Who Gives A Cr@p Toilet Paper Coming! Get Ready for COVID-19 : A Message To My Patients
March 9, 2020
I promise that I am usually very detailed oriented. If you ask me about how many appointments are needed on any particular day in our department, I can give that to you. If you ask me what my networth is, I can tell you that to the thousands place. I usually know the 30-year versus the 15-year-fixed-interest rate for mortgages on any given week, even if I am not actively looking to purchase or sell real estate. Don’t ask me the adjustable because that would just be silly. Or ask me the Na concentration of any common resuscitation fluid, I can tell the mg/L concentration and if there is Potassium in it. That is because Dr. Young-Ho Yoon used to drill that into me when I was his intern at Man’s Greatest Hospital https://drplasticpicker.com/dr-young-ho-yoon-pediatrian-and-environmentalist-1/. As you know, Dr. Plastic Picker is a fiscally responsible pediatrician and I advocate for everyone to be FISE: Financially Independent so they can Save the Earth https://drplasticpicker.com/fise-financial-indepedence-and-save-the-earth/.
But for some reason, the last few months I was unsure if Who Gives A Cr@p toilet paper had given me a box of toilet paper for free? Had I paid for it? Had I signed up for a subscription? I am going tto go through our credit card statements carefully today for various reasons. I have written about my confusion over our new toilet paper in several blog posts. One was entitled “Who Gives A Crap Toilet Paper and Dr. Plastic Picker is Not Sure If I Got the Toilet Paper for Free?” https://drplasticpicker.com/who-gives-a-crp-toilet-paper-and-drplasticpicker-is-not-sure-if-i-got-the-toilet-paper-for-free/. So turns out I just got their introductory box of 3 tissue boxes, 2 paper towel rolls and 2 toilet paper rolls for free. We received our first box of 50 recycled toilet paper rolls in early December and were charged for those. But I was not sure if I had signed up for their quarterly subscription or not? Honestly I had forgotten about the toilet paper. Amidst all the COVID-19 hoarding, I was looking at bidets at Home Depot’s website last night. And lo and behold, I got the email above! Our toilet paper is coming! We still have about 20 rolls in the house so are fine, but another 50 rolls of recycled toilet paper are coming! Yeah! I still might get a bidet today at Home Depot.
When I got up this morning, I wasn’t sure what I was going to blog about. It is 5am and pitch dark because of daylight savings. But now that I got this wonderful email from Who Gives A Cr@p Toilet Paper, I know that nature wants me to blog about updates on COVID-19 and what my patients should do to prepare. As I always put as a disclaimer on my posts, “If you are a patient, this blog is for entertainment purposes and environmental advocacy only – so please go through normal procedures to contact me at the office through the patient portal.”
And then here is some general advice from a non-specific pediatrician just typing into the internet ether that is the blogsphere for random people who should talk to their own doctor for specific advice.
Six Things That I learned about COVID-19: These are summary notes of summary notes that are circulating around physicians’ facebook pages. Presented at a public forum at an Infectious Disease Conference in California. This was during a Winter Symposiom that summed up current clinical experience from clinicians in Santa Clara, San Francisco and Orange County who have cared for patients with COVID-19. Also parts of the recent Cal-OSHA training I just completed.
- COVID-19 presents differently than Influenzae: Influenzae usually presents as an uprupt illness of fever and body aches and respiratory symptoms. COVID-19 presents with one week of prodromal symptoms including malaise, cough, and low grade fevers that gradually lead to more severe trouble breathing in the second week of illness. It is on average 8-9 days after onset of illness that dyspnea develops, and then pneumonia/ pneumonitis can set in. We still expect most pediatric patients to have no or only mild symptoms (knocking on wood). So this is relevant to the hopefully very small subset of pediatric patients that will reach hospital level care. Fever is NOT prominent in several cases. Only lab findings consistent were lymphopenia (low white cell count) and radiology finding of bilateral insterstitial /ground glass infiltrates. Otherwise the other markers we look for to rule out “badness” like CRP are not reliable. I do want to emphaszie this is the experience of those patients that were ill enough to land into care. The Chinese data which I’ve shared before shows that the majority of pediatric patients will have no to mild symptoms (knock on wood). This is what we are hoping for (knocking on wood again).
- Co-infection with Other Viruses <2%: This the ID people got from the China data, that coinfection with Influenzae and RSV is low. So if you get a positive viral panel with something else, than it’s unlikely COVID-19. This is helpful for us front-line physicians who may have more access to other viral panels as we are still in flu season. .
- Bacterial Co-infections are that to be Uncommon: This is the opposite of influenzae where secondary pneumonias, ear infections and other secondary bacterial infections are common after the initial viral illness. If you are one of my patients, there were many of you that I had to place on antibiotics after you completed your tamiflu because of a biphasic illness and then your children had fever after initially improving from documented influenzae – and we saw an otitis media, pneumonia or bronchitis. This is not thought to be the case for COVID-19.
- Telemedicine/Virtual Care is a Good Method to Reduce Exposures: This is a great resource and we will likely try to deploy more of these appointment types when COVID-19 arrives. This is especially good for non-urgent issues like developmental concerns, rashes that don’t have fever, sleeping issues, feeding issues. Saves most people a co-pay as well!
- Patients with Underlying Cardiopulmonary Disease: This applies again mostly to non-pediatric patients hopefully. But the clinical observation is that patients with underlying cardiopulmonary disease seems to progress at variable rates to ARDS and acute respiratory failure requiring ventilatory support. There has been thought to be some cardiomyopathy from direct viral infection. Intubation rather than BiPAP is thought to decrease transmission and equivalent to patient “wearing a mask” whereas BiPAP requires everyone in the patient room to wear PARPs. This is more for the ICU doctors but it’s good for outpatient providers to know what is going on as well.
- Infection Prevention in the Medical Setting: This is more for me to review. It helps me to type it out, as it’s a form of studying for me. I just completed Cas/OSHA Training of “Aerosol Transmissible Diseases: 2010 Novel Coronavirus (COVID-19) Training” and it states if a patient is suspected or confirmed to have COVID-19. Nurse L and I will (1) Place a surgical mask of the patient (2) Place the patient if possible in a negative pressure room, and if not possible in an exam room and keep the door closed. We have a room in our office, we call the “Ebola Room.” (3) Isolation procedures will include Standard, Contact, and Airborne precautions including eye protection. (4) PPE will be worn which includes gown, gloves, N95 ot PARP respirators, goggles or face shield. (5) Standard hand washing with soap and water, or alchol degermer (6) Use only dedicated or disposable patient-care equipment (7) Only essential persons should enter the room (8) Keep a log on who enters and exits the room.
Five Things My Patients Should Do
- Make sure You have Access to Your Patient Portal: We don’t know what the patient demand will be like. To contain spread, the more virtual care we can deploy the better. Please make sure you update your phone number and an alternate one is on file with membership services. I routinely call many of my own patients and you often have the WRONG number on file. Please make sure your patient portal is up and running! This will ease the burden for the entire health system.
- Asthma Patients, Have a Supply of Your Medications: A 30-60 day supply is sufficient. Please make sure you have your asthma medications at home and have your nebulizer machines, and aerochambers located. Please review their proper use, as Dr. Plastic Picker has reminded you each and every visit until I am blue in the face! You can review again via this entire blog post I wrote just for my asthma patients! https://drplasticpicker.com/do-you-use-your-asthma-spacer-correctly-you-will-save-money-your-lungs-and-greenhouse-gases/ If I told you to be on your controller, please use your controller medication as directed with proper spacer technique. Did I say that again?
- Update All Your Vaccines: Please make sure all your vaccines are up to date. We remind you at each visit, again until we are blue in the face. If you are one of my rare families that is not up to date, you will find a very irate pediatrician if you ask me COVID-19 questions and don’t have your child fully vaccinated. The regular vaccine schedule includes vaccines that protect you from bacterias that cause pneumonias, ear infections, bronchitis and sinusitis. There is time to get your influenzae vaccine this season as well.
- Do Not Ask For Masks and Do Not Hoard Masks: That is it. I will say no. I am not wearing a mask until directed. Practice good handwashing. There are a lot of fun Tik Tok videos of handwashing techniques in different countries. If you see me in the office, I will show you and we can sing the songs and practice washing hands together.
- If You are Immunocompromised Heed The Same Advice the CDC is Giving About Grandparents: This applies to all my patients who are going through chemotherapy or on immunosuppressive medicines due to Inflammatory Bowel Disease or various Rheumatologic diseases. Whatever they say about grandparents should apply to those children. Social distance them away , and no plane travel and no cruises and I would say no unnecessary gatherings especially in groups greater than 20.
- Please Keep Grandparents Safe: I am mostly worried about the grandparents in clinic. Please try to have grandparents practice “social distancing” and avoid Cruise travel or long airplane trips as advised by the CDC. Make sure they have a supply of all their complicated medicines that Dr. Plastic Picker does not know about, because I’m a kid doctor. Don’t send them into our clinic to bring the grandkids if possible, I don’t want them exposed. We convinced Mr. Plastic Picker’s parents to cancel their upcoming vacations and we are grateful as they likely would have been quarantined in New York. Since they have health insurance here, it is safer that they stayed home and just living life quietly and tending their garden. We have lots of food as I have blogged about so they will be fine here https://drplasticpicker.com/covid-19-and-curtailing-travel-razelle-m-from-hotels-com-helped-us-save-over-345/. The best thing about keeping Mr. Plastic Picker’s parents at home, is that we have Ginny our crazy black puppy here. My mother-in-law went into urosepsis one early morning several months ago and it was our puppy that alerted us and found her. That little black dog 100% sniffed out her illness and saved her life. So wherever Ginny is, is the safest place for our grandparents.
I was going to post a picture of my trash art of the COVID-19, but it has our HMO logo on it. Don’t come into clinic to see it. I’ll show you after all this craziness is over. I’m hopeful as Dr. Anthony Fauci from the National Institutes of Allergy and Infectious Disease has stepped up to lead the national efforts. Have you seen Dr. Ben Carson? You know the joke Vascular surgeons would say about neurosurgeons, it doesn’t take a brain surgeon to do neurosurgery. Did I just say that? He sold his soul years ago. I’d trust an infectious disease specialist to lead us during an epidemic over a neurosurgeon anyday. It’s like Dr. Oz going around spouting out crazy things on Oprah trying to make money off people. He’s a cardiothoracic surgeon. Did you know Dr. Rand Paul and the dictator of Syria are both eye surgeons? I’ve never met a pediatrician who is a dictator. Have you? Dr. Plastic Picker is not trying to make money off anyone through this blog, nor am I trying to be a dictator. I just want COVID-19 to be over so we can get back to worrying about plastic. It’s still dark but hopefuly in 45 minutes or so it will be light enough for me to go the beach to pick up a bag.
Additional resources that you may find helpful:
World Health Organization https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
Dr. Plastic Picker’s favorite Tik Tok video of Handwashing from a country in which I do speak the language. Dr. Plastic Picker speaks four languages. This is not impressive because my upper management person speaks six languages with greater proficiency than I do. And I have a young physician I manage that I think speaks five languages. Anyway, this video is super cute. https://www.youtube.com/watch?v=bdnOsroyYiE
Here is another post on COVID-19 https://drplasticpicker.com/covid-19-the-health-care-system-will-only-work-if-we-all-think-of-ourselves-as-essential/