If you have a fever, new cough, shortness of breath, sore throat, or muscle aches, call your doctor’s office. Watery diarrhea is also seen in a minority of cases, and a new loss of sense of smell or taste has been reported frequently in mild and severe cases.
Over 80% of cases of COVID-19 are mild, but in high risk groups (people over 60, and people with serious underlying chronic diseases such as COPD, asthma, cardiovascular disease, diabetes, kidney disease, or immunocompromised state), risk of serious illness or death is higher than the general public.
Mild symptoms
Generally speaking, for MILD symptoms, we encourage patients to monitor their own health at home. This is in part to avoid spreading the disease, and in part to avoid overwhelming the hospitals in our state. People with mild symptoms are not usually going to qualify for a COVID-19 screening test at this time because there are not enough tests. Hopefully that will change soon. Whatever the case, it is still cold and flu season also, and most tests are coming back positive. Those who come in for a test are also running the risk of exposure to the virus that causes COVID-19.
People with mild symptoms should isolate at home for 14 days as long as the symptoms remain mild (and at least three days free of fever without medications). One should call back for medical advice if the symptoms become severe, and call ahead before going to the doctor or the emergency room. Health workers need to know if there is a chance you might have this highly infectious disease.
If symptoms remain mild, stay home, isolate in one room, use one bathroom that is not shared, avoid contact with others, and do not share plates or eating utensils. Have someone else bring you groceries and medications. If you must leave the house for any reason, avoid public transportation and wear a mask. Do all that you can to avoid spreading this disease. Wherever you are, cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. Throw all used tissues in the trash. Wash your hands with soap and water immediately after coughing, sneezing, or blowing you nose. Wash hands often with soap and water for at least 20 seconds to avoid spreading virus to others. If soap and water are not readily available, use an alcohol-based hand sanitizer that contains 60% alcohol. Always was hands if hands are visibly dirty with soap and water. Here is one resource to go over these issues: CDC
If you are sick, stay hydrated, and get good nutrition. Please let your doctor’s office know, and ask loved ones to check on you by phone if you do not live with someone.
For people with SEVERE symptoms:
Call ahead to your local ER that you are coming in, or inform EMS of your symptoms and that you might have COVID-19. Wear a mask immediately upon entering ER or ER registration. If you have called EMS put on a mask prior to seeing them.
If you haven’t put your code status in writing, it is time
There is no easy way to say this. We should all know our code status. For the uninitiated, code status refers to whether you would want heroic measures to be taken if your heart stopped, or if you had serious problems breathing. In other words, would you want chest compressions, possible shocks to restart or normalize your heart (cardioversion), or a tube down your throat to help you breathe (intubation), and be put on a machine (a ventilator) that would breath for you? Many of you have thought this through and have an advance directive, POLST form, or similar document. That is good, as long as it covers code status clearly, and it is available to EMS or the ER.
Under Maine law, advance directive refers to any spoken or written instructions you have given about the health care you want should you become too ill to decide. An advance directive will let others know what treatments or interventions you want, and those you do not. Having decided these issues well before you become ill is helpful to medical personnel, helpful to you, and helpful to your loved ones by sparing them the burden of making tough end of life decisions.
In Maine, anyone 18 years of age or older may use the Maine Health Care Advance Directive Form, (click here to download the .pdf). This form can be canceled or changed at any time. This document does not take away your rights as a patient. Once you state your wishes in writing, please let your loved ones know what you want. The ER and the intensive care unit (ICU) are not good places for surprises. The key thing to medical personnel is what you want. Your doctor and local hospital should have copies too. Most people keep the document with their code status handy, perhaps on a refrigerator door, along with a list of medications.
In our lifetimes there has never been such a threat in our communities. The percentage of those who experience serious illness or die is much higher in people over age 60. About 20% of people of all ages with COVID-19 have a severe case requiring hospitalization, with about half of them winding up in an ICU. About half of those patients wind up on a ventilator (5-10% of COVID-19 cases overall). We can break the risk apart by age to some degree. On March 21, 2020 I noted here in MPDN that the state of Washington that day had 1793 confirmed cases with 95 deaths (today the numbers have climbed to 4,896 cases and 195 deaths). Deaths up to March 21 occurred as follows by age and (percentage): 60-69 (10%), 70-79 (23%), 80 and up (60%). If a person winds up in the ICU and on a ventilator risk of dying is high, much moreso in older people.
A research letter to JAMA March 19, 2020 noted that at Evergreen Hospital in Kirkland, Washington a case series of 21 people with COVID-19 was admitted to the ICU (average age, 70 years with a range of 43-92 years). Mechanical ventilation was used in 15 patients (71%) and acute respiratory distress syndrome (ARDS) developed in all of those patients. As of March 17, 2020, death had occurred in 67%, and 24% of patients remained critically ill.
In a summary of 72,314 cases from the Chinese Center for Disease Control and Prevention published in JAMA, 14% of cases were defined as severe, and 5% of cases as critical. The case fatality rate for all ages was 2.3%, but 14.8% for patients over 80, and 8% for those 70-79 years of age. Of note 3.8% of all cases were healthcare personnel, and 14.8% of them were classified as severe or critical. Healthcare workers risk exposure to high inoculation of virus particles, especially while performing intubation and other invasive procedures. All patients in this group who were listed as critical died from COVID-19.
A study published in The Lancet Respiratory Medicine reported that of 52 critically ill patients (average age 59) at a Wuhan, China hospital 30 (81%) of 37 patients requiring mechanical ventilation had died by 28 days. The age of those patients was not given.
The point is that older people, especially those with chronic illnesses, do not have good outcomes with this disease, especially if they become critically ill. Please consider your code status carefully.
