uncomfortable, especially for families with small children or for kids who love to play with their friends. But even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent. The symptoms of coronavirus take 4-5 days to manifest themselves. Someone who comes over looking well can transmit the virus. Sharing food is particularly risky – I definitely do not recommend that people do so outside of their family. We have already taken extreme social measures to address this serious disease – let’s not actively co-opt our efforts by having high levels of social interaction at people’s houses instead of the schools. Again – the wisdom of early and aggressive social distancing is that it can flatten the curve above, give our health system a chance to not be overwhlemed, and eventually may reduce the length and need for longer periods of extreme social distancing later (see what has transpired in Italy and Wuhan). We need to all do our part during these times, even if it means some discomfort.

2. Take walks/runs outside, but maintain distance (ideally 6 feet between people outside your family). Try not to use public facilities like playground structures as coronavirus can live on plastic and metal for up to 3 days, and these structures aren’t getting regularly cleaned. Try not to have physical contact with people outside of your family. Going outside will be important during these strange times, and the weather is improving. Go outside every day if you can but stay physically away from others. Try not to have kids play with each other (even outside) if that means direct physical contact. Even basketball or soccer involve direct contact and cannot be recommended. If people wish to go outside and have a picnic with other families, I strongly recommend keeping distance of at least 6 feet, not sharing any food at all, and not having direct physical contact. Invariably, that is hard with kids, so these shared, “distant” picnics may be tricky. Do not visit nursing homes or other areas where large numbers of the elderly reside, as they are at highest risk for complications and mortality from coronavirus. We need to find alternate ways to reduce social isolation in these communities through virtual means instead of physical in-person visits.

3. Reduce the frequency of going to stores/restaurants/coffee shops for the time being. Of course trips to the grocery store will be necessary, but try to limit them and go at times when less busy. Consider wearing gloves (not medical – but perhaps washable) and of course washing hands before and after really well. Leave the medical masks and gloves for the medical professionals – we need them. Maintain social distance from folks. Take-out meals and food are riskier than making food at home given the links between the people who prepare food, transport the food, and you. It is hard to know how much that risk is, but it is is certainly higher than making it at home.

4. If you are sick, definitely stay home and contact a medical professional. If you are sick, you should try isolate yourself from the rest of your family within your house as best as you can. If you have questions about whether you qualify or should get a coronavirus test, you can call you primary care doctor or the health dept. Don’t just walk in to an ambulatory clinic – call first. Obviously if it is an emergency call 911.

5. We need to push our local, state, and national leaders to close ALL schools, events, gatherings, and public spaces now. A local, town by town response won’t have the needed effect. We need a statewide, nationwide approach in these trying times. Contact your representative and the governor to urge them to enact statewide closures. As of today, 6 states had already done so. We should be one of them. Also urge them to fund emergency preparedness and make increasing coronavirus testing capacity an immediate and top priority.

I realize there is a lot built into these suggestions, and that they represent a real burden for many people, businesses, and communities. Social distancing is hard and may negatively impact others, especially those who face vulnerablities in our society. I recognize that there is structural and social inequity built in and around social distancing recommendations. We can and must take steps to bolster our community response to people who face food insecurity, domestic violence, and housing challenges, along with the many other social inequities.

I also realize that not everyone can do everything. But we have to try our absolute best as a community, starting today. It is a public health imperative. If we don’t do this now voluntarily, it will become necessary later involuntarily, when the potential benefits will be much less than doing so right now.

Asaf

Asaf Bitton MD, MPH

Brigham and Women’s Hospital | Harvard T.H. Chan School of Public Health

See Why outbreaks live coronavirus spread exponentially, and how to “flatten the curve.”

Allergies vs. Flu vs. Corona

If You Think You May Have Coronavirus

Thanks Sarah King Johnson

PSA: I know we’re all tired of hearing/talking about it, but one thing I HAVEN’T really seen going around is advice for what happens if you DO get Coronavirus (many of us will), we’re only seeing advice for how to try to AVOID it. So as your friendly neighborhood RN, here we go:

Things you should *actually* buy ahead of time (Um, not sure what the obsession with toilet paper is??): Kleenex, Acetaminophen (Tylenol) in 325 mg tablets, Ibuprofen (Advil/Motrin) in 200 mg tablets, Mucinex, Robitussin or DayQuil/NyQuil, whatever your cough medicine of choice is. A real oral thermometer because we are in a game for guessing.

If you don’t have a cool vapor humidifier, that would also be a good thing to get. (You can also just turn the shower on hot & sit in the bathroom breathing in the steam). Also a good time to make a big batch of your favorite soup to freeze & have on hand.

If you have a history of Asthma & you have a prescription inhaler, make sure the one you have isn’t expired & refill it/get a new one if it is.

You basically just want to prepare as though you know you’re going to get a nasty respiratory bug like Bronchitis or Pneumonia. You just have the foresight to know it’s coming. Prepare.

For symptom management, use the meds I mentioned. For a fever over 101, alternate Tylenol & Advil so you’re taking a dose of one or the other every 3 hours. In the ER we dose healthy adults (those with it liver or kidney issues) with 1000mg of Tylenol and 800mg of Motrin every 6-8hrs. That’s dosed timing Tylenol to Tylenol and Motrin to Motrin. You can stagger the doses to keep fever down. Use both cough suppressants & expectorants (most cough meds have both). Drink a ton of water, hydrate hydrate. Rest lots.

If you’re sick, you should NOT be leaving your house except to go to the doctor (call ahead) You DO NOT NEED TO GO TO THE ER unless you are having trouble breathing or your fever is very high & unmanaged with meds. I cannot stress this enough. Take the meds. We will believe you and test you the same if you tell us you’ve been running fevers at home. Do not let yourself become septic to prove to healthcare that you’re sick!!

The CDC is still trying to figure out how this virus spreads (Community Spread, Contact &/or Droplet). ALWAYS wash your hands.

90% of healthy adult cases thus far have been managed at home with basic rest/hydration/over-the-counter meds. We don’t want to clog the ERs unless you’re actually in distress. The hospital beds will be used for people who actively need Oxygen/breathing treatments/IV Fluids.

If you have a pre-existing lung condition (COPD, Emphysema, Lung Cancer) or are on Immunosuppressants, now is a great time to talk to your PCP or specialist about what they would like you to do if you get sick. They might have plans to get you admitted & bypass the ER entirely.

One major relief to you parents is that kids do VERY well with Coronavirus— they usually bounce back in a few days, no one under 18 has died, & almost no kids have required hospitalization (unless they have a lung disease like CF).

Just use pediatric dosing of the same Tylenol and Motrin. You can also use cool baths to lower temperatures.

Please, please, please just stay home if you are NOT feeling well, whether you think you might have COVID-19 or not. The hand washing and sanitizer isn’t just about protecting you. We should also be protecting the vulnerable. Be respectful and considerate of others. The elderly & the Immunosuppressed are at the highest risk of getting Coronavirus.

As always, the only sources to get real information from should be the World Health Organization and the Centers for Disease Control and Prevention.

(Please Copy & Share To Raise Awareness)

To be continued . . .