By Russ Herring, DNP, FNP-BC, CSCS
I received a message from my mother last night, telling me that my brother was going to be coming to spend the night, and bringing his daughter. She was going to “spray them with disinfectant” at the door.
“Nice try”, was my reply, “that doesn’t work when it’s INSIDE them”.
Shortly after, I received a message from my brother, asking me what my message to mom had said. It was then that I thought, momentarily, that I’d accidentally started a war without meaning to. My brother was driving up from Casper, Wyoming to our hometown of Kaycee, with a load of groceries for mom and dad. Small-town folks can sympathize, I suppose. You go to “town” for groceries, much like residents of smaller communities come to Great Falls for weekly shopping trips. Gary was going to bring groceries and spend the night with Mom and Dad.
He was understanding when I told him that some of our most challenging recommendations right now, as healthcare providers, are directed at grandparents who need to socially distance from their children and grandchildren. It is hard to tell someone that their loved ones could accidentally give them an infection which may kill them. There is no “loved ones” protection from SARS-CoV-2 (COVID-19, “:coronavirus”), you can catch it from anyone who is infected themselves, and the worst-case scenario is that an otherwise healthy grandchild gives it to their grandparent.
In my position at Great Falls Clinic Northwest, I’ve had to tell many families that they need to video chat, or use the phone like we used to when we were younger.
There have been questions about social distancing and what it means. In a nutshell, it means not interacting with anyone you don’t absolutely have to. It means that you have to take steps to isolate yourself from other humans. We’re a social species, and this is challenging, but it means that you need to engage in activities with yourself, or those with whom you share a dwelling. It means walking the dogs as a family, but not stopping to chat with the other people who are doing the same. It means that non-essential businesses have had to shut their doors.
Social distancing slows the spread of disease by limiting the opportunities for infection to spread, person-to-person
I thanked my brother for his kind act, and asked that he drop the groceries at Mom and Dad’s door, wave “hi” through the window, and drive back to Casper. Are he or my niece carrying COVID-19? Who knows, but that is the point. He is 40 and she’s 16, it is entirely possible that they may both be carrying the infection, asymptomatically. My parents would not be asymptomatic. Both are in their 70s with comorbidities – they are the unfortunate target audience for poor COVID-19 outcomes. All parties remained calm, my folks got their groceries and a smile through the window, and social distancing was maintained.
Not all individuals have taken this guidance in stride.
Quarantine versus Isolation
Quarantine is the separation of those who may have been exposed to disease, but are generally asymptomatic. The idea of “symptomatic” has been very fluid with COVID-19. Generally, we’ve been defining “symptomatic” as any condition of respiratory illness/fever, while still ambulatory, as an entry point for quarantine. For instance, I’ve been in an exam room with patients who tested positive for COVID-19. There was a full discussion with the infection control team regarding my use of personal protective equipment (PPE), so that a determination could be made as to whether I needed to be placed in quarantine myself or not.
Every person who we’ve tested for COVID-19 has been placed in quarantine for 14 days, or until we have test results to support their safe removal from that status. Quarantine means that you stay at home. It means that you may have an infectious disease and that you’ve been asked to limit its spread, by remaining apart from others.
The difference between social distancing and quarantine
The core difference between social distancing and quarantine is the likelihood of actual exposure to the infectious organism. Social distancing is the basic act of remaining at a safe distance from other people. However, if you’ve had symptoms which necessitate testing, you are placed in quarantine long enough to find out whether or not you’ve contracted the infection. Since COVID-19 has been widely spread amongst communities in the US, even without foreign travel, any respiratory illness could represent a potential exposure. This has been very frustrating for both employers and employees. Yes, it means that you cannot go to work. It means that, ideally, somebody delivers milk to your porch, and that you don’t go to the store. Every person we’ve tested has been in a mask, which they’ve kept. I’ve had to tell many to keep the mask on, and to get enough supplies to last a week or two on their way home.
Isolation implies certainty of exposure
This is confusing. Social distancing versus outright isolation seems a little too similar, doesn’t it? Once we know a patient actually has COVID-19, they are asked to isolate themselves from other people, entirely. Even within the same house, if possible. 80% of those infected with this respiratory infection will be fine, but it is hard to predict prior to infection how any individual will fair. Globally, people of all ages have died from COVID-19. There is no Magic 8-Ball to tell you that your 40 year-old spouse will be fine or not. Maybe, maybe not, but it’s better to not find out. Isolation means that you have tested positive for an infection and need to remain separated from others for their safety.
Asymptomatic patients must have empathy for their fellow Montanans
The hardest part of being infected, or exposed to COVID-19, yet asymptomatic, is that you could transmit a potentially fatal infection to another person. To your friends… To your family and loved ones. The burden of this pandemic is upon those who are not ill, to do everything they can to slow the spread to persons who may not fare so well. Be compassionate. Stay home.
If you have questions, call. If you’re worried, call. If you think you’ve been infected, call. Our COVID-19 helpline is available 24/7 at (406) 454-7275.
About Russell Herring, DNP, FNP-BC, CSCS
Russell R. Herring, DNP, joined the Great Falls Clinic in 2018 and is among the newer healthcare providers and prescribers in the State of Montana. He works alongside Dr. David Engbrecht and Dr. Carey Welsh in Family Medicine at the Great Falls Clinic Northwest location. Russell specializes in diagnostic, preventive, and therapeutic healthcare and treatment plans for acute and chronic illness, and in education and guidance of patients regarding disease prevention and health promotion. He is currently accepting new patients at the Northwest Clinic, 1600 Division Road, Great Falls. For more information or to schedule an appointment, please call 406-268-1600.