March 2, 2020 — Written by Dr. Patricia Blanchette, Chief Medical Officer, University Health Partners of Hawaii
Featured photo by Vina Cristobal
In preparation for the possibility of one of our clinic patients having COVID-19 and the likelihood that they will have influenza, we have taken the following steps and have the following advice for our UHP clinics.
First, it’s not too late to receive the seasonal flu vaccine. The symptoms of flu and COVID-19 are similar. People with underlying respiratory illnesses are likely to have worse symptoms if they also get COVID-19. So, protect yourself.
Recognize symptoms: We should know that COVID-19 and influenza present with similar symptoms. The initial difference was that the COVID-19 patients would have a history of travel to affected regions. There is a possibility that we will also see patients who have symptoms but have not traveled to areas where COVID-19 is known to have spread. So, we should be alert to patients with influenza-like symptoms, such as fever, cough and shortness of breath. The State of Hawaii Dept of Health has collected data that shows that more than 8% of patient visits to primary care physicians in January/February were for flu-like symptoms.
Wash your hands with soap and water frequently: It is amazing how protective frequent hand washing is to prevent contagious illnesses. To remember how long you should wash your hands, sing “Happy Birthday” to yourself twice while doing so. Use plenty of soap and dry your hands well.
Consider Zoom or telephone visits: It may be possible to do a telephone or Zoom visit to help the patient avoid travel to the clinic when they are feeling sick. In this way they could reduce the chances of spreading influenza (flu) or COVID-19. If the provider feels comfortable doing so, providing prescriptions for the appropriate flu medicine over the phone could be done. If you don’t know how to do a Zoom visit, someone in the UHP central office can walk you through it. Every clinical department now has a Zoom account.
Immediately isolate a patient with flu-like symptoms in the clinic: We have distributed “stop signs” to post in the clinics to alert patients that if they have flu-like symptoms to notify the clinic staff immediately upon their arrival. The clinic staff should then don a face mask, eye shield, gloves and a gown, provide a surgical mask to the patient, and then isolate them in an exam room by themselves. For children or elders who need someone to accompany them, also put a surgical mask on the person aiding them. Then notify the examiner of the situation and have the examiner don protective equipment before entering the room.
Clean and disinfect the clinic: Be sure to clean high touch surfaces frequently. A reasonable cleaning schedule would be before the clinic opens in the morning, mid-morning, noon, mid-afternoon and after the clinic closes. If the clinic is open for irregular hours, clean and disinfect high touch surfaces every two hours.
Disinfecting sprays and solutions may come into short supply. If so, a 10% solution of Clorox household bleach is an excellent and very effective substitute. There are six different types of odors of Clorox bleach, so try to select one whose odor is not unpleasant in the clinic. NEVER mix bleach with ANY other chemical as this can generate a gas that is highly toxic. When preparing a bleach solution, first wear goggles and gloves, and wear something to protect your clothes from getting a bleach splash. Use a container, such as a new spray bottle or another clean container. New spray bottles are widely available in drug and variety stores. Place one-ninth of the total solution that you are planning to create, then add 8 ninths of water. For example, use one cup of bleach to nine cups of water, or ¼ cup of bleach to 2 ¼ cups of water. Put the bleach in the container first, then add water.
Pay special attention to clean places that are frequently touched, such as door handles and surrounding areas, elevator buttons, counters, telephones, keyboards, sink faucets and sinks, and toilet handles.
Personal behavior: Cover your nose and mouth well when coughing or sneezing, cough or sneeze into your elbow if needed, and use a tissue if you can get to one quickly and then discard the tissue. Wash your hands frequently. Greet others without shaking hands. A slight bow, or fist bump, depending on the situation is enough. This cannot be emphasized often enough. DO NOT COME TO WORK IF YOU HAVE A COLD OR FLU-LIKE SYMPTOMS. Check to see if it is possible for you to work from home, but if that is not possible, then don’t come in.
Personal Protective Equipment (PPE): Stay in touch with Kim Kaohi in the UHP central office. Kim is working to ascertain supplies and suppliers. Kim’s work phone number is 469-4951 and her email is firstname.lastname@example.org. Go to cdc.gov for the most current and reliable information.