• Russell Hill

Is the road clear to launch recovery

A good friend recently asked me "Is the coronavirus virus epidemic and all these precautions all overblown?" Certainly without local context it might feel like we and our loved ones are protected. Can we all just go back to work or do we still need to follow “stay at home” guidelines? I’m a practicing ER doctor --not a politician or policymaker-- so I guess that gives me a “front row seat” to report on what’s happening in local community hospitals. Many cities, counties and hospital systems throughout the country face similar situations. I have no other motive that the safety and well being of the people here, my friends and neighbors; including the doctors, nurses, respiratory therapist, EMS providers, and other hospital staff. First of all, the readiness, spread, responses, and resources deployed during the coronavirus pandemic will be scrutinized in agonizing detail for years to come. Everyone with an opinion will express it. So-called experts with the benefit of 20/20 hindsight will write articles, have podcasts, and make Facebook posts about what should have been done.  This week as citizens hold demonstrations in Tennessee as well as in neighboring states and as officials make plans for reopening businesses, questions abound about whether it's now time simply to get back to work or if it is too soon to do so. There are no clear answers. In this time of uncertainty, few courses of future action are crystal clear. But the past few weeks have now given us enough time to figure out a few things that work and point to what may be necessary at least in the coming weeks.  What is apparent is that timing matters: how quickly a state or area responded initially to the spread of the coronavirus made a big difference. For instance, California was the first state to implement stay at home guidelines. Despite being the most populous state in the country with several large urban areas, they have had a comparatively low COVID-19 death rate: they are ranked twenty-ninth in the country. New York, which waited to implement similar guidelines, is now the epicenter of the COVID-19 outbreak with more than 37% of all US COVID-19 deaths. In fact, Northeastern states in general have not fared well with about two-thirds of all COVID-19 deaths in the US occurring in those states.   Tennessee’s “safer at home” order came on March 31st. Unknowingly, I saw my first positive coronavirus patient in the Holston Valley emergency department ten days before that on March 21st. He had no known contacts, no recent travel, and no fever or cough. When admitted to the hospital, he had symptoms that were atypical for the disease. His shortness of breath, in part, was chronic secondary to congestive heart failure. His condition worsened in the following days while in the hospital. A week later his COVID-19 test result came back positive. It was only then that we knew spread without our community had been going on longer than previously suspected.  More recently, a patient came to the ER with typical COVID-19 symptoms including fever, cough, and body aches. She worried that she was infected with the coronavirus and, as a healthcare worker, could infect others. She had classic yet minor symptoms at the time which did not require hospitalization. She was tested and sent home to self-quarantine, monitor her own symptoms, and await lab results.   “What about my kids and family members who came for family dinner yesterday?” she asked while getting discharged. “Should they get tested, too? Should they also self-quarantine?”  I told her for now they should avoid contact with others until her test results were available. I also told her that anyone she had recently been in contact with needed to be carefully monitored for any symptoms, but not to become alarmed since it appears that most healthy children are at low risk for serious symptoms. While potentially worrisome, there was no cause for panic. The coronavirus is highly infectious so it was always going to affect even small towns and rural areas. It is easy to label precautions as overblown if the only cases we read about are in places like New York City, Florida, or Califionia. But they are here, too. No doubt the Governor’s “stay at home” order had an impact on reducing the spread of the disease in my state along with other measures such as hand washing and social distancing. Rather than being unnecessary, in all likelihood thousands of us have been protected by these timely measures. The pandemic is not over. A surge of cases could still occur here. Safe economic and health related recovery efforts are critical to protect the most threatened members of our community. As businesses reopen and the economy begins to shake off the coronavirus effect, a few actions can help all of us.  Continue to practice social distancing. A popular national outdoor chain has long promoted the slogan: “Get Outside.” I couldn’t think of a more appropriate treatment plan as restrictions are relaxed. We can get outdoors and explore one of Tennessee’s 56 state parks with its 1,100 miles of trails and over 80 waterfalls.  These parks, trails, and waterfalls are often overlooked by local residents. Yet, these state parks have unique outdoor activities and colorful hiking trails. In fact, Tennessee was awarded the gold medal for state parks a few years ago and has repeatedly been a finalist for this same annual award. The basic health benefits of getting outdoors and exploring nature are well-established. Let the natural environment inspire and renew us. It is easy to keep your distance from other while outdoors.

Currently Tennessee State Parks have reopened with restrictions in place including daytime use and social distancing distancing guidelines.

Those with compromised immune systems should stay home and let the rest of us carry the workload for a while as the economy recovers. This is a time for those with health concerns to remain at home for an extended time period while  those who are younger and in good health can cautiously return to work and begin to revive the economy. Reopening business and restarting the economy in phases will help mitigate any widespread community outbreaks and allow health care workers to monitor the effects of various actions as they occur. Caution is still vital when uncertainty dominates and much is still unknown about the transmission of this disease.  In the meantime, Spring is here and hope springs eternal. Get outdoors!

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