Do you like your primary care doctor or your primary care nurse practitioner? Do you want her to keep taking care of you, and other patients like you?

If so, you shouldn’t walk into her office with your cough and maybe fever and ask her to test you for the coronavirus.

Because if you do have the coronavirus, and she tests you by sticking that swab all the way back your nose, and you sneeze all over her, and she isn’t wearing eye protection and a mask and a gown, now you’ve contaminated her, and you might have given her the coronavirus.

Unless she self-quarantines herself in her bedroom, well away from her kids, who wonder if mom doesn’t love them any more, she can now give SARS-CoV-2 to all of her other patients.

Or (best case scenario) if she’s not infected, you’ve still put her (and everybody in her office) out of commission for two weeks. If she is infected, and she’s old or maybe has a touch of diabetes or a touch of heart disease, maybe she’ll end up in the hospital.

Or maybe she’ll give it to her 82 year-old mom, who ends up in the hospital and dying (more heartbreak for the grandkids).

Medical supplies at a doctor’s office. Patients must guard against infecting their primary care physicians in the wake of COVID-19. Flickr: Daniel Lobo

If you don’t want that, do the responsible thing, and call her office instead. You might be directed to one of the sites doing drive-up coronavirus testing, but it’s not like you’re short of breath, and maybe needing oxygen, are you?

Because, if you are, maybe you need to be in the hospital. If you need oxygen, or if you need to be intubated and on a mechanical ventilator, you need to be at the hospital, and not at your primary care doctor’s office in the first place.

“I think we should really be overly aggressive and get criticized for over-reacting.” — Dr. Anthony Fauci

Up until now, with the focus on individual cases, we have been doing containment — and we’re still doing containment. As of March 18, all the cases identified so far in Hawaii so far have been travel-related.

While community transmission has not been demonstrated yet, it is inevitable that it will be. The coronavirus doesn’t make young, healthy people that sick. In South Korea, a great proportion of those infected with SARS-CoV-2 have been found to be asymptomatic.

As Anthony Fauci says, when we’re trying to contain, we’re tracing contacts, we’re quarantining particular individuals. Because community transmission is inevitable, we have crossed the threshold from containment to mitigation with the social distancing measures announced on Tuesday by Governor David Ige.

When we’re mitigating, we’re doing social distancing. This means everybody. If everybody cooperates with serious social distancing, the mitigation should be more manageable. China was able to dial from mitigation back to containment.

“We’ve entered the phase where more and more health care providers will drop out as they become needlessly infected … so we need to protect them now, for the fight of their lives has just begun!” — Dr. Skip Burkle

It is possible. It isn’t easy, but it’s possible. Will Hawaii’s geographic isolation be on our side? Those local college kids that have been studying on the Continent canceled their Spring Break plans and are home already. Putting a hold on visitors will keep outside cases from adding to the mix.

Spring Break has been extended further already. Social distancing will help flatten the epidemic curve, i.e., keep the number of cases from spiking suddenly and overwhelming our hospitals — so that we don’t have to choose who to put on the mechanical ventilator, choose who gets a chance to live, and who dies.

We must still ramp up testing for COVID-19, and demarcating the health system into 1) a sector where the workers have adequate personal protective equipment to protect themselves (to see any patients with any respiratory symptoms) and 2) a sector which does the usual health care we used to do.

More than 2,600 of Italy’s physicians and nurses have been infected (8%), and two have died. Again, do you like your primary care doctor or nurse practitioner?

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