I’m a Physician Who's Studied Infectious Diseases My Entire Life. Here’s Why I Closed My Practice to Prevent COVID-19.
I'm a physician and public health expert who has been practicing medicine for over 18 years and, yes, I have always been obsessed with keeping my hands clean. As cliché as it might sound, understanding germs and their impact on humans has always fascinated me ever since I was a little girl. I knew I was destined to focus on viruses and the human immune system my entire career — and now, the spread of COVID-19 has challenged my life’s work.
Personally, I try my best to practice what I preach. Long before COVID-19, I have made it a habit to keep a bottle of hand sanitizer in all four of my car doors, and I even make my kids disinfect their hands as soon as they step into the car or walk into our house. Another obsession? I always keep my nails very short. If they start to grow past my fingertips I trim or file them. Why? Well, we forget about how many germs can get trapped under our fingernails—and those germs can spread germs and make us sick.
In light of COVID-19, it's so important for everyone to stay at home and work on “social distancing” to limit exposure. Everyone really needs to stay put right now, as best as they can, and only leave the house if absolutely necessary. That’s a new fact of life that I’ve taken to heart — and why I’ve completely overhauled the way I try to help my patients. It might seem counterintuitive, but I’ve decided to close my practice altogether.
We should all be busy keeping up with the Centers for Disease Control and Prevention's online resources to get the latest advice on battling the spread of COVID-19. As someone who has indirectly worked her way through the pandemic in my own community, however, I’ve created a few of my own best practices stemming from my own experience here in California.
I don’t just move my body — I move with my hands, face, and mouth in mind.
I’ve always been extremely careful about personal hygiene and hand washing, but especially now. Because germs can spread easily from your hands to your face, I have been pretty conscious of what my fingers do touch throughout the day: Items in my house, any surfaces on public transportation, and even touching my family, friends, or patients. Our hands are the number one way we can transmit the virus to ourselves, so I consciously make an effort to limit touching various parts of my body, like my nose, eyes, and mouth. Being more vigilant and aware of how your body moves is key — you can control what you touch, where you touch, and how often you do. And you can learn to monitor how often you clean your hands, too.
Right now, it’s crucial to limit shaking hands, and I wash my hands thoroughly with soap and water for 20 to 30 seconds whenever I get a chance (multiple times a day). And if I can't find the time or access a sink, I will use hand sanitizer every single time I've had a potential exposure to a contaminated surface. How thoroughly am I using hand sanitizer? After touching doorknobs, Uber seat belts, tables or chairs at a coffee shop, a keypad when checking out at a grocery store or CVS — you name it.
I’m avoiding leaving the house if I can.
I have been isolating myself frequently in the last few weeks and have been practicing social distancing as much as possible. So, that means unless I need to go out — for work, groceries, or errands — I am staying home and avoiding larger crowds of people. And when I leave, I make sure I’m carrying protective materials like sanitizer or disinfectant wipes, plus staying at least six feet apart from others with zero direct contact.
No hugging or kissing those outside of your home, as these kinds of actions could transfer bacteria onto our hands and possibly back onto our face, which we unconsciously touch almost 200 times each day.
I’ve closed our offices until further notice.
We already keep an extremely clean and sanitary environment in my office because we do a lot of medical procedures requiring a high level of cleanliness. For the last several weeks, though, we have been disinfecting every surface touched by any patient with alcohol wipes, including elevator buttons, iPad screens, telephones, and many more surfaces that you forget you touch. When a patient walks through our doors, they are asked to wash or sanitize their hands and then use an alcohol wipe to disinfect their phones, too. So, we make sure all patients are less likely to catch anything and infect others who might be in the office.
But in spite of all of our proactive work, I made the decision to close our clinic until further notice. To combat the risk of spreading viruses, our team has pivoted to telemedicine and virtual medical appointments to serve even more people in the community — something that could be a great resource to those who need help. We are doing our part to encourage everyone to stay home, and I am equally committed to the safety of my staff. If we are sick, we cannot serve you! Only essential staff members are in the office for a limited time, and everyone else is working virtually from home.
We do have new cases of COVID-19 popping up in San Diego, and while I have not personally come in contact with the virus at this point, I know colleagues who have. This is why we are asking the public to do their part by not showing up to hospitals, emergency rooms, and medical clinics without calling or emailing in advance. We don't want to unnecessarily expose healthcare workers at a time when we need them most.
OTC medicine may be your best treatment for COVID-19 symptoms.
Since immune systems can be vastly different on a case by case basis, there isn’t one blanket solution for someone who suspects they have developed COVID-19.
If you are a healthy individual and you can manage your symptoms at home, I would recommend you stay home and isolate yourself. Use over-the-counter remedies such as Tylenol, ibuprofen, and decongestants to minimize your symptoms. (Editor's note: Talk to your doctor about which ones are most appropriate for your case beforehand. A recent article published in The Lancet raises questions about the role that ibuprofen plays on the severity of the disease). And yes — quarantine! Stay isolated for at least 14 days.
Showing up to a doctor's office or to the ER when you are already infected has the potential to affect everyone around you, including many healthcare workers who will and be under quarantine and unable to work in the coming weeks if this gets worse. This is what we mean when we talk about flattening the curve. You are just slowing down the rate of transmission so that our healthcare infrastructure can manage it better and that hospitals and clinics won’t get too overwhelmed.
I would call 911 only if I couldn’t breathe.
If it’s an emergency, however, you should be immediately contacting paramedics. If you are older than 65 (or of older age), are pregnant, or you have a pre-existing medical condition or autoimmune condition that creates a weakened immune system, then you’ll need to get in touch with a doctor to figure out immediate next steps, since it’s more dangerous for you than someone without these conditions. The most concerning symptom would be severe difficulty in breathing. If you have underlying conditions, such as lung disease or heart disease, or you are immunosuppressed in any way, then contact your primary care provider via email if possible or phone to get advice on what to do.
Unfortunately, it’s become clear that we do not have enough tests to go around and get everybody tested. Tests are largely reserved for people who may require hospitalization and critical care, or have known exposure either through travel or a confirmed COVID-19 case, at this time. So, call, FaceTime, or email your doc and stay indoors if it’s not an emergency. Medical professionals can help you virtually.
My mother, being an older adult, certainly falls into this high-risk category. I have been encouraging her for the last week to stay home and not leave the house. Continue to connect with family and friends virtually and find ways to enjoy your time and home and ease anxiety: Play puzzles, games, watch movies, sew, dabble in creative writing or journaling, and keep FaceTiming relatives and friends.
Dr. Georgine Nanos, M.D., M.P.H. is a board-certified medical doctor with a private practice just north of San Diego, California, and advanced training and expertise in epidemiology, the science of how diseases are spread.
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