Here's what we've been doing. It's all very basic and doesn't feel like enough, so I'd like to hear if anyone else has some ideas.
- Preparing patients. Counseling our highest-risk patients (elderly, debilitated) and our patients who we assume to be high-risk (e.g. severely immunosuppressed) on appropriate precautions and self-isolation and which symptoms require them to call us.
- Trying to prepare adequate social support for our highest-risk patients who need to self-isolate. Our most vulnerable patients are mostly poor and without much assistance. They generally don't have credit/debit cards or much ability to use the internet. So we're trying to assign each patient who needs to self-isolate a volunteer who, if necessary, can help them with things like groceries and medications. Depending how bad it gets in the clinic, we may start doing house calls for these patients.
- Telling all patients to CALL US if they can before going to the ER. We always offer 24/7 phone/text triage, but many patients go to the ER without bothering to call first. When patients call with intentions of going to the ER, 80% of the time an ER visit can be prevented. We're also kind of using covid as an opportunity to intervene with our worst ER-abusers. There's an ortho practice that I've spoken to about accepting our patients with ortho emergencies as walk-ins when covid hits the ERs hard. The urgent cares around here SUCK, so we'll do all other urgent care ourselves.
- Reassuring healthy patients that they're not at increased risk from covid, that if they do catch it they're unlikely to get severely ill, and that they don't need to go to the hospital for respiratory symptoms that are minor. We have a lot of patients who are HIV+ but on ARVs with excellent CD4 counts and otherwise great condition who are overly anxious about covid-19 and would show up at the ER for any minor cough or sniffle.
- Bugging the local health department for tests. No help. They're still "working on" getting the HepA/B vaccines I requested for uninsured homeless patients 3 years ago. I'm sure they'll have some coronavirus tests for me sometime around 2026.
I have no idea what to do for homeless patients, many of whom are already in poor condition and high-risk due to age, smoking, and comorbidies. As things currently stand, it's probably going to spread through the encampments and shelters like wildfire. There are no resources, as far as I can tell, to do anything here. I'm open to ideas and could even find some money if there's anything that can make a difference.
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