CEO Blog

 

Evergreen Family Medicine's Response to the Coronavirus

I am writing to share Evergreen Family Medicine’s response to the coronavirus pandemic and address misinformation posted on social media sites.

As of today, there has still been only one documented case of COVID-19 in Douglas County but I believe there will be more identified as we actually test for this disease. The one identified in the press does not work for Evergreen Family Medicine. But if they did, we would openly support that person since a pandemic is not the fault of any individual. Additionally, health professionals and staff at Evergreen who are ill for any reason are asked to remain at home and not risk exposure to our patients or community. 

I am grateful of Evergreen Family Medicine’s team of professionals and staff who have acted in innovative ways to serve our community.  Below are some of the positive steps that Evergreen have taken to meet the challenge:

  1. We continue to be an important access point for health care in our community.

  2. We are offering car waiting and triage to isolate ill patients from our waiting rooms.

  3. Masks are being placed on ill patients outside the clinic setting before entering the building to receive more care. 

  4. Designated spaces within our clinic are being used to evaluate patients with respiratory complaints.

  5. We are sending Evergreen personnel to nursing homes and assisted living facilities, as those entities are on lock down and we want to reduce exposure to this vulnerable population.

  6. We have increased physician staffing for hospitalized patients.

  7. We are initiating tele medicine visits to see patients in their homes.

  8. Evergreen is using personal protection equipment judiciously but appropriately.

  9. Evergreen members have volunteered in so many ways in our community – including staffing the public health hotline.

  10. Our staff has recently handled over 4,000 Evergreen calls/day to address questions and concerns of our patient community.

  11. The above measures have reduced the demand on important hospital emergency resources.

English philosopher, Francis Bacon wrote in the 16th century of his observation that persons with fortitude will not be shaken by adverse changes in their circumstances whereas a person who is fearful will suffer much. I recognize there are a lot of people selling fear right now.  It is not helpful.

There will be a marked increase in the number of COVID-19 cases identified going forward because we are just now rolling out more testing capacity.  This does not necessarily mean we have a nation-wide spike in cases of COVID-19.  It likely means that we are just better at identifying the disease.  The virus has already spread across the United States.   Hopefully, in the coming weeks, we will have an antibody test to better gauge the true denominator of this disease- including those who experienced no or minimal symptoms.  If that is the case, we will likely understand publicly that the mortality and morbidity rates are overstated by the World Health Organization and CDC. It is understood that there has been an adverse selection bias in our previous CDC testing process.  I hope that antibody testing will also provide reassurance to those who have immunity and we can deescalate our quarantine efforts soon.

In the meantime, it is important to keep our most vulnerable safe and use reasonable precautions to reduce the spread of disease.  Evergreen will remain a community partner to help weather this storm.  At this time, I would urge everyone to support our local businesses and temporarily unemployed persons as they are impacted by the significant but hopefully brief, disruptions to our economy.

Sincerely,

John Powell M.D.

 

 

Anti-Vaccination - Fear or Complacency?

 

The 2019 Samoa measles outbreak began September 2019.  By Christmas on this small island of 200,000, over 5,600 confirmed cases and over 80 deaths of children had occurred. The outbreak has been attributed to a sharp drop in measles vaccinations from the previous year.

How many times will we repeat history? Is it fear or complacency that is responsible for a parent’s decision not to vaccinate?

I have found it is both, but apathy plays the heavier hand. It is not so much these folks do not believe in vaccines as they do not believe in the disease. At least, they do not believe it will happen to them or those they love.

This is a tragic mistake. In 1900, the average life span in North America was in the 40’s. Most of the shortened average was due to childhood death rates. Vaccines, antibiotics and public sanitation account for most of the improvement to the current average life of nearly 80 years. And vaccines arguably have played the greatest role.

Not many would reject antibiotics for an abscessed tooth or pneumonia. Few would dismiss the importance of fresh clean water and flush toilets. Why the ambivalence toward vaccinations?

Because vaccines have been so very effective, many parents have not seen a case of a vaccine-preventable disease first hand. Those who choose not to vaccinate are afforded protection because there are enough parents who do – until there isn’t. See Samoa.

Fear can be addressed by education for those willing to listen. Your child is 100 times more likely to be struck by lightening in his lifetime than to have a serous allergic reaction to the vaccine that protects against measles. And the MMR absolutely does not cause autism.

Complacency or obstinacy is more difficult. A 6-year-old Oregon boy was playing on a farm when he suffered a mild simple forehead laceration. Six days later the physical expression of tetnus began. The boy, who had not received vaccinations was taken to Oregon Health Science University. He spent 57 days in the hospital and racked up medical bills of over $800,000. He then had an extensive rehabilitation center stay before going back home. But he was a rare person to have survived tetnus.

Despite extensive education of the risks and benefits of vaccinations, the family declined the second tetnus booster – or any other recommended immunization. How do you fix that?

An anti-vaccination person at an EFM town hall, who had no medical training but surfed the internet, declined to accept data from the CDC, WHO, AAFP, AAP, etc. He kept repeating “everyone should do their own research” He came from a family of electricians. I could not help but wonder if the same standard should apply to folks wiring their own home. Should we stick two wires together and see what happens?

I have found that one of the important life decisions is to decide who you will trust. If I cannot convince a parent that it is worthwhile to have their child vaccinated, I will never convince them of any medical decision. Because any other issue will have far less evidence to prove its value.