A doctor offers urgent coronavirus pandemic advice
Fever. Chills. Body aches. Runny nose. Cough. The classic symptoms of a viral illness. They are also symptoms of Covid-19. When we get sick — especially if we think we may have a serious illness the entire world is worried about — our gut instinct is to run to the doctor and seek medical attention. But for the majority of those with viral symptoms, this is the wrong thing to do. As the U.S. marches toward hospital surge capacity, we must focus attention on the worried well patient.
Managing the “worried well” patient during coronavirus may be the single most crucial issue facing our health system.
Who are the “worried well”?
The “worried well” is a loose term referring to those with mild illnesses who are better off getting care at home but tend to seek medical treatment at the first signs of symptoms. Primary care and emergency room providers are very familiar with this patient category.
These patients are not hypochondriacs. They often have a valid health problem and feel terrible. Fever, muscle aches, fear, and anxiety trigger their visit to the ER. Testing may verify an illness such as influenza or even Covid-19. But a positive test for Covid-19 does not change the management.
The “worried well” is a loose term referring to those with mild illnesses who are better off getting care at home but tend to seek medical treatment at the first signs of symptoms.
When a nonelderly patient without underlying medical conditions or respiratory distress has a viral illness, the recommendation will be home quarantine. Regardless of the test results, the management will be two weeks of home isolation and supportive measures such as fluids, rest, and acetaminophen.
The worried well need to understand: When we are sick, we do not always have to go to the doctor. Sometimes, Grandma’s recipe for hot tea with honey and two Tylenol suffice. Unfortunately, Covid-19 is a new virus for which we don’t have a vaccine, effective medication, or baseline immunity.
Why are the “worried well” a problem?
As testing scales across the country, the number of diagnosed cases will escalate. Many more patients will experience symptoms. Symptomatic patients will be tempted to go to a hospital or urgent care facility for testing. For the vast majority of patients, an ER visit is a wrong move with potentially catastrophic consequences.
Each patient who presents to an ER, urgent care center, or physician’s office exposes other patients and, importantly, medical providers to the infection. Once exposed, the medical provider is removed from duty and placed on home quarantine. This limits the number of available providers to treat others. We need as many doctors, nurses, and hospital staff to care for those in need as possible.
For the vast majority of patients, an ER visit is a wrong move with potentially catastrophic consequences.
After all, hospitals must continue to provide care to everyone. Heart attacks, strokes, and hip fractures will not stop happening. Pregnant women will go into labor. Kidney stones, gallbladder attacks, and appendicitis will occur.
Hospitals must have resources to care for these patients as well as the 15% of Covid-19 patients who require admission and intensive care treatment. Every ER visit ties up beds, providers, and equipment. When the worried well present to the ER, fewer resources will be available to those in need.
Who needs to go to the ER?
Only those experiencing severe symptoms, such as difficulty breathing, need in-person medical evaluation. Most Covid-19 patients will experience a flu-like illness without respiratory distress. Those with respiratory symptoms should call a health care provider for guidance. Telehealth visits may be useful for quick medical advice. The bottom line: If you feel sick and are not sure what to do, call a provider before going anywhere in person.
What can I do at home if I get sick?
Here are a few things you can do, including some suggestions from the Centers for Disease Control.
- Stay at home and away from others, including family.
- Wash your hands with soap and water for at least 20 seconds.
- Cover your mouth if you cough or sneeze.
- The sick should wear a mask. The healthy do not need one.
- Clean surfaces in the home using household cleaning sprays or wipes.
- Stay hydrated.
- Treat fever with Tylenol per the package instructions.
- Monitor for worsening symptoms and present for evaluation if you experience difficulty breathing.
- Notify your provider before a visit so that precautions can be taken.
Protect each other
We must come together as a nation to keep each other safe. We all must do our part. Follow the CDC’s guidelines. Practice social distancing. Help protect your doctors, nurses, medical assistants, and hospital staff. We need them to care for all of us.
The coronavirus outbreak is rapidly evolving. To stay informed, check the U.S. Centers for Disease Control and Prevention as well as your local health department for updates. If you’re feeling emotionally overwhelmed, reach out to the Crisis Text Line.