Call to action

By Marc Mentel, D.O. (Physician), President, Montana Medical Association

The entire planet is facing the outbreak of the COVID-19 virus and now it is in Montana. Make no mistake, this is a very dangerous virus and it creates an extremely challenging and stressful time for all of us. We currently have two options: shrink away from the challenge and give in give in to panic, or lean into the challenge and rise above our primal fears. Fortunately, your local public health system is built to take action in times of a pandemic. You are encouraged to follow their guidance as what we do today can have long lasting effects for all Montanans. We are not powerless, and we can exert control over the course of this disease outbreak. 

As Montanans we are already familiar with the basic concepts of fighting viral outbreaks, because we have already learned how to live with wildfire and combat it when it occurs. The essential steps for fighting a viral outbreak during viral season are no different from fighting fires during fire season. First, PREVENT the possibility of fire, second CONFINE the fire, third PROTECT high-value targets, fourth reduce COLLATERAL damage, and lastly establish a centralized fire control CENTER. Remember, all fires will burn out when there is no longer any combustible fuel to consume. Viruses are no different. So, let’s apply these principles to the COVID-19 viral outbreak. 

STEP 1: PREVENTION 

During fire season we make sure the areas around our homes and property are free from as much combustible material as possible. Fighting viruses during viral season is no different. You want to prevent the virus from getting a foothold in the first place. Wash your hands frequently, use hand sanitizer with at least 60% alcohol, wipe down surfaces that could harbor the virus, cough or sneeze into your elbow, and avoid touching your face, eyes, nose and mouth. Since schools put a lot of combustible fuel all in one place, school closures are one of the most important prevention measures being undertaken. 

STEP 2: CONFINEMENT 

Once a fire breaks out, it is all hands-on deck time. All resources are directed at the front line of the fire to keep it from spreading. We create fire breaks, drop fire retardant, drop water and send in hotshots to the front line. To combat COVID-19 we use the principles of self-isolation and quarantine to confine the virus and keep it from spreading and send in health care professionals. 

Our current challenge with fighting COVID-19 is that we can’t see the edge of the fire line. Due to the nature of the virus having a five to seven-day incubation period before symptoms present and not having enough testing kits to test asymptomatic individuals, many of us may have the virus and may be spreading it while appearing well. Once someone comes down with the virus, we are now finally able to visualize where the fire line was five to seven days previous, but we can’t tell where it may have spread. Right now, we need to assume that the fire could be anywhere. However, this does not mean we are powerless. There are a lot of things we can do. 

The most obvious, stay at home if you are ill and call your health care provider to see if you might have symptoms consistent with COVID-19 or might have symptoms that require medical attention. Follow your provider’s recommendations. If you are asymptomatic, work from home if you can. If not, maintain social distancing about six feet apart from co-workers. Order your food to go and try to use delivery as much as possible. Avoid large gatherings, public areas, and keep travel patterns consistent and minimal. This way if you do come down with COVID-19, health care professionals can better track your pattern over the past five to seven days and create a fire break. 

STEP 3: PROTECTION 

When a fire breaks out, special efforts are made to protect high-value structures such as homes, historical features, and unique natural areas. During the COVID-19 outbreak, the elderly, those with underlying health conditions, and those with a suppressed immune system, are our high-value populations. These individuals have a much higher mortality should they develop the infection. Special efforts need to be made to protect this population. So, if you are not feeling well, and to avoid accidently infecting others, stay away from nursing homes, hospitals, emergency rooms, health care facilities, or any place where high-value populations are present. The only time to disregard this information is if you are directed to these facilities by a health care professional. 

STEP 4: Prevent COLLATERAL Damage 

If a fire breaks out in a theatre, there are two possible outcomes when someone yells “Fire!” The first outcome is that everyone leaves in a calm and orderly fashion and those that need help to exit get the help they need. The second outcome is that everyone panics and half of the moviegoers are trampled. Those trampled are most often the most vulnerable in our population. Make no mistake, we are at that stage of panic as evidenced by runs on food and toilet paper. 

I am asking for a “call to action” for all Montanans to remain levelheaded and act in a calm and orderly manner. Our success in navigating the COVID-19 pandemic and preventing a second wave of death from trampling others is dependent on our actions today. I am asking for everyone to enact the buddy system and check in on family, friends and neighbors. While we are in the midst of the COVID-19 pandemic, let’s not get so singularly focused and forget that influenza, pneumonia, heart attacks, diabetic complications, congestive heart failure, chronic lung disease, strokes, asthma, accidents, trauma, suicide, drug overdoses, etc., still remain some of our biggest health threats. As opposed to holing up in our homes and barricading ourselves from society, our efforts might be better served to check in on an elderly neighbor and make sure they have plenty of medications and food so they don’t need to venture out and possibly get exposed to COVID-19. 

STEP 5: Centralized CONTROL Center 

During a forest fire, a centralized command center is set up to keep communication coordinated, concise, and accurate to avoid confusion and prevent accidents. Right now, the centralized command centers are the Centers for Disease Control (CDC), the Department of Public Health and Human Services (DPHHS), and your local Health Departments. These are the experts with the most knowledge and the most up-to-date information to coordinate our resources to combat the COVID-19 infection. For example, if you are having a heart attack do you go to FOX, CNN, MSNBC to find out what to do? No, you go to the ER and get seen by a cardiologist. Do the same with this pandemic and utilize our specialists at the CDC, the DPHHS and your local health department to get clear, concise, accurate, and up-to-date information. 

In closing, you might ask what am I going to do tomorrow? Well, I have already cancelled my travel plans to New Orleans and Denver for medical conferences. I am going to wake up, take my dogs for a walk, and shower. Next, I am going to check my local hospital and public health department, CDC and DPHHS websites and follow their most recent recommendations and go to work. Once at work, I will man the phones to provide guidance for my patients to see if they need to be seen in person or if they can stay home. I will wash my hands frequently, wipe down surfaces frequently with anti-viral products, visit with patients who need to be seen in person, and refill medications for my patients. Since I have telehealth capabilities in my clinic, I will do as much with my patients as I can over the internet. On my way home, I will pick up a pizza using the drive through. I will check in on my elderly neighbors, make sure they are doing well and see if they might need any help. I might make some phone calls to family and friends to maintain my social contacts. To close out the night, I will stay in for entertainment and binge on a Netflix series. If I get sick, I will call my doctor and see if I need to be seen in person or not. Stay safe, stay calm, and remember to look out for one another. We are all in this together, and we will get out of this together.