Honestly, it feels a little bit like the conversations we have around safer sex.  Who have you been around?  And who have they been around?  And can't I make this thing I want to do with you safe enough that we can break the rules? 

The First Rule of Social Distancing = Essential Activities ONLY
Stay home.  Anything you do in your home, in your yard, and with your household members is good.  Walking outside in a public space (or on private land with permission) by yourself or with other members of your household is also fine.  

Getting food, medicine, essential household items, and health care are considered essential activities.  It is best to do that with minimal contact. Use curbside pickup or delivery for groceries or other consumer products.  Take out (stay outside) or delivery is the only option for prepared food.  Reschedule routine health care visits or do them by phone or video conferencing.  Ask if labs, X-rays, ultrasounds or other studies can be rescheduled. Rarely, folks will need emergency home repairs, will need to sign papers, will need to make a larger purchase like a car or an appliance. Limit this to the essentials and be creative about reducing your time in a building you don't live in and contact with anyone not in your household (even at a distance). 

Only Household Members.

Whatever contact, even distant, you have is to be with members of your household only. Some folks have gotten clever and decided to make one household out of two and agreed to limit ALL their contact to just the members who live in those two households.  This doesn't work if someone  leaving the house to go interact with others on a regular basis, like for work or is going into stores to get supplies. 

Wash your hands. 

After using the restroom of course, before eating. Before and during food preparation.  Before and after touching shared surfaces. Use soap and water.  No need for antibacterial soap. A second choice (not as good as soap) is alcohol-based hand sanitizer with 60-70% ethyl or isopropyl alcohol. Stronger isn't more effective.  Avoid touching your face. 

Cover your coughs and sneezes.  

Wear a mask. If you need to cough or sneeze while wearing the mask, lower your face, use a tissue or catch it with your elbow.  
A mask will reduce (but not eliminate) the amount of aerosols you spread into the air.  If you have an infection, it will reduce the amount of virus that floats in the air for hours after you pass through a space.  
No mask works as well as staying out of the space in the first place.  Talking, laughing, and singing all seem to increase the amount of aerosols and droplets you send out.  

Distance= 2 meters of distance determines our existance
If you have already determined that your errand is essential AND that you can't do it without crossing paths with others, THEN please make every effort to stay 6 feet (2 meters) away from everyone else.  Current recommendations advise that  you cover your mouth and nose with a mask, wash your hands, use hand sanitizer, don't touch anything you don't have to,  and get your business done quickly so you can return home. 

Intentionally getting together socially and staying 6 feet away or wearing a mask is NOT on the current guidelines.  Taking a walk with a friend but staying 6 feet away?  NOPE.  Having a neighbor over to garden outside?  NOPE.  Having friends over for a campfire?  NOPE.  Having a community work day to pick up trash/pull out invasive?  NOPE.  Stopping by to see your grandchildren and sitting out in the driveway 6 feet or more apart? NOPE.  Why?  because none of these things fits into the above definition of essential activities.  And they all include folks who aren't in your household. 

Clean surfaces. 
Use the same soap for wiping down surfaces and objects.   For surfaces a third choice is bleach, 10% solution   Stronger doesn't work better.  Do not apply bleach to your skin. We have all read about how long the virus lives on various surfaces--from a few hours to a few days.  If someone outside of your household has touched a surface, it's wise to either leave it alone for a day or two or wipe it down with soap and water, alcohol, or a dilute bleach solution.  As you do this, remember that the PRIMARY way SARS Co2 is spread is by respiratory droplets and aerosols.  The most important things seems to be to stay out of buildings that you don't live in.  High exposure folks like health care workers and emergency responders should probably launder their clothes on returning home and shower before touching other people or surfaces.  We don't know if there is any benefit in doing that after a trip to the store.  There is no need to even consider that if you picked up curbside or had your items delivered. 

  
Everyone has to make their own best decisions of course.  Each person knows what is essential for themselves.  We are all in this together.  We are being asked to do the really hard things so that hospital workers and emergency responders don't have to do so many horrific things.  

 Three weeks ago, I stepped out of my usual routine and into a new world of testing for COVID19. Monday, March 16 I found tests were available for me to order through Boone Hospital.  I swabbed noses and submitted 10 samples in the next few days. Wearing my home made PPE was sobering.  Looking into the eyes of people who were so sick and so afraid is something I will not soon forget.  Sadly, those samples went to LabCorps and took weeks for the results to return.  Those weeks were forever for me and even longer for the people waiting for those results. Since then I have been ordering the tests and having the swabs be collected at Boone Hospital. Results are coming back in a day or two. Right as I started testing, local officials recommended I have my office manager work from home and I then hired my daughter to work in person in my office.  Lots of shifting.  Learning to manage health care with a new staff arrangement, over the phone first and now also by secure video, responding to shifting requirements for testing.  Friday March 20th, I posted about testing on a local FB community group and within an hour, there were hundreds of likes and shares.  My sleep that night was disrupted by dream and waking fears of being overwhelmed. I woke the next morning to internet and phone lines down.  An hour later, the phones started ringing and didn't stop for days.  I haven't counted, but I am guessing I have ordered testing on 50 people and talked to another 25 who didn't meet the criteria from the lab. There has been so much grace in the overlapping of a slowing of need from my regular practice just when the testing was so busy.  Now that the testing system is streamlined and the demand for testing has slowed, I am ready to get back to seeing my patients.  If you are one of those people who had to wait a little longer to get your medication prescriptions refilled, I am so grateful to you for your patience.  If you have been waiting and hoping to get to see me soon, now is your time. 

In response to questions about how to prepare for and to provide home care for those who are sick:
First, just know that you probably know more than you might think.  Most of us have had a cold or a fever or a respiratory illness.  This one might not be any more severe than the ones you have had before. What you have learned in previous illnesses is relevant and applicable.   
For the sick:  rest is so helpful.  Rest for the body, yes, but also rest for the mind.  Avoid social media, screens of any kind, disturbing stories, harsh words.  Surround the sick with beauty, soft light, quiet, peace, comfort, and of course, drinks and foods to appetite. Speak with a cheerful confidence of their body's healing journey.  Soups with lots of onions and garlic, ginger, turmeric, chicken broth, astragalus, and savory herbs are comforting and healing.  So many plant medicines can come to our aid when we feel unwell:  echinacea, astragalus, olive leaf extract, yarrow, mullein, elder, garlic, . . .  Of course each person's reaction to any plant should be considered and adapted.  
Sugar and flour, processed foods, alcohol (in excess of what is in herbal extracts--taken in the fractions of ounces), and worry are to be avoided. 
Supplements like fish oil, zinc, vitamin C, and vitamin D support healing.  Always customize the regimen to the person.
For the caregivers:  Care for yourself first.  Sleep is so important, as is being well-nourished in body and soul.  Asking for help is hard even in the best of times.  Notice if the obstacle to getting help is inside of you or external.  Who is your support--both physical and wise guidance?  Hygiene is important.  Separate the sick person's toothbrush, towel, washcloth, etc from the rest of the household.  Can the sick person have their own room and dedicated bathroom?  If so, that's the easiest.  Of course washing hands and surfaces is important. Soap and water is our oldest and most effective ally for hands and surfaces.  Use products that have your confidence and make you happy.  
We are asking people to practice social distancing, and once people are sick to practice isolation (for the sick) and quarantine (for the exposed well). It is true connection with people is so important to health.  (This applies mostly to the caretakers.  The sick are generally internally focused as is right and have little energy or interest in social interaction--this is to be respected)  Use technology to communicate as regularly as you can. Stay honest with yourself.  Connection with nature and the divine are also health-giving, as is movement.  

In an effort to be available to my patients in a way the reduces the chance of spreading COVID19 (and other infections as well), I am asking that my patients who have fever, cough, shortness of breath or otherwise feel unwell call the office rather than coming in.  I will be making myself more available by phone and by videoconferencing.  In addition, I am making greater efforts to see sick folk at their homes.  

I am exploring ways to get testing for COVID19.  The state makes that testing available, but due to limited supplies, they are only testing people with symptoms and with high risk exposure (contact with a documented case or travel to an area with documented community spread).  Others will need to pay for testing, either themselves or through their health insurance.  That testing should be available any day now.  
I am fielding questions about the specifics of social distancing.  It's new to all of us.  Sharing perspectives is so important. 
Are there ways I can be more helpful to you? 

Social distancing (closing schools, cancelling the gatherings, staying home) only works well if we all do it at the same time.  I think it's time.  I might be wrong.  Folks in charge locally don't agree with me.  It won't be coming from the top anytime soon.  If people ask me if they should travel, if they should host a large gathering, my answer is no.  Most of us will do fine.  Some of us won't.  If we all get sick at the same time, we can easily overwhelm the hospitals.  We have two models already on display for study: In both Wuhan and Italy, officials hesitated and only took drastic action when the hospitals were overwhelmed.  Hospital beds full.  Ventillators at capacity and the folks who need them next don't get them.  Medical personnel working at past their capacity and getting sick.  In Wuhan, the government was able to do what democracies so far have not done:  built two large hospitals in weeks and shipped in doctors and nurses from the rest of the country.  And had people STAY HOME.  In Wuhan, they did it--the number of cases has decreased to where it is less in China than in the US.  We shall see what will happen in Italy.  And the US.  We can vote with our behavior.  We can keep our children home, stay home ourselves, don't go to the parties, political rallies, and the events.  I get it.  I went to films at True False.  I hope we will act in time.  

Based on my own experience and reading Stephen Buhner (an  herbalist and author I admire) I have been obtaining some plant medicines to help me and my people through viral illness, most specifically coronaviruses.  
Of course, none of us have experience treating COVID19 with herbs, cause it's new to humans.  But it's in a family of viruses that we are very familiar with.  Coronaviruses cause the common cold and SARS and MERS. 
Elder--berries and other parts--show some effectiveness in helping people recover from coronavirus infection.  So I stocked up on elderberry juice. I might harvest some stems and leaves later this spring  when the plants leaf out to make into medicine. 
Ginger--fresh only is recommended.  I hope that includes frozen.  I am adding a tablespoon or so to my morning smoothies.  
Chinese Skullcap for tinctures.  
I already have a great supply of Echinacea, Astragalus, and Goldenseal.  
I will also be buying a big bag of onions.  I have a lot of garlic remaining from the harvest last fall.  And greens coming up in the garden.  

First an update: 
105 total cases in the US, 10 hospitalized, 6 deaths.  Population-based testing is promised but not yet underway, so there is likely to be a big bump in cases once that starts.  It won't mean the disease is suddenly spreading, it will mean we are finally measuring it better. 

Here's what I am doing today:  

​

It was a beautiful day with the promise/suggestion of rain in the evening.  I know that my absolute favorite experience is hearing rain on my metal roof knowing that I planted seeds in the garden today.  I planted seeds in the garden. And then watered them when the rain passed us by.  I took a walk with my husband and dog, twice.  Got some house holding projects done. I did some yoga.  I went to bed early.  I ate vegetables.  I drank water.  I washed my hands. I pondered COVID19 and life.  I decided to get a flu shot.  I called my mother and we chewed on the question of if I should try to visit her at the end of March.  I made some lists of other preparations to make.  

I am going to head out to get a flu shot and encourage my household to do the same.  Why a flu shot?  Will that protect me from Coronavirus?  No.  They are different viruses so will need different vaccines.  No coronavirus vaccine exists now.  Here are my reasons for a flu shot:

1.  Public Health folks who are thinking about this more than I can imagine are recommending it.
2.  I have taken and tolerated the flu shot many times.
3.  In the years since I stopped, I have gotten influenza (or an influenza-like illness) 4 times.  It's miserable and memorable. 
4.  I expect to be needed to do my work pretty intensely if things unfold as predicted.
5.  Part of my confidence that I can survive influenza is that there is a hospital nearby that can offer me supportive care if I need it.  That may not be the case if there are lots of folks with COVID 19 already taking up the resources. 

UPDATE:  I got the flu shot.  It was easy. 

So there's a new virus infecting humans.  Well, not a new virus, but newly capable of making humans sick and of spreading from one person to another.  Catchily named COVID19.  Last I have read credible news, we now have evidence of community transmission in the US and that means it's not likely we will stop the spread.  Some presumptions: 
1. This is new to humans so none of us have acquired immunity in the form of specific antibodies.
2. Typical spread is each infected person infects 2.2 others.  This means it can spread pretty quickly. 
3. Incubation period is about a week.
4. Most of us who interact with other humans are going to get it 
5. Most of us who get it are going to be mildly or moderately sick for a week or two and then get better.
6.  Mild and moderately sick folks will be best cared for at home with things like chicken soup, elderberry syrup, and rest.  Those people will need to be checked on
7. A small number will get seriously sick, some will need intensive care and a few of them will need to be on ventillators. 
8.  Somewhere between 1/1000 and 1/100 of those who get sick will die.  Most of them will be people who are old and who have other health conditions. Children seem to be spared serious illness. 
9.  Higher death rates will occur among people who can't get intensive care, either cause they decline it, can't access it, or the system is overwhelmed and can't offer it to everyone.
10. Slowing down how rapidly this virus spreads seems like the best approach to keeping the death rates low.  Our health system can do a good job of providing intensive care, but it's a limited capacity.  
11.  There may be weeks where the wisest, most generous, most civically responsible thing to do is to stay home.  

So today I did my first act of being prepared for that:  I ordered my prescription early.  So if my current supply runs out when I should be staying home (and so should my pharmacist and my postal delivery person, etc), this will be one trip I won't feel pressed to make/ask someone else to make.  What are you doing?