Category Archives: Pandemic

COVID-19 at Altitude Update

This is a Corona virus update from Children’s Hospital of Colorado and Ebert Family Clinic as of March 27, 2020.

Dr. Chris attended the weekly Children’s Hospital providers update webinar last night.  The good news is that the number of admissions and outpatient visits for children with respiratory illness is down by 50% compared to this time in previous years.

Another hopeful report about COVID transmission is that only 10% of family members develop symptoms when someone in the household becomes ill.

Testing priority update:

  1. Hospitalized patients and health care workers with symptoms;
  2. People in long term care and/or over age 65 with underlying health conditions, first responders and those working with seniors AND symptoms;
  3. Others with milder symptoms.

Testing involves inserting a swab deep into the nasopharynx. This requires having the swabs, tubes, protective equipment for the care provider, test kits and coordinated delivery of the specimens. There are shortages in all these areas, along with the risk to the health care worker. Thus, in Colorado at Children’s Hospital and in Summit County there are very limited controlled locations where respiratory specimens are collected. Currently, this is at the Summit County Community Care Clinic at a station behind the medical office building.

Anyone needing a test or face-to-face exam for respiratory symptoms must call ahead to any of these locations providing care: 970-668-4040.

Both the American Academy of Pediatrics and the Center for Disease Control recommend we continue providing well child care to those under age 2 in order to maintain vaccination rates at a level that will reduce the risk of another outbreak, such as measles or pertussis. If the child or any family member has respiratory symptoms, the visit should be rescheduled.

Telehealth visits for everyone with mild or moderate respiratory illness are being offered at Ebert Family Clinic and most other facilities. Because the illness can rapidly worsen, even after five days, IT IS CRITICAL THAT YOU HAVE A PULSE OXIMETER TO MONITOR YOUR OXYGEN. Blood oxygen saturation level is a critical vital sign that greatly aids in medical assessment. You can obtain a pulse oximeter at any pharmacy or at Ebert Family Clinic: (970) 668-1616.

Most patients can be treated at home with oxygen if they have saturation readings in the 80’s or high 70’s, but a rapid increase in oxygen requirement, shortness of breath, and readings below 75% merit an evaluation in the Emergency Room. CALL BEFORE YOU GO! (970) 668-8123. 

Health care providers in the mountains can evaluate your breathing effort by phone and video, and order oxygen to be delivered to your home.

Ibuprofen is safe (barring allergy), and along with acetaminophen, are the only medications recommended to treat the fever and pain (headache, backache, earache) of COVID-19, according to the infectious disease experts at Children’s Hospital. Other medications mentioned in the news are experimental, used on very ill patients in the hospital, and could possibly make an individual’s condition worse.

COVID-19 at Altitude

I am here at the Ebert Family Clinic waiting for the Public Health nurse to arrive for our staff training. Our plan is to set up an outdoor facility to screen individuals for COVID-19, Influenza, Strep, and Respiratory Syncytial Virus, when symptoms indicate to do so. The guidelines are ever-changing, but we are staying updated on the daily, even hourly changes. We are following guidelines published March 15:

  1. If you have mild respiratory symptoms – stay home!
  2. If you have a fever over 100.4° with respiratory symptoms (cough), but no shortness of breath or trouble breathing – stay home! Testing for COVID-19 is reserved for health care workers or senior services at this moment.
  3. If you have a fever, respiratory symptoms and trouble breathing – call the Emergency Room to set up a time to be screened and examined. If symptoms are severe – call 911.

EVERYONE AT ALTITUDE MUST HAVE ACCESS TO A PULSE OXIMETER!

Pulse oximeters are available at pharmacies and most stores. If you are unable to find one, please let us know. Your oxygen saturation is the key to assessing the severity of your illness.

Respiratory infections (such as influenza or COVID-19) puts high altitude residents at higher risk for pulmonary edema. Symptoms of pulmonary edema are cough, shortness of breath, and an oxygen saturation below 89%.  Supplemental oxygen is the treatment, but it must be ordered by a physician.

Resources such as laboratory testing, x-rays, antibiotics and inhalers may be limited during this pandemic.  As a physician, I use clinical judgement when sending patients for additional testing and treatment. I will take extra caution when sending stable patients to the hospital if they can be treated without an x-ray or lab test, or when no treatment is available. I am conservative in prescribing inhalers to people without a clear indication in order to conserve these for patients with definite reactive airways disease that respond to these treatments (i.e. asthma). These individuals should make sure that they have their medications on hand.

Viral pneumonia and pulmonary edema look the same on an x-ray, and clinical standards of care do not require an x-ray for diagnosis. The health care provider will prescribe antibiotics based on clinical suspicion and risk factors since chest x-rays do not always indicate whether someone has pneumonia.

Eagle County has 50 confirmed cases, so far, and several who were severely ill had to be transferred to Denver. As Governor Polis stated, the small mountain hospitals will be quickly overwhelmed as cases increase. There will also be a time when the hospitals in Denver are full and cannot accept transfers.

Ebert Family Clinic will continue seeing patients for preventive care. Wellness visits are scheduled in the morning and sick visits in the afternoon. Patients are not left to mingle in the waiting room as they are taken immediately back into a room. If they wish, they may also stay in their car or outside until we are ready for them to be roomed. Specific rooms are reserved for well visits. Deep cleaning and sanitization is performed after all visits and at the end of the day.  We ask that you also take preventative measures, like covering your cough, staying at home, and washing your hands.

Dr. Christine Ebert-Santos and an MA assess a patient and test a sample for COVID-19 in the parking lot in front of Ebert Family Clinic, Frisco, CO.

Influenza vaccines are important and available. There are cases of combined COVID-19 and Influenza, both of which attack the respiratory system, which is serious. Other vaccines that also prevent respiratory illnesses, such as pneumococcal, pertussis and HIB, can be LIFE-SAVING! These important vaccinations are administered at 2 months, 4 months, 6 months, and 1 year of age. Adults over 50 should receive the pneumococcal and flu vaccines. Children under 18 years have not had severe cases of COVID-19, but they are very contagious, even when they have no symptoms.

If you or your child are otherwise well and do not need vaccines, it is reasonable to postpone contact with the medical system and to reschedule routine checkups.

Dr. Chris is always available on her cell outside clinic hours for advice and treatment to continue her epic and ongoing efforts to keep patients healthy and out of the emergency room.

Please monitor our Facebook site for updates from our viewpoint.  Read our blog for a wealth of information on living in a low-oxygen environment, including interviews with local physicians practicing here for 20-30 years.