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Madigan Army Medical Center on Joint Base Lewis-McChord, Wash., first published a story on COVID-19 in January. The virus has consumed every day since; and it rages on. Where does that leave a pandemic-weary world?
As we head into the holiday season where people are yearning to gather with family and friends, and behave as normally as possible, medical professionals are encouraging caution and vigilance.
On November 15, Washington's governor instated heightened restrictions statewide in an attempt to reduce infection rates and avoid the overburdening of medical facilities and staffs.
"We're going into a precarious situation," said Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, in a livestreamed interview with Dr. Howard Bauchner, editor of the Journal of the American Medical Association.
As the weather chills and people spend more time indoors and in closer quarters with one another, the opportunity for this virus, or any virus, to spread increases. Add to that the interest in getting together with loved ones who do not live in the same household and there is real cause for concern.
"You get one person who's asymptomatic and infected, and then all of a sudden, four or five people in that gathering are infected," said Fauci. "To me, that's the exact scenario that you're going to see on Thanksgiving."
The Numbers
COVID-19 cases and hospitalizations are soaring throughout the country, including in the Pacific Northwest. With current numbers of more than 141,000 confirmed cases and 2,600 deaths in the state of Washington and over 12 million cases and 255,000+ deaths in the U.S., the numbers are increasing at a record-breaking pace.
Possibly the last thing medical personnel who have been dealing with a very infectious virus all year need is overwhelming numbers of people sick with either COVID-19, or influenza, which is also a big concern now that cold and flu season is here.
The Centers for Disease Control and Prevention estimates that during the 2019-2020 season, influenza was associated with 38 million illnesses, 18 million medical visits, 405,000 hospitalizations, and 22,000 deaths. Influenza is not to be ignored, especially in older and medically-vulnerable populations.
Madigan's Preventive Medicine, which has been responsible for contact tracing of exposures on Joint Base Lewis-McChord, Wash., has found that causes for transmission of COVID-19 in the on-base community are similar to the greater community where social events spread the virus.
“We're seeing transmission among small social groups; it's not necessarily at big events. It's things like dining together in restaurants or in homes, people are perhaps not distancing, not using masks," said Lt. Col. (Dr.) Luke Mease, the chief of Preventive Medicine at Madigan, at a JBLM town hall.
For an already exhausted society to try to keep these illnesses from claiming more lives is daunting, but now is not the time to let the guard down.
Allergies vs. Cold vs. Flu vs. COVID-19
One way to reduce the strain on hospitals and clinics this time of year is to recognize the difference between allergies, a regular cold, the flu and COVID-19. Consult the graphic for symptoms.
Another route to both maintain health and decrease stress on the health care system is to get a flu vaccination.
Flu Vaccine
According to the CDC, recent studies show the influenza vaccine reduces the risk of flu illness by between 40 and 60 percent. Each year, a different vaccine must be formulated to tackle the dominant strains of influenza emerging. The high number of strains and variables in terms of how they will affect any given population deflates efficacy compared to a single illness vaccine like what is used for polio, for example.
Service Members and civilians have a variety of options to get their flu shot, to include at a regular medical appointment, through a clinic or flu drive in their unit, at one of Madigan's flu drives or at a clinic or pharmacy off base. Watch Madigan's official Facebook page for more information on on-base options, to include drive-thru events, by visiting: https://www.facebook.com/MadiganHealth/ or Madigan's website at: https://madigan.tricare.mil. Watch a video with Madigan's chief of Preventive Medicine, Lt. Col. (Dr.) Luke Mease on flu vaccine info here: https://www.facebook.com/MadiganHealth/videos/1582192658619456.
To find community options, Tacoma-Pierce County Health Department is sponsoring drive-thru vaccine events as well. Check www.tpchd.org/flu to find information.
Non-Pharmaceutical Interventions
Though some of the specifics about how strict to be with different interventions have changed over time, the basics of how to respond to this virus have not. The three “W's" serve us well. These are all measures we have heard again and again throughout this pandemic, but it is easy to be lax with them. It is important to recognize that these measures should be exercised in tandem as no single one provides nearly the protection that all three do together.
Wash your hands
Try an experiment. Spend the next hour being hyper aware of your hands. What do you do with them? What do they touch? What do they get on them? Do you touch your face? Do you wash them at all in that time? It is surprising how much our hands get into each and every hour of the day. Good hand hygiene is known to reduce the spread of germs.
Frequently wash your hands for 20 seconds, or twice through singing the Happy Birthday song, with soap and warm water. Vigorously scrub them together and make sure you cover every bit of them, including under the nails. When soap and warm water are not available, a hand sanitizer with at least 60 percent alcohol will do the trick.
For a video tutorial, check out Madigan's own Preventive Medicine doc, Col. (Dr.) Paul Faestel by visiting Madigan's Facebook page here: https://www.facebook.com/293304441350/videos/224547312130222
Watch your distance
“Spread happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. The droplets can also be inhaled into the lungs," instructed the Centers for Disease Control and Prevention. “Since people can spread the virus before they know they are sick, it is important to stay at least six feet away from others when possible, even if you—or they—do not have any symptoms."
What does six feet look like? Here are some common things that give a good idea of what six feet is:
two golden retrievers nose to tail; the length of a twin or full-size bed; a standard, three-seat sofa; or two shopping carts.
Wear a face covering
When medical personnel are performing procedures where they can come in contact with bodily fluids, they don personal protective equipment – PPE – in the form of gloves, gowns and masks. These masks, typically the N95 variety, have a higher level of filtration than those recommended for the general public. But, simple cotton face coverings can be very effective.
“The CDC recently released a science update highlighting that masks are protective to us, as well as to others," said Lt. Col. (Dr.) Luke Mease, the chief of Preventive Medicine at Madigan. “So, we wear our masks to show our respect for others, but also all of us can wear this to protect ourselves."
One of the reasons masks are so important is that people can spread the virus without even knowing they were exposed to it, before they become sick, and even if they never get sick themselves. Masking puts a barrier between you and others so that whether anyone appears sick or not, the free flow of any droplets is restricted.
To learn more about masks, to include selecting and caring for one, visit this CDC page:
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html.
Overall fitness
In addition to the 3W's, maintaining overall fitness is a good way to combat any illness, to include infections like COVID-19.
“It's so important for us to stay physically active and physically fit. It helps us prevent infection, both COVID and other types of infection. We feel better; it is good for our mental health. So, absolutely all of us need to find ways to stay fit," said Mease.
Stay at Home
Humans are social creatures. As such, the need to be around other people cannot be hampered long without repercussions.
Vice Adm. Jerome Adams, the surgeon general of the United States, and Lance Robertson, administrator for the Administration for Community Living, writing on the U.S. Department of Health and Human Services blog, offered some insight.
“Research tells us that social isolation can threaten health, and regular social interactions and having a strong personal network are important to a person's mental and physical health, resilience, and longevity," they wrote. “Health concerns stemming from social deprivation include high blood pressure, sleeplessness or less restful sleep, anxiety, depression, and thoughts of suicide. In addition, lack of human interaction may increase hormone levels that contribute to inflammation and weakened immunity, thereby increasing the risk of diseases." The article that can be accessed at: https://www.hhs.gov/blog/2020/09/10/harnessing-technology-to-address-loneliness-and-social-isolation.html.
The holidays are a time of particular interest in social activities, and gatherings among family and friends are a central part of traditions. This year, the potential to spread disease should be weighed heavily.
Like many other states, in the state of Washington, the governor has prohibited indoor social gatherings with people from outside your household unless additional quarantine and testing is performed prior; and outdoor gatherings are limited to five people from outside the household.
These, and all state guidance, can be found at: https://coronavirus.wa.gov/what-you-need-know/safe-start/whats-open-each-phase.
Recognizing that the holidays may be the only time Service Members can see family in a year, Lt. Gen. Randy George, the commanding general and I Corps commander, has chosen to allow already approved leave requests, but a 14-day restriction of movement following out-of-state travel must be observed.
Whatever choice is made, the 3W's are essential.
COVID-19 – Accessing Care
When symptoms point towards COVID-19, it's time to consult your care team. If possible, it is best to communicate with them before heading to a facility.
MHS Nurse Advice Line
You can contact the Military Health System Nurse Advice Line at 1-800-784-2273 to ask questions and get information about your symptoms and options for evaluation.
MHS GENESIS Patient Portal
Sending a secure message to your provider and care team is easy with through your Patient Portal account at: https://patientportal.mhsgenesis.health.mil.
Puget Sound Military Appointment Center
If you feel it is time to schedule an appointment, call 1-800-404-4506.
You may see your doctor at Madigan in person, if that is best, or virtually. Telehealth appointments can be conducted using video applications or by a simple phone call. The type of interaction you have with your provider will depend on needs, timing and risk.
COVID-19 – Testing
“There are several places that Soldiers can go get tested," said Col. (Dr.) George Leonard, Madigan's chief medical officer at the JBLM town hall. “One of them is being tested in the community, which you can do, but there may a payment associated with that."
He added that the most common testing location for Service Members who are showing symptoms is the testing tent that Madigan has been operating throughout the pandemic.
“You also could get tested there if you're identified as a close contact by one of our tracing teams for somebody who was symptomatic," Leonard said, adding that any directed testing, such as for personnel on orders for TDY, is also authorized for testing at the tent.
Leonard noted that those who cannot get tested at Madigan's tent are those who are asymptomatic or who are testing ahead of personal travel. These situations can be addressed at testing facilities off base, which is where civilians need to go with a few exceptions.
“COVID testing is authorized for civilian employees who may have an occupational contact to COVID. So, if here on base, you're working, and you're potentially exposed and referred by one of our contact trace teams," said Lt. Col. (Dr.) Luke Mease, the chief of Preventive Medicine at Madigan. “Similarly, DA civilians who are PCSing or TDY and have official PCS or TDY orders, are authorized testing."
COVID-19 Positive Care
If you have been exposed to COVID-19 and have symptoms, reach out for testing. If you believe you have been exposed and have no symptoms, quarantine. If you have been tested and are positive, isolate.
The Centers for Disease Control and Prevention details what each of these terms means.
“Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. Isolation separates sick people with a contagious disease from people who are not sick," explained the Centers for Disease Control and Prevention.
Many people who become sick do not require hospitalization. But, to keep others around them healthy, they need to isolate, even in their own homes. Separate from others, using separate spaces for eating, drinking and toileting. They should not share food or utensils, and should wash hands and disinfect surfaces frequently.
Communicate with your doctor, especially if you have a chronic condition, and monitor your health overall. COVID-19 has shown to exacerbate chronic conditions, reveal underlying ones or develop long-term effects. Stay on top of any changes in your health and share them with your provider.
Impacts and Resources
Whether you or a loved one has become ill with this virus or not, COVID-19 has had a pervasive effect on our entire society. The need to maintain heightened attention and awareness for months on end is tiring, regardless of initial health condition or role in this pandemic. Frontline workers like nurses, housekeepers and others who provide care, and in-person support in the medical response to this disease have been hit hard by the demands related to COVID.
Continued vigilance in practicing the basics – the 3W's and staying home whenever possible – is necessary. But, do not compromise your other health needs in the process.
“We urge our patients to not delay or avoid routine appointments, checkups, exams and vital screenings that potentially could detect life-threatening conditions. For any patients previously-diagnosed with any chronic health care conditions, such as heart disease, diabetes, kidney disease, hypertension or any form of cancer, staying continuously engaged with your healthcare team is vital," said Leonard in a recent video that can be viewed on Madigan's Facebook page at: www.facebook.com/MadiganHealth.
Leonard also encouraged everyone to seek the support they need to address the emotional and social toll this pandemic has taken on many of us. For Madigan patients, behavioral health professionals are always ready to talk with you. Madigan staff can also contact the Department of Behavioral Health to learn about resources to aid them as well. Anyone can find support in the community too.
Mental/Behavioral Health Resources:
Substance Abuse and Mental Health Services Administration's national helpline: 1-800-662-HELP
U.S. Department of Health and Human Services: https://www.hhs.gov/coronavirus/mental-health-and-coping/index.html
CDC: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
Washington State Department of Health: https://www.doh.wa.gov/Emergencies/COVID19/HealthcareProviders/BehavioralHealthResources
Thurston County: https://www.thurstoncountywa.gov/phss/Pages/covid-19-resources-mentalhealth.aspx
Hope on the Horizon
In the past couple of weeks the news has come out that multiple vaccine trials are producing encouraging results. With upwards of 90 percent efficacy and initial reports of few reactions, a viable vaccine could be available to some parts of the population before year's end.
Frontline health care workers and high-risk individuals would likely receive a vaccine first, with a rollout to the general public in the following months.
The federal government's Operation Warp Speed has brought experts together to develop a vaccine and a plan to distribute it at a rapid pace.
Dr. Moncef Slaoui, chief advisor for Operation Warp Speed, explained in a press conference on Nov. 18 the factors that have allowed a quicker pace for the development of this vaccine than most.
“We took financial risks to invest in parallel in very large clinical trials, as well as in manufacturing, before we knew whether these vaccines, would be effective or not," Slaoui described. “The trials are about two, three, maybe even four times larger than what's required normally. The reason we've done that was to be able to accrue enough cases faster by having more people into the trial. But the other reason we have done that is because by running larger trials, we're able to document the safety of these vaccines on larger populations, then have higher confidence in their safety before we use in the population."
Slaoui also pointed out that trials and follow-up will continue after the vaccine gains emergency use authorization from the U.S. Food and Drug Administration. This continued research will confirm safety and efficacy that have been seen thus far, and track any concerns that may arise.
Lt. Col. (Dr.) Luke Mease, the chief of Preventive Medicine at Madigan, expressed his view on the approach being taken in developing the vaccine, and addressed safety specifically at the JBLM town hall.
“I would say that the data suggests that it's happening appropriately; all the timelines are being met. Prominent national experts are backing this and saying, 'Yeah, the FDA is taking the right steps, things are moving the right way,' so I think we can be confident," opined Mease.
The military has been engaged in planning for distribution of a vaccine for months.
U.S. Army Gen. Gustave Perna, chief operations officer for Operation Warp Speed, discussed, in the aforementioned press conference, the expectation for getting the vaccine into American arms.
“We will begin distribution of the vaccine within 24 hours after emergency use authorization is approved," he said. “Every jurisdiction will have access immediately."
He explained the distribution plan is broken into 64 jurisdictions, those being the 50 states, 8 territories and 6 metropolitan cities.
Following the introduction of the vaccine, “We will begin a weekly cadence of delivery of vaccine," said Perna. “So, initial push and then continuous cadence of delivery of vaccine to ensure that we rapidly expand the availability to the entire country."
These videos can be found online in the following places.
The video produced by the U.S. Department of Health and Human Services entitled, “Tell Me More About Vaccines" with Dr. Anthony Fauci and Dr. Stephen Hahn, FDA Commissioner and other HHS leaders that can be viewed at: https://youtu.be/Z06JQhyZLUI. This explains how vaccines are developed in general, and how the COVID-19 ones are being trialed and manufactured simultaneously in order to speed their eventual delivery to Americans.
A link to the press conference with HHS Secretary Alex Azar, Slaoui and Perna, discussing vaccine development and distribution planning can be found within an article on the Department of Defense website called, “Officials Optimistic About COVID-19 Vaccines in Near Future." That can be accessed at https://www.defense.gov/Explore/News/Article/Article/2420190/officials-optimistic-about-covid-19-vaccines-in-near-future/.
End in Sight
This year started with little indication of what was in store. Madigan and the Military Health System have answered the unusual call that this virus has presented with adapted operations, to include vastly expanded virtual health care, a constantly engaged staff, even when working remotely, and plans to deliver vaccine as soon as possible to stem the tide of illness and death from COVID-19.
After a year of physical, mental, emotional, professional, social and financial hardship for the world and certainly the U.S. from this virus, a real turning point is within view.
Perna, in discussing military delivery of the vaccine to the waiting nation, could have easily been talking about Madigan and the JBLM community's response to the virus itself.
“It is a large task, but it is a task that we are up for," he said.
| Date Taken: | 12.02.2020 |
| Date Posted: | 12.31.2020 23:57 |
| Story ID: | 386362 |
| Location: | TACOMA, WASHINGTON, US |
| Web Views: | 108 |
| Downloads: | 2 |
This work, COVID-19 continues to challenge, by Kirstin Grace-Simons, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
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