COVID-19 a ground-level view, removing panic; the need for great primary care

by Rose Rohloff

​We need to change the dialogue, remove panic. This is a virus that can infrequently lead to death, as opposed to "a deadly virus." If this veteran can fight it off, so can millions of people focused on strengthening their immune systems.

With perpetual reporting of the COVID-19 virus, there has been a lot of panic reaction from the public, fostered by the media, as well as from local clinical staff. These reactions have brought existing issues in the healthcare system to the forefront, that we can address go forward, especially for discernment to champion better quality of care. The following two use case examples happened last week, which demonstrate panic reactions from clinicians, the need for good primary care, and the need to address care standards, especially in crisis, with sense at the delivery level.

An immune suppressed mother has three children, one being a 10 yr. old daughter who woke with a 102 temperature and a sore throat. The mother is not reactionary, having good instinct regarding when her children are fighting off bugs, building up their immune systems. She phoned the pediatrician to ask for testing if it is strep or a virus. The pediatrician stated they only test for COVID-19 if someone is hospitalized, and they would not do a strep test, “Don’t bring your child in”, and then the pediatrician went on a rant about social distancing, “This virus will not end …” (with no reported cases in the area) etc. and simply ordered Amoxicillin.

The mother phoned me commenting, "I don't feel comfortable with this situation, the doctor's reaction and their approach. 

I don't want to give my daughter an antibiotic if she doesn't need it, and especially if it is a virus, let alone the Corona virus." Removing all emotion from the situation with her, we discussed getting zinc in EZC Pak from the CVS a mile away, that she could pick up via their drive through, along with foods high in Vitamin A to boost her daughter's immune system. I also called the local Urgent Care center explaining the situation: a mother immunosuppressed, her daughter is in the EMR system, she just wants a strep swab to avoid unnecessary antibiotics, to please have a nurse do the swab through the car window when she drives up - avoiding any cross contamination issues. They stated no problem.  ​

The mother called the Urgent Care center and they informed her she got bad information, they would absolutely not do a swab from the car, she must come in. She stated, “You want me to walk into that center with sick people along with my two other smaller, healthy children so in less than a minute you can swab my other daughter’s throat to verify if she needs an antibiotic?” They told the mother that she could not bring that many people into the facility with her. The mother asked, “What exactly to do you expect me to do then to protect myself, and what do you want me to do with my other kids?”

The healthcare personnel demonstrated panic, without some basic sense. I finally asked the mother what she wanted to do. She stated, “My daughter is alert, drinking, not that bad. I am going to get Zinc and good foods, push fluids especially with warm lemon and honey, have her gargle with warm salt water, and see how she is in 24 hours.” 
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The daughter’s  temperature was 99 by nightfall, and 98 degrees by the next day without a sore throat. If the mother had not questioned the panic of the doctor and nurse, her daughter would have been put on an unnecessary antibiotic, opening her up to secondary infections, and exposing herself to unnecessary virus and bacteria while being immunosuppressed. 

From the NIH Amoxicillian: Additionally, there is a moderately increased risk of secondary Clostridium difficile (C-diff) colitis when compared with other classes of antibiotics. Females taking this medication can also develop vaginitis secondary to vaginal mycosis or candidiasis. (Our bodies keep C-diff and candidiasis in check with our needed good bacteria.)

The next day, the mother stated, "The doctor lost all credibility with me going on in a panic about the issues with the COVID-19, "this will never end by Easter, etc." when the hospitals have little volume, no reported cases. "She refused to do any history and basic assessment to swab my daughter to rule out strep before writing a prescription."

Our healthcare system has been broken regarding the lack of some basic sense at the ground level, with reactionary versus proactive care; missing great primary care doctors, avoiding the quick symptom = writing a prescription form of care. 

The same week, a second mother of four small children, one being a seven year old who was having sore joints and some blood in her urine. The doctors in Green Bay did a wonderful job of a full, very detailed history and then exam with targeted tests, quickly diagnosing Rheumatic Fever. Her and her other three, healthy children were instructed to do proactive strep testing since they all had close exposure with the daughter. "The center made us feel like lepers. Instead of simply coming out to the car to meet us, they brought us to an empty lobby with a nurse who came out in a full hazmat suit to do simple strep swabs. The nurse freaked out when my son simply cleared is throat, creating anxiety, complaining, "He just coughed." 

The clinicians throughout both cases should have been calming, simply asking good questions, and then only ordering the correct test before ordering medication. And, in both cases, clinicians could have had the tests quickly, avoiding the waste of hazmat gear, not frightening healthy family members as well as not exposing them to potential germs in the health facilities - avoiding cross contamination issues.

What we need to focus heavily on:

• Great education nationally in diet to strengthen the immune system. Great nutrition understanding regarding what vitamins to focus on, removal of sugars from the diet, etc. The idea of waiting on vaccines after the fact, for every virus, is not realistic or proactive.
• Better testing of high risk patients regarding their health with focus on strengthening their own immune system. 
• Zinc and other nutrients when one is immediately feeling poor. Fights inflammation, works with immune system ​or exposure to infectious persons.

Replay video, with permission via Dave Chase, Health Rosetta https://vimeo.com/403748057/1b07436d73

Health Rosetta hosted a wonderful webinar with Chief Medical Officers (CMOs) from around the country speaking, without panic, about the effective care of their patients at home with COVID-19. Their stories demonstrating the importance of shifting back to great primary care.

One point stood out regarding their focus that is so often missing in health systems: seeing 'clean' patients first, and then seeing contagious patients grouped together, ensuring avoidance of cross contamination, and minimizing the volume of masks, gowns or hazmat suits used.  

​Hopefully, many good things will come from this virus experience to positively shake up our healthcare system, including basic sense procedures, with the importance to rebuild and focus on great primary care again. Another glaring issue to address is the role of clinicians as cool, calm professionals, removing emotion when instructing with full information, with clearly explained options for informed consent and decision-making for delivery of quality care.