Remember that this virus is a respiratory one. A simple mask is worn to prevent your cough/sneeze/talking from spraying droplets. The no touch thing is to prevent introducing the virus into airways.
As an anesthesiologist I always associated scrubs with the OR. I later have become aware of the many others who use scrubs as a comfortable uniform and therefore wear them to/from work, in the store on the way home et al. Of course people change when the scrubs need it (spills…).
Speak up as others have stated, hawkbird! There is always a risk/benefit ratio. Needing bathroom priveleges or not visiting a home seems proper to me. It is up to the patient/family to determine if the home care is worth being exposed to an outsider. Constantly changing clothes doesn’t seem to be the answer- the likelyhood of contaminating the new clothes in the process risk is there. Totally different for a disease with a different transmission. If the home based patient is that fragile so you would have to change they shouldn’t be getting outside care coming into the home.
I work for a state owned center that closed at the end of February. Now the state is telling us we need to re-open and expect as many as 250 patients, so we are in the process of getting everything together, and then another branch of the state is putting up all sorts of hoops we need to jump through. My hope is that we are just preparing with an abundance of caution, and we don’t end up re-opening.
My wife did home health visits while in Anesthesia school to pay the bills. It was a rural, depressed area where we grew-up. Some people still had outhouses.
Does not seem practical when places to change clothes are difficult to find, and changing in the client’s house can also risk cross contaminating the clean clothing and exposing the next client.
Perhaps a more practical way:
Buy 6 (or the maximum number of clients per day) burkas or similar outer covering garments and 2 containers (labeled "clean" and "dirty").
Put the laundered burkas in the "clean" container.
Bring both containers.
Wear clean scrubs.
When arriving at the client, put a "clean" burka over your scrubs.
Do work with client.
When leaving the client, take off the burka and put it in the "dirty" container.
After finishing with all clients, go home and put the "dirty" burkas and scrubs in the laundry.
That still does not solve the restroom problem, though.
My apologies for my first response. Take your guidance from the agency who has hired you. Do the best you can to protect yourself and your clients from infection…which you have to do anyway as part of your work.
I have some therapist friends who are not doing any home visits for now.
Your job sounds like an essential one…thank you for continuing to work. Some folks might not have done so.
Thanks for all the responses. My job has changed so much over the past month. And it seems to change almost daily. I enjoy working with my patients, and especially now, they do not get to see many people outside of their own household. A few even live alone. I am taking all the precautions that I can, believe me. My biggest fear is that if I do come down with covid 19, I could potentially pass it to my patients while being asymptomatic. So I am definitely following the directions from my company. And when not at work, I stay home. I order online and then pick up my groceries.
I will avoid going into stores while in my scrubs. My company has been able to supply us with hand soap, hand sanitizer, gloves, and disinfecting wipes. Masks are to be reused and then turned it to be cleaned for future use. Gowns will be supplied if a patient has tested positive or is pending.
We have had many patients decline home care and our census is down, especially with elective surgeries on hold. However, I am still busy. We will see what next week holds.
My son starts his new caregiving job on Monday. He got experience through helping my dad in Texas, but I think he’s in for a shock.
When he gets home from work, I’m going to have him strip in the garage, wrap a towel around himself, and immediately take a shower. I’m a little nervous about the exposure.
My wife parks outside now. Sprays down her car. Also sprays her shoes. I’d leave them outside too. Comes in through garage and throws her stuff in the wash. Right upstairs for shower. Cleans shower and puts the towels in the wash with her clothes. Good luck.
When my H had to go to the “bunker” last Saturday I made him do the same thing.
I put a list of instructions on the outside of door leading from garage to laundry room. I had told him what to do when he came home, but he’s a guy, so I thought having written instructions would reinforce them.
I also took out clean towels and wash clothes - do he didn’t have to touch the ones on the bathroom shelves and left a change of clothes out for him, too. Probably overkill but better to be safe than sorry.
The head of Montefiore Hospital gives an update to the staff most days at lunch time, dh and I eat lunch together and listen to him. He has a very soothing voice. (British accent with just a hint of a stammer.) They have five more days of isolation gowns and some hospitals in the city will run out in two days. They are participating in one of the double blind studies, but because it’s double blind and not over yet, they have no idea if it’s promising or not.
They have doctors working in the ER who haven’t been there in decades.
(DH does medical research, but not clinical research and not Covid related so his lab is shut up.)
I should also add that I think shoes are important. I think when the pandemic settles down (hopefully soon) we’ll find that a lot of it was spread by walking through contaminated areas and carrying them on our shoes. I am not a doctor or scientist.
Also, no surprise but PPE shipments aren’t showing up. Hearing the backorder is 6 months. Not good.
We’re looking at evaluating a local person who is printing masks via 3D printing. He just came out with version 2.0. It looks good. He put a patent together. He walked me through the improvements on Facetime. Good stuff.
Thanks for asking! He worked only one shift so far and it went OK. He can’t say much due to HIPAA. He works again tomorrow. He would prefer working more than 10 or 15 hours a week but he’ll take what he can get. We’ve told him he can stay here through June without contributing to household expenses.
Below are ten treatment points I have learned from dh, who is an infectious disease specialist, and from the podcast “This Week in Virology” which is hosted by Columbia University professor Vincent Racaniello. The podcast features scientists from around the country and world. A doctor from the front lines is a frequent guest, and he explains infection control and Covid treatment for the general public. Although the TWiV scientists constantly uncover new questions, I find it uplifting to see the progress they are making.
Here are two episodes of the podcast loaded with information about the virus. The guest doctor speaks for the first 15 minutes or so after a brief intro:
*Note: I have summarized some of the info. from the podcast below, but I am not a doctor or a scientist.
There is a role for steroids in Covid-19, however, steroids are harmful in the first week of illness. Studies show they may double mortality if given in the first week because the patient needs their immune system to go full throttle against the virus. The time for steroids is during the second week, for the right patient at the right dose. This can even keep some people out of the hospital.
During the second week, the viral load is starting to go down, but patients can get worse due to a cytokine storm (their own immune system overreacting). This cascade of unhelpful cytokines can be prevented/calmed with steroids. However, care must be taken because a dose that is too high may reactivate the virus.
For some patients the cytokine storm is so severe that steroids are not enough. These people will have a very high neutrophil to lymphocyte ratio, and high IL-6. They get better with one IV dose of the IL-6 inhibitor tocilizumab.
Tocilizumab should not be given without first giving a properly dosed and timed steroid. This is because tocilizumab is an IL-6 receptor inhibitor (it blocks the receptors for IL-6). If the steroid is not given, then when the patient receives tocilizumab, their immune system will ramp up production of IL-6 even higher due to feedback that IL-6 is blocked. When the tocilizumab wears off, all that extra IL-6 will bind to the newly free receptors and patients will rapidly go downhill.
Another subset of patients will improve with steroid + tocilizumab, but then get worse again. In these patients D-dimer levels go up, 5-7 times above normal. 90% them are having pulmonary embolisms (clots clogging the blood vessels to the lungs). These patients need anticoagulants, but at a much higher dose than originally thought.
Covid-19 behaves more like high altitude pulmonary edema than ARDS. Initially, ICU docs thought it was mostly a pulmonary illness, and ARDS type treatment would work. That has not panned out.
In ARDS, you don't want to push fluids because the alveoli are filling with water and the lungs are like wet sponges, so you use diuretics. But, if you do this in Covid-19, you harm the kidneys. In Covid, patients need high hydration.
Keep people off ventilators as much as possible. Even tolerate oxygen saturations down to 80. Something about ventilation is making some people worse, likely the pressure in the lungs where there is already so much inflammation. The pressure the ventilator creates may be closing off the capillaries, preventing oxygen exchange (unknown).
Proning is very helpful (patients lying on the stomachs rather than backs). Prone early and often. This may help keep patients out of the ICU.
Well designed, double blinded studies of hydroxychloroquine are in progress. One arm of this study is for healthcare workers over 50 in NY (because it's such a high risk area) to see if it works as a preventative: https://www.patchstudy.com/s/
We are not at the finish line, but we do have treatment for many of the permutations of Covid-19. Every single day they are learning more.
Wow, interesting that they will tolerate oxygen saturation down to 80. My dad’s caregivers go nuts when he’s below 90. Bizarre that ventilators can be harmful!
You’re welcome, @CMB625 ! I’m happy to find this thread because learning as much as I can about the science and medicine of the virus is helping me stay sane and support DH.
One problem DH is having right now is shortages of oxygen. They would like to keep people out of the hospital by giving oxygen in the outpatient setting. Also, they want to discharge improving patients from the hospital with oxygen. Due to shortages, this is getting difficult.
Another issue is people hearing “cytokine storm” and wanting to treat with IL-1 inhibitors such as Anakinra. According to DH, this is unlikely to help as IL-1 levels are not elevated in these patients. According to immunologists, there are many different cytokine pathways, so you need a specific strike to block the right one (IL-6). I hope manufacturers of IL-6 inhibitor tocilizumab are ramping up production, but because it is a monoclonal antibody, it is apparently complicated to make.