Investments in health infrastructure that address the need of the solo practice, small to medium size healthcare provider groups often play catch-up in a for-profit system controlled by large corporations and insurers and a government that often hands down laws and regulations that can be selectively punitive on these groups, leaving a swat of primary care providers at a subsistence level, to fend, scavenge in what might sometimes look like a rat race  mixture of MDs, DOs and NPs etc. This is in spite of the fact that time and time again it has been proven that these healthcare and primary care providers (HCP and PCP) are an indispensable group in the health of a nation and worse still will now come into the frontline of a fight against an outbreak as the deadly rapidly evolving COVID-19, that now is in a community transmission phase. As we watch history repeat itself, large organizations, corporations ,Wall Street, Airlines etc. both government and private, have put in place early measures to address the pandemic, implementing programs geared primarily towards mitigating economic losses (as is in the case of most large corporations in private sector) and secondarily to protect staff and public. But the little man HCP and PCP industry who is at the frontline is often ill-prepared, having been left to fend for himself or herself. This group will confront choices, in an effort to keep their Hippocratic oath go on to source and maybe borrow to make available resources needed to keep their doors open to patients and at the same time reduce the risk of contracting and/or passing a deadly virus to his/her poor patients and staff or to shut down the office. And while they may be denied reimbursement of services offered to patients even in these circumsatnces by the insurance companies and third party payors, the role of these frontline providers cannot be underestimated, the least of which is to relieve the pressure on resources that would otherwise be placed on our system at the Emergency Departments, at the secondary and tertiary care levels where the sickest have to be managed. Frankly, a decision to shut down when and if a provider cannot scale to provide the necessary conditions to ensure safety of staff and patients, is the right decision well within the interest of patients, staff and larger community. It is a moral duty and the ethical thing to do. And very often there is no capacity to scale and allocate required and appropriate resources and funds in order to follow accurately the simple CDC guidelines however simple it is made to appear. This predicament that confronts the small, solo and medium practices replays itself time and time again as we saw when there was a requirement to implement the EHR system years ago. Unlike the EHR example the HCP and PCP's life and that of patients and staff depend on observing these life saving guidelines as issued by the CDC to the letter and keeping a close tab on local health directives as we watch the epidemiology of COVID-19 evolve. It is now that these groups must think through these scenarios and be prepeared to take the correct actions.

https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

At the time of our first post a month ago, COVID-19 (formerly known WN-CoV infection) over 6000 cases and 132 deaths were reported. The now renamed virus infection is worldwide, has infected more than 92,000 people and led to more than 3,200 deaths. It has touched all the continents, affecting over 70 countries, causing the World Health Organization to issue that the outbreak has reached the "highest level' of risk for the entire world. We now know that the virus is here in the USA and with strong evidence that there is community spread of the infection with at least four of US cases having no travel-related history. The United States has just announced its very first death in the US at the time of writing this post.  California reported its second case on Friday February 28th 2020, and this was followed hours later by cases reported in in Oregon and Washington. Amidst efforts to contain transmission, treat infected patients and the evolving understanding of COVID-19 epidemiology including the immunologic status of persons who have recovered from infections viz-a-viz transmisibility, there are those that have concluded that this outbreak meets the criteria to be described as a pandemic. Particularly now that we are faced with community spread of the COVID-19 virus in the USA as well as other parts of the world, primary care providers are at the front-line and can be the first port of call for an infected patient, hence they are at increased risk of exposure to and infection with COVID-19. That said, their vigilance and actions will make huge difference in containement efforts, stemming transmisson, protecting themselves, staff and the public. Educating staff and patients about the Wuhan coronavirus infection, the symptoms of the disease which includes fever, runny nose,sore throat, cough and difficulty breathing, is paramount. Knowing what to do even in the most remotely suspect-case and following the CDC published guildlines is critical to protecting staff, oneself and the public at large. General tips regarding potential encounter with COVID-19 infection remain valid. High level of suspicion and early identification of potential cases calls for elucidating answers to questions regarding recent travel to China, Italy, Iran, or South Korea. Not the least important is elucidating possible contact, household or workplace history etc early in the encounter of any suspect case. While travel history remains important, with community spread established now, the absence of a positive travel history does not rule out the COVID-19 infection. CDC website provides constantly updated and important guidelines on how to continue to approach this rapidly evolving outbreak of respiratory disease . Telephone or telemedicine encounters and interviews offer unique opportunity to engage, triage and evaluate a patient with respiratory symptoms and determine best setting for additional evalaution and how to recieve additional care before any physical contact with healthcare staff or members of the public may happen with a potential COVID-19 case.

https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

https://www.ecdc.europa.eu/en/novel-coronavirus-china

As the world faces yet another respiratory virus infection outbreak in China with over 6000 cases and 132 deaths at the time of this post , Primary care providers’ vigilance can make huge difference in stemming transmission to the next victim and protecting the public in places far away from mainland China. Educate staff and patients about the Wuhan coronavirus infection and symptoms of the disease which includes fever, runny nose,sore throat, cough and difficulty breathing. Here are some tips regarding potential encounter with WN-CoV infection.  Identifying potential cases as soon as possible, those persons with respiratory symptoms, questions regarding recent history of travel to China when booking patients is critical . This very important initial screening can often be accomplished during that booking encounter over the phone.
Preventing exposure and transmission of infection to staff and patients is paramount in potential cases.
Ensure potential cases avoid using public transport or taxis to get to the hospital
Avoiding direct physical contact during examination or exposures to respiratory secretions
Isolate suspected cases in a room away from other persons.
If a potential case is identified during a consultation, leave the room, wash hands, and prevent others entering the room. Continue the consultation by phoneand inform local Health authorities. .
Do not permit the patient to use shared amenities including toilets
If transfer to hospital is required, best to alert the emergency room and transportation before moving patient with potential WN-CoV infection.

References:

https://www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-case.html

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200122-sitrep-2-2019-ncov.pdf

https://www.ecdc.europa.eu/en/novel-coronavirus-china