As I write this, some of you are in areas of the United States that are already deeply feeling the effects of this pandemic. You may be feeling torn between wanting to Stay At Home and wanting to serve your community. Your children may be suddenly out of school, and you may be overwhelmed with all the changes to your life and practice.
For others of you, the realities of COVID-19 seem far away, and you may be wondering if all of this is overkill that will cause more damage to our economy than the virus itself will to our people.
My family is sheltering in place, and have been since Saturday. I've spent much of my time reading, and will be sharing with you below the information I found most helpful to midwives. If you have a question not listed below, please email jesica@HiveCE.com. We will be continually updating this page.
While you are out there serving families, we'll be right here finding you answers.
A: Most of us will, yes. But the rate at which we do can make the death rate much higher, or much lower, than other nations have experienced. You may have heard of Flattening The Curve, and that is exactly what social distancing does.
This amazing simulator will show you not only how that works, but how it works BETTER than forced quarantines.
(If you aren't yet convinced we need this, it will convince you. If you are convinced and totally freaked out, it will help reassure you that this can work. Check it out! Right now!)
A: If you feel confused about what social distancing is, that's probably because the term has been used to mean many different things...all in the past week!
This is because social distancing needs will vary depending on how much the virus has already spread through your community.
If there are not yet any cases in your community, or only less than five cases, social distancing may only include:
- not hugging or shaking hands with anyone other than those you live with
- not participating in non-essential gatherings
- moving meetings and classes to online when possible
- staying home if you are sick with any illness (see our Q&A about symptoms)
- avoiding public transportation if you are able
- limiting contact with those who are older or have other risk factors
You should also:
- wash hands often (when you or anyone else enters a home, before eating or prepping food for others, after you use the bathroom, and any other time you think of it)
- use alcohol pads or other sanitizing wipes on the keypads at the grocery store, ATM, gas station, etc. (don't mind the looks - everyone will be doing it soon!)
- reaching out to at-risk friends and family to be sure they understand how important it is for them to stay home, and seeing if you can help them by bringing groceries, etc.
- talking to friends, family, and co-workers about creating strategies to increase social distancing in the days to come
Within two weeks after the first case in your community, social distancing also should include:
- work from home if possible, or create ways to have part of your work be remote
- avoid all contact with at-risk people, or, if you live with at-risk people, avoiding all contact with anyone else (this is for their protection)
- only go in public for essential items, like food, and then only when necessary
- using sanitizing wipes on cart handles, etc, when grocery shopping
- NO playdates for children (see Q&A on kids and transmission)
- socialization through phone or video chats, or with physical distancing of at least 6 ft, preferably outside
- keep 6 ft away from other humans when going for walks/runs/hikes
It is best to do everything on the lower list as soon as the first case appears, but many people find that overwhelming. Do the best you can.
A: Midwives and other health care workers can't work entirely from home, and it is vitally important that they remain healthy so they can do their jobs, and don't become vectors.
But there are ways that midwives can alter the way they provide care to keep everyone safer.
- Avoid all optional contact with other humans, both personally and professionally - use the phone, or video chat instead
- Consider using telemedicine in lieu of some in-person visits
- Limit visits to only the client and baby, if possible
- If providing home visits, wash your hands and sanitize your equipment between clients
- If you see clients in your clinic, have all clients wash hands upon entry to your clinic, space visits such that clients do not wait or interact between appointments, and sanitize all equipment and high touch surfaces (door knobs, faucet handles, etc)
- Practice social distancing within the visit by keeping 6 feet away except when providing direct physical assessment
- Advise all clients not to come to your clinic or birth center if they have any symptoms, including cold symptoms
- Consider moving to electronic charting
Guidance to read and watch:
A: That depends on the surface. There are things we know, and things we speculate.
The following grid is what the research specific to this virus has shown, as published in this study in the New England Journal of Medicine:
For up to:
||Time - wait 24 hours before touching it, if you can. Wash your hands after if you can't.
||Wipe clean with approved solution
||Wipe clean with approved solution
||Wipe clean with approved solution
A: For your hands, a wash for 20 seconds (or more!) with soap and water is best - this will physically remove the virus and wash it down the drain. Hand sanitizer is better than nothing, if hand washing isn't available.
If you can't wash your hands, and commercial hand sanitizer in unavailable, DIY hand sanitizer should be made based on a isopropyl alcohol ("rubbing alcohol") recipe, NOT a vodka based recipe.
Hand sanitizer is for HANDS, it will not sanitize surfaces! For surfaces, you may use any of the following, per the CDC:
- any of these commercial products
- a solution of at least 70% alcohol (isopropyl alcohol is 91%)
- bleach diluted to 1/3 cup per gallon, or 4 teaspoons per quart
- 0.5% hydrogen peroxide - probably, but only with enough contact time. Use as is or dilute with water to 0.5% (apply liberally, as it must be in contact for at least 1 minute).
- 0.1% sodium hypochlorite - same as peroxide
May or may not be effective:
- vinegar - possibly, but not likely
- tea tree oil or other essential oils - we have no data to suggest this yet
First we heard that children were spared, then we heard they could be asymptomatic carriers who could pass it to others, and now we are hearing that children, especially babies and preschoolers, absolutely can get sick in a very scary way.
Until more clear data is available, we should use extreme caution. COVID-19 does not transmit through breastmilk, but parents can still transmit the virus to their babies through any close contact. The CDC recommends separation but the WHO recommends that infected parents wear a mask and wash hands before touching the baby.
Testing is not yet widely available, but hopefully will be soon. Each state has different criteria for testing. Drive-thru testing is the best option, but it is currently available only in a few of the hardest hit areas. Also, we don't yet have enough test kits to go around, so tests aren't available to everyone.
NBC News put together this state-by-state list, of how it is being handled in each state as of March 14th.
In some areas, midwives are able to provide testing, and I expect that will become more common over the weeks and months to come.
Simply put: You can't, not without testing. Even people with no symptoms may be spreading the virus, which is why it is important that everyone reduce social contact right now, as much as they are able. (Those that are sick need to eliminate social contact until they meet these criteria, per the CDC.)
WebMD has the best symptom list I have seen, breaking down all the symptoms of COVID-19, and the rate at which they occur. Please note that not everyone gets a cough, not everyone gets a fever.
A few reasons:
1. This virus spreads more easily than the flu, because humans don't have immunity to it yet.
2. The death rate is many times than of the flu.
3. We don't yet know the best ways to treat it.
4. We don't fully understand why it is deadly for some people - even young people with no risk factors - and not for others. As was the case with The Spanish Flu, part of that puzzle seems to be the cytokine storm. But again, we don't understand why some people - even young people with no risk factors - have that reaction and others don't.
There are two basic reasons:
1. We need to give the infrastructure time to ramp up to handle the influx of critically ill parients, and
2. There will be better options for treatment down the road.
One of the options I am most excited about is those who have survived the disease donating their plasma. The antibodies from that plasma can be used to help others. We aren't there yet - but we very likely will be!