15/03/2020
Notes from The Dolhun Clinic
Overview
Dolhun Clinic Covid-19 14MAR20
(Internal document intended for my patients)
Emergency declarations at both the local, state, and (now) federal level are in place. Reliable, easily accessible tests kits still not available in San Francisco.
Testing and treatments are now being fast-tracked.
IV shortage. We had an IV shortage as recently as Jan 2018. We should expect another. As of last night, CPMC has had NO confirmed cases of Covid-19.
US Healthcare Preparation
Most hospitals are now in full gear preparing for the expected overflow of patients.
Transmission
• Air
o If you are coughing or sneezing, wear a surgical mask (protects others). If you are flying, use your N95 or N100 mask (protects you).
• Touch
o Minimize touch and STOP using your elbow to touch others elbows and
elevator buttons. Elbow bumps still transmit disease. Slow down and
look the person in the eye and say, “hello.”
o I use the tip of my key to press elevator buttons, for example.
• F***s
o Not yet proven, please behave as if Covid-19 is spread this way.
o It’s never been a bad idea to wash your hands after using the restroom and
before making food.
o It may be a good time to learn how to cook, a key life skill I have been
strongly recommending for 20 years.
Dolhun Clinic Covid-19 Summary 14MAR20
Symptoms
This disease progresses rapidly once shortness of breath presents.
Diagnosis and Testing
Clinical diagnosis will determine who we test, as we do not have an unlimited supply of test kits. Easy-to-use test kits that are widely available with fast turn-around times are in development.
Colorado has beaten California to the punch by now offering “drive thru” testing. As of today, there is NO reliable and rapid testing that is available to community clinics in San Francisco.
Dolhun Clinic was one of the first independent clinics in California to receive tests kits from LabCorp. Unfortunately, the correct swabs that are critical for testing we not included. We expected them yesterday, but they did not come in. We called local urgent care centers and pediatric clinics to see if they offered testing...none of them had reliable testing.
Difficult as it may be to believe, if you think you have Covid-19 and you live in San Francisco, and we deem you suitable for testing, the only option is to go to an emergency room to get tested this weekend. I will send an update as soon as we get the swabs.
It feels to me a bit like having a fishing pole without the line and hook. (I was raised in Wisconsin, surrounded by lakes.) It’s frustrating.
Hopefully, the new emergency status accelerates private and public partnerships to “fast-track” testing.
Treatment
In the meantime, there are helpful measures that everyone can take.
I want to emphasize the importance of the supportive aspect of medical care: even if you have antibiotics, you will still need to maintain adequate hydration due to insensible water loss. Insensible water loss is the fluids lost through breathing and sweating. They are increased in fever. If you have respiratory and gastrointestinal symptoms (nausea, vomiting and diarrhea) you will have even more fluid and electrolyte losses.
Dolhun Clinic Covid-19 Summary 14MAR20
Dolhun Clinic Covid-19 Supportive Treatment Recommendations:
• Dehydration: DripDrop® ORS for rehydration. It also has zinc, proven to boost immune system. ‡
• Nausea: Ondansetron (prescription) for nausea reduction. This helps to keep down an oral rehydration solution (ORS) so as to help avoid IV.
• Fever: Ibuprofen (Advil® or Motrin®) and acetaminophen (Tylenol®) are useful.
• Thermometer.
• Pulse Oximeter. To purchase.
• Hibiclens hand soap. This special soap is used in surgery and to help reduce bacteria on the skin of individuals with MRSA. The active ingredient binds to the stratum corneum for about 24 hours. A good strategy is to use the soap at the beginning of the day. As it is always difficult to keep kids clean, you can use this soap to wash their hands and face, especially the nose, before coming into contact with a “high risk person,” a situation which we are recommending against.
Higher
risk patients:
• Inhalers.
• Nebulizers. Just nebulizers has a wonky CC checkout, so I used PayPal without a
problem. There are other companies. If you need an Rx from me, just let me know.
• Antibiotics.
• Anti-viral medications.
Since the last week, I have added oral steroids and anti-retroviral drugs to the inhaled steroids and antibiotics I recommend. This is per evolving CDC protocols. It is important not to use oral steroids too early as they are immunosuppressive and can INCREASE risk of bacterial disease. Proper clinical management is key to surviving the severe form of this disease.
Timing and Communication with Dolhun Clinic
Early communication with me is essential and a key component of making the best decisions for your health.
Dolhun Clinic Covid-19 Summary 14MAR20
Protection and Prevention
• Ifindeedthefecal-oralrouteisavectorroute,thenpleasebeawarethatthefoodyoubuy, prepare or order, may harbor Covid-19 pathogens. Foods that are commonly associated with food-borne illnesses are spinach, chicken, and mayonnaise.
• Bewarethemulti-layereddelisandwichandyourfavoriteburrito.
• Nowisagoodtimetolearnhowtocook.
• Every entryway, especially businesses, should have hand sanitizers at the door. If not available, every individual should be required to properly wash hands with soap and water.
• Usechlorine,hydrogenperoxide,oralcoholtodisinfectdoorhandlesandcommonsurfacesor your smart phones.
• NitrileGlovesmaybeconsideredbyhigh-riskindividualswhoareshoppingforgroceries,for example.
• Irecommendmasksforhighriskindividualsorthoseinhigh-riskareas.
• Self-quarantineandusesurgicalmasksifyouhaveanyCovid-19symptomorhavebeenin
contact with a Covid-19-positive individual.
Vaccinations
Effective, mass vaccination(s) are... a long way off.
Our Clinic
We have not had any known Covid-19 patient present to the clinic.
The Clinic is disinfected after every patient with respiratory symptoms.
HEPA filters with built-in UV lights are functional.
Our medical building has 50% less traffic than 2 weeks ago and is sanitized three times daily.
Personally, I feel safer in my clinic than in a coffee shop or grocery store. Every patient will have to make their own decision as to whether they want to defer regular visits or conduct tele- health, of course.
Dolhun Clinic Covid-19 Summary 14MAR20
Summary
I am preparing cases to surge in the near future, meaning ~2 weeks.
Prepare (in all forms: practically, psychologically, financially, etc.) for your local healthcare/hospital system to be overwhelmed.
A quarantine of San Francisco is not out of the question. Thus, if you are considering leaving the city, I would make that decision soon.
There are trade-offs, of course, to leaving. Remote locations are remote.
I am not leaving San Francisco and will be available 24/7 to m patients. Only when I am asleep, will I not be immediately reachable. My day starts around 5:00am, so do not hesitate to reach out early.
Sincerely,
Eduardo Dolhun, M.D.
Dolhun Clinic
2100 Webster Street Suite 302 San Francisco CA 94115 415-9230-3090
‡As the inventor, founder and co-owner of DripDrop ORS, I have a financial interest.
