Anyone with questions on coronavirus is urged to call the ODH Coronavirus Hotline at 1-833-4ASKODH (427-5634).


Daily 2pm Press Conference with Ohio Gov. DeWine & Ohio Health Department Director, Dr. Amy Acton

WATCH HERE. CHOOSE "LIVE GOV CONFERENCE"

Clinic Advisement Regarding Coronavirus as of 03/10/2020

Reminders:

Wear a mask, or scarf when out in public to try to decrease exposure; wash daily.

Wash your hands when returning home from being out.

Stop wearing contact lenses, could increase risk of infection.

Wear glasses.

Healthcare workers advised to stop wearing makeup, to keep masks re-usable.

In general, consider mascara as a potential foreign body allowing increased exposure as well.

Wash your hands for at least 20 seconds with soap & water. 

Considering showering twice a day (once in the morning for Ohio allergy related sinus congestion; once at bedtime to rinse of allergens, & any possible virus exposure).

Don't touch your face, nose, mouth, or eyes.

Cough & sneeze into your elbow.

6 feet away from others is the MINIMUM. 

OHIO!

Take your allergy meds so you don't scare yourself because of allergy symptom season.

The 2+ week incubation period is A LOT of time & contact potential. Social distancing is necessary.  

KEEP TRACK: Consider keeping a journal, or log book, of every place you travel, or people you see; this will be of benefit for contact tracing in the future.


PRO TIP, DAILY TEST, HOW WELL YOU ARE BREATHING:

Start doing this while healthy.

Every morning, take a deep breath in, hold it for 10 seconds while still healthy. This will help you to learn your baseline lung function. It could save your life.

If you don't know your normal lung ability, it will be hard to know your abnormal lung ability. This will also reduce panic.


STATE ORDER OF OHIO:

If you've been traveling, you must do 2 week quarantine at home. This is to save lives.


Update from Ohio Gov. DeWine, click here, as of 03/10/2020.


Ohio Department of Health

To OHIO Dept of Health

Ohio Dept of Health Coronvirus Questions Site 03/15/2020

To Coronavirus Site

Ohio Dept of Job & Family Services for Unemployment Benefits 03/17/2020


Ohio State University Wexner Medical Center Call Line

614.293.4000


Interesting Articles For Points of Reference

National Geograpic Article (CLICK HERE): These underlying conditions make coronavirus more severe, and they're suprisingly common.


Medscape News (CLICK HERE) : Risk Factors for Death From COVID-19 Identified in Wuhan Patients


Medscape News (CLICK HERE) : Coronavirus May Cause Environmental Contamination Through Fecal Shedding

JAMA research article here.


Quick reminder: A successful public health campaign is one where we all look back and say, "nothing happened." That's the point -- to avoid what could have been. That is what success looks like.


Follow Dr. Heather Bartlett on Twitter: @DrBClintonville


MOST RECENT UPDATES WILL BE TOWARDS TOP OF LIST BELOW.

Ohio Department of Health (ODH)

Public Health Laboratory Coronavirus Disease 2019 (COVID-19)

Testing Procedures

March 20, 2020

ODH COVID-19 Testing Overview

The Ohio Department of Health Public Health Laboratory (ODHL) continues to provide targeted testing of those patients who are most severely ill and who pose the greatest risk of transmission to others. ODH adapted these testing procedures to provide adequate surveillance capabilities so that local health partners could identify COVID-19 cases in their counties. The ODHL is designed primarily to meet surveillance needs, and not to provide comprehensive diagnostic services.

The goal of the current ODHL testing guidance is to identify the following cases of COVID-19: those who are most severely ill and professionals who are critical to providing care and service to those who are ill. This approach will allow for the most appropriate use of the available resources.

For testing at ODHL, the patient must meet one of the following criteria:

  • Patient has fever and signs/symptoms of lower respiratory illness, (e.g. cough or shortness of breath) AND is either a healthcare worker with direct patient care or in a public safety occupation (e.g., law enforcement, fire fighter, EMS) AND has had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset
  • Patient has fever and signs/symptoms of lower respiratory illness, (e.g., cough or shortness of breath) AND is a resident of long-term care facility (LTCF) AND is hospitalized
  • Patient has fever with severe acute lower respiratory illness (e.g., pneumonia, ARDS as evidenced by imaging) AND is hospitalized AND the healthcare provider has a high clinical suspicion of COVID-19 after thorough evaluation (i.e., no alternative plausible diagnosis).
  • Other special circumstances where there is a requirement for prompt receipt of results such as patients involved in an illness cluster in a facility or group (e.g., healthcare, corrections).

Source: https://med.ohio.gov/Portals/0/Resources/COVID-19/3_21%20ODH%20Lab%20Testing%20Procedures.pdf?ver=2020-03-21-155906-440&utm_source=BenchmarkEmail&utm_campaign=3.21_Updated_COVID-19_Testing_Guidance&utm_medium=email


Updated Guidance for Testing & Resource Management
Issued by the Ohio Department of Health March 20, 2020

Overview
ODH, in collaboration with community partners, has developed a tier-based testing strategy for individuals with suspected COVID-19:

  • Tier 1: Inpatients at hospitals and other healthcare facilities, including long-term care, with symptoms suggestive of COVID-19
  • Tier 2: Healthcare workers at Tier 1 institutions with symptoms and all individuals in public safety occupations
  • Tier 3: Individuals with mild-to-moderate symptoms who are high risk- elderly, and those with serious medical problems
  • Tier 4: Individuals with mild/moderate symptoms and without risk factors for adverse outcomes – testing not currently recommended
  • Tier 5: Asymptomatic individuals – testing not currently recommended

 

At the present time, ODH advises that only individuals in Tiers 1, 2, and 3 be tested for COVID-19. Based upon availability of testing materials, these recommendations will be modified.

Specimens should either be processed in hospitals with internal testing capacity or at another laboratory that has an acceptable turn-around time.


March 12, 2020 1:18 PM

A quick follow up on concerns if the hotline is not answered, or ERs do not answer their phone:

First, do not panic. Give it some time. We are all in this one together. 

Current plan is personal responsibility and social distance. Believe it or not, this more than most are getting advised. We have to stop transmission. That is key. When people answer that they are not worried about themselves getting sick, they are missing the entire point -- this is about VIRAL TRANSMISSION. That is what we have to stop. Again, personal responsibility and social distance is necessary.

Personal protective equipment (PPE) is being reserved for the healthcare systems that can actively test, and care for those affected with high respiratory support (think respiratory distress: intubation, vent machines; outpatient clinics are never intended for this). Without PPE, no provider should be testing. As said, I've tried on multiple occasions to order, and my orders are cancelled due to shortage concerns for healthcare systems.  

As said in video, if those specific concerns occur, then calling 1) hotline, 2) if they refer to ER, then call ahead if possible. Not bogging up the phone lines is key if there is not true concern. 

For my current patients:

I can do supportive care for asthma as normal (rx for inhalers, nebulizer rx for home, etc), and if you have a pulmonologist, look to them for advice as well. 

If seasonal allergies are an issues, allergy care should be initiated in advance, as you can tolerate, and whatever you feel you can tolerate (same advice for all patients).

Sinus symptoms, and other symptoms, same as always, email, and we'll go from there.  

All other plans are a day to day with the Coronavirus as this develops along with local and CDC guidance. We are all in this one together. 

It's always wise to develop your own family plan, and thresholds for care, planning, etc as well. 

All other concerns will be handled through telemedicine as prior. 

Best, Dr. B

Heather Bartlett, M.D.


FROM THE STATE MEDICAL BOARD OF OHIO

COVID-19 Guidance for Primary Care and Outpatient Providers (3/15/20)

According to the Ohio Department of Health, the number of confirmed positive cases of COVID-19 in Ohio is low but rapidly increasing and public health experts expect the number of positive cases to expand significantly in the coming weeks and months. At the same time, Ohio and the nation are facing a dire shortage of personal protective equipment (PPE), including that maintained in the national cache.  

This situation warrants a unified, consistent approach and requires primary care providers and other outpatient services providers to comply with the following course of action regarding screening and treatment of potential COVID-19 patients. Please note the course of action detailed below is a revision to the guidance issued on March 11, 2020.  

Telephone Consult: Patients should be encouraged to receive a phone-based triage, which in most cases will be done by their primary care provider. Based on these phone consultations, and utilizing CDC guidance, roviders will decide whether patients require an in-person assessment (at hospital).  

Hospital Assessment Locations Will be Coordinating the Testing  

Temporary central assessment and testing locations are being established throughout the state of Ohio.

Providers should contact the local hospital to which you would refer a patient for admission to learn where your community’s assessment and testing location is. Trained primary care professionals will be at these central assessment locations to assess whether the patient should be tested, sent home or admitted to the hospital. Patients who present to an outpatient setting other than a central assessment and testing location and are determined to need testing for COVID-19 should be referred to the central location for testing. Providers are strongly discouraged from doing patient assessments for COVID-19 at sites other than central assessment and treatment facilities.

Testing  

Patients with mild systems will not be tested and will return home to self-monitor. Patients with moderate symptoms with other risk factors should receive a test at a commercial laboratory. Patients with severe symptoms should be tested through hospital laboratories (if available) or the ODH laboratory and be admitted to the hospital. Test results from the ODH laboratory will be returned within 24 hours.

Why are these steps required?  

PPE is very limited (including the national cache). Those providers who do currently have PPE are using it at a rate that cannot be sustained. The need to minimize in-person interactions to the extent possible. The complexity and scope of the public health issues involved in mitigating this problem requires a centralized, coordinated approach. It is absolutely vital that hospital capacity be reserved for the sickest patients. Please refer patients to coronavirus.ohio.gov or to 1-833-4ASKODH (1-833-427-5634) for additional information.

****

As I have said from the beginning, I have been trying to get PPE, but unable to, and this clearly explains why. The risk is if I contract it due to lack of PPE, I will then spread it further, especially with those with increased risk. We have to honor the above.

Most likely symptoms associated with Coronavirus as this is a lung attacking virus:

  • Dry cough
  • Fever (greater than 100.5 Degrees F)
  • Fatigue 
  • Unusual shortness of breath, May or may not yet be present
  • Above numbers 1-3 seem for most to come on fairly quickly. 
  • Even if symptoms 1 - 4 are present and mild, testing is NOT advised. But home symptomatic, supportive care and quaratine is advised. I will help assist with breathing symptoms with Rx as able. 
  • If symptoms are severe, call 1-833-4ASKODH (1-833-427-5634) for additional information. Based on your location, you will know you where you should receive assessment, and possible care. This is all pending hospital ability & staffing.


Please keep in mind, those getting tested are HIGHER risk. Even being around that situation, "just to find out", will pose potential risk to you, that you might have never been exposed to if following appropriate Social (Physical) Distancing. Please follow the guidelines. 

I'm still awaiting hearing when these testing sites might up and running. 

Best, Dr. B

Heather Bartlett, M.D.