Who Should Be Tested For COVID-19

As a physician working for one of the big local healthcare systems, starting Monday I will have the ability to order outpatient testing for the coronavirus. University Hospitals of Cleveland and the Cleveland Clinic are both offering drive-through swab testing with a doctor’s order.

Credit: bangordailynews.com

I’m anticipating a LOT of phone calls on Monday. Before you call, I want to go over the guidelines for who should be tested for COVID-19.

The very first question that will be asked when someone calls is “ARE YOU SICK.” This sounds silly but the worried well are going to want to be tested. I was at Costco Friday morning, am I at risk? I work in healthcare, am I at risk? Yes, of course. But I do NOT need to be tested because I am NOT sick.

The symptoms of COVID-19 include fever, cough, and shortness of breath. If you have a runny nose and cough, but no fever, you have a cold and do NOT need to be tested. And you don’t need to go to the doctor, urgent care or emergency room either! Stay home, drink fluids, rest and wash your hands until you are feeling better.

Suppose you do have a fever and a cough. If so, I guarantee that anxiety is going to make you feel short of breath! The next question is, have you been exposed? At this point, if you have not traveled and have not been in contact with a known or suspected case of COVID-19, and are well enough to stay home, you do NOT need to be tested. The exceptions are healthcare workers and those at high risk (like cancer patients and those 65 and older with multiple medical problems).

If you or a family member have any of THESE symptoms, you need to call 911.

  • Shortness of breath
  • Chest pain, pressure or discomfort
  • Bluish discoloration around the lips or fingernails
  • Confusion or difficulty waking up

If you need to call 911, let the dispatcher know what’s going on so they can give the paramedics and ER a heads-up and be prepared.

Social distancing, closing schools, avoiding large groups, good handwashing and sanitizing surfaces will help slow the spread of the virus. It’s inevitable that some people will be infected, and knowing who needs tested is important. We don’t have unlimited ability to test the general population. Just because you are scared and MIGHT have been exposed is not a reason to get tested.

If you need more information about this infection, here are some good resources for facts, not hype or hysteria:

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Caregiver Stress And The Sandwich Generation

I’m planning to give a talk on caregiver stress in a few weeks, and I figured I’d ask my lovely readers to help me make this talk awesome.

What is a caregiver?  A caregiver is defined as someone who provides care for another person in need.  Generally the person being cared for is unwell in some way and needs help with daily tasks.  Those with cancer, dementia, and many other chronic conditions may need help with dressing, bathing, eating, medication management and other critical tasks.

Who are our nation’s caregivers?  According to womenshealth.gov, over 20% of adult Americans will provide unpaid care to an elderly or disabled person each year.  61% of informal or family caregivers are women, and most are middle-aged.  59% of women who provide informal care to a family member are also employed. Over half of these employed female informal caregivers have made changes at work to accommodate caregiving, such as scaling back their work hours or changing their schedules.

There is an interesting term to refer to those providing informal or family caregiving:  The Sandwich Generation.  There are several types of Sandwich Generationers:

  • Traditional Sandwich – those caring for both aging parents and their own children
  • Club Sandwich – those caring either for both aging parents and their own adult children and grandchildren (4 layers!) OR aging parents and grandparents and their own children
  • Open-Faced Sandwich – anyone else involved in informal caregiving

Sandwich generation caregivers have an extra level of stress because they have competing priorities.  There is only so much time and they often feel they can’t do justice to any single task because they’re pulled in so many different directions.

Caregivers have definitely Got Stress.  How does one know when caregiver stress is becoming unhealthy?  The Alzheimer’s Association has a lot of information on their website about caregiver stress and burnout.  Symptoms can include anxiety, irritability, trouble concentrating, depression and anger.  Caregivers may be in denial about their loved one’s illness.  They may withdraw from friends and family, have trouble sleeping and feel exhausted.

Caregivers’ own health may suffer due to stress and burnout.  Researchers at the CDC found that 20% of caregivers surveyed rated their own health as fair or poor.

If you are a caregiver and find yourself struggling with stress and burnout, what can you do about it?  Better yet, if you find yourself (or know someone else who is) in the caregiver role, how can you minimize the risk of burnout?

  • Don’t beat yourself up because you can’t do everything.  Recognize you’re only human and be gentle with yourself.
  • Look for resources.  Check with the local Area Agency on Aging to explore what services are available near you.  There may also be disease-specific resources and services available.
  • Be proactive and take a problem-solving approach, rather than worrying and feeling helpless.
  • Do your best to take care of yourself.  Exercise, eat right, and get enough sleep.  See your doctor for your annual physical and other scheduled visits.  Remember, you can’t take care of others if you’re not well yourself.
  • Actively practice proven stress reduction strategies.  Meditation and yoga are good options.  Check out this recent post about Sudarshan Kriya Yoga.  Go to church, temple or other religious services regularly.
  • Don’t be afraid to ask other family members for financial help if you need it.
  • Ask for and ACCEPT help.  Have a mental list of things people can do and let them choose one.  For instance, a sibling can take Mom for visits on weekends to give you a break.
  • Be realistic and don’t be afraid to say no if you can’t commit to something.  Someone else will be able to chair the PTA and run the fundraiser.
  • Stay in touch with family and friends.  Isolation makes stress worse and accelerates burnout.
  • Keep a sense of humor!

I want to make sure you realize that there are significant upsides to the caregiver role too.  Many of my patients are providing care to aging parents and grandparents and find it incredibly rewarding.  For instance, one patient was the full-time caregiver for her father until he passed away in his 90s.  She has told me it was wonderful being able to share that time with him, knowing the time was limited and coming to a close.  Focusing on the blessings rather than the trials and keeping her (boisterous!!) sense of humor helped her keep burnout at bay.

Research has also shown that the healthiest and longest-lived people on Earth tend to live in multi-generational households.  Maintaining close relationships between generations is good for your health and for society.  One of my friends is a caregiver for her grandfather who has Alzheimer’s disease.  She is homeschooling her son and they spend the day together as a family.  Her grandfather is fascinated by his great-grandson’s schooling and the little guy adores spending time with him every day.

Providing family caregiving services to an elderly or ill family member is stressful, no doubt about it.  Caregiver stress is common and falls largely on women.  It doesn’t have to lead to conflict, burnout and physical illness though.  Acknowledging your limitations, asking for help, practicing good self-care, and seeking out the positive can help keep you healthy and make caregiving a rewarding experience for you AND your loved one.

QUESTION:  Are you providing caregiving services for someone you love?  What are you struggling with, and what helps you manage?

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How To Wash Your Hands

I was browsing the health news reports to get an idea of a topic for this weekend’s post. Literally every post is about the coronavirus outbreak and its spread to numerous countries.

While this is very important, unfortunately I’ve already written about this topic. I have seen a number of posts this week on social media about proper hand washing, and decided this was a good time to review the right way to wash your hands.

Everyone from Mayo Clinic to the CDC has put out guidelines about how to wash hands correctly. I have included a video at the end but here are the steps:

  • Wet hands with warm water
  • Use regular soap. Antibacterial soap actually increases the risk of staph infections and is not recommended.
  • Lather the hands thoroughly and rub them together. Get between the fingers, the tips, and the thumb.
  • Continue to rub the hands for 20 seconds. This is the time it takes to sing the Happy Birthday song or the Yankee Doodle song through twice.
  • Rinse the hands thoroughly under warm water.
  • Turn off the tap with a paper towel, NOT your clean hands
  • Open the bathroom door with a paper towel, NOT your clean hands

Studies have shown over and over that good hand hygiene is critical in preventing infection. This is true not only in hospitals and doctors’ offices but in the general public as well. Especially with the growing concern about coronavirus infection, proper hand washing is a critical measure everyone can and should take to reduce their risk of illness.

QUESTION: Are you washing your hands correctly?

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