Central Maine health care providers urge isolation, distancing to halt coronavirus

Dozens of central Maine health care providers have banded together to directly appeal to the public to do everything they can to halt the spread of coronavirus amid growing concern that hospitals and other facilities will be overrun as the number of cases continues to grow.

More than three-dozen physicians, physician assistants and nurse practitioners have signed a letter in which they say that Maine residents have no other option to fight the spread of the disease than to stay home and away from crowds, families and friends.

In interviews, a pair of local physicians who spearheaded the letter also said they did so because many people seem to still not be heeding physical distancing; in response to mixed messages at the federal level; and because states are taking different approaches in combating the spread of the virus.

There is no cure for COVID-19, the illness caused by the coronavirus, nor any drugs available to treat it nor immunizations against it.

“There seems to be some confusion in the public about what’s the appropriate right thing to do,” said physician Abbi Hoke, who practices at Gardiner Family Medicine and co-authored the letter. “We wanted to clarify from a medical standpoint that it really is important to distance yourself as much as possible from other people to minimize the spread of this virus.”

Dr. Abbi Hoke helped draft a public letter that about three dozen physicians, physician assistants and nurse practitioners in central Maine signed Tuesday, encouraging residents of Maine to stay home during the coronavirus pandemic. Kennebec Journal photo by Andy Molloy

Hoke said in an interview Tuesday that she’s scared. “I think we as health care providers are scared for our families, our patients and ourselves,” she said while home with her children. “That’s where we’re at.”

“We do not have enough hospital beds or ventilators to care for the number of people that will become gravely ill,” the providers wrote in a letter-to-the-editor appearing in Wednesday’s Kennebec Journal and Morning Sentinel newspapers. “The healthcare system is running low on the gowns, gloves, and masks that are worn by healthcare workers. We do not know when or if these problems will improve. In brief, this virus is deadly and we cannot cure it, and our resources to care for people who become ill are limited.”

Elizabeth Rothe, a physician who treats patients at the Family Medicine Institute, Augusta Family Medicine and MaineGeneral Orthopaedics, said the letter she co-authored came in response to mixed messages from federal officials. President Donald Trump on Tuesday suggested coronavirus-related restrictions could ease by Easter, in less than three weeks, and has said “we can’t let the cure be worse than the problem.”

State health officials Tuesday announced Maine had 118 confirmed cases and Gov. Janet Mills ordered new restrictions on “non-essential” businesses. During a news conference, Mills continued to stress the importance of physical distancing and urged Mainers to only leave home when necessary and not gather in groups.

In their letter, the local providers underline that the only way “to slow the spread of this illness is with social distancing and isolating at home.”

“This means distance from your friends, family, and coworkers. While this may seem like a drastic step, we have no other option,” the providers write. “Going out to visit even 1-2 other people runs the risk of spreading illness, as you spread the disease before you begin to feel sick. If we do not stay at home, thousands more will become ill and we will run out of resources to care for them. By staying at home you can protect yourself and the ones that you love from becoming sick and being unable to receive adequate medical care because our hospital systems are overrun.”

Hoke and her colleagues see that Maine residents are not heeding advice to stay home and away from others.

“People are acting as if this is not going to affect them or their loved ones in a severe way,” Hoke said. “I think we, as healthcare providers, need to publicly ask that people heed the recommendations and isolate themselves.”

Rothe said Tuesday she feels like we’re in the “calm before the storm.”

“We don’t have any sort of cure for this,” Rothe said. “All we can do is try to support people’s body systems as they fight this. We don’t have any sort of magic bullet that can kill this virus.”

The first presumptive positive case in Maine was reported on March 11. On Tuesday, the Maine Center of Disease Control reported 118 cases across Maine, with 17 hospitalizations, and said seven people have recovered. But there is also a backlog of several thousand samples awaiting testing.

Dr. Nirav Shah, director of the Maine CDC, said in his briefing Tuesday that those numbers are only the tip of the iceberg. “The absence of evidence of cases in your county in not evidence of the absence of cases in your county,” Shah said.

“Unfortunately, the fact is that this going to I think hit Maine particularly hard,” Rothe said. “We have a very elderly population here. This disease does seem to affect our elderly more seriously. They are much more likely to require more intervention at the hospital level. We want to be able to have sufficient resources for that.”

Those resources include caregivers and supplies, like personal protective equipment, required to take care of a large influx of patients.

“We’re going to see an increase in the number of people sick no matter what. It’s just a matter of slowing down how fast this is spreading from person to person,” Rothe said.

Early reporting on COVID-19 indicated that the infectious viral disease had little impact on the very young and on healthy people, but that it was deadlier for older people and those with chronic illnesses. But as the death toll continues to rise globally, it’s now clear COVID-19 is a dangerous disease to people of all ages.

Mills, the governor, underlined that point during Tuesday’s news conference by saying she knows someone whose 25-year-old died recently from coronavirus.

“As a result,” Hoke said, “our patients can and will become much sicker if we don’t across the board, and across age ranges, stay at home to keep ourselves and our loved ones safe.”

Unlike most other viruses, this coronavirus can be spread by people who show no signs of illness, Hoke said. So people who have been infected but still feel well are at risk of infecting others with whom they come into contact. And because it’s a novel or new coronavirus, there is no widespread immunity to it.

That combination, Hoke said, makes the virus even scarier.

Rothe said she’s been spending time educating her patients about the importance of staying home and breaking long-held routines, like weekly visits to the hairdressers.

“For a lot of people, this is a hard change, and you have to be empathetic to that,” she said. “But you have to take the time to explain why even a small interaction is potentially dangerous.”

For health care providers, she said explaining exposure risks is particularly important right now. And while it can mean sacrifices on the part of residents, it’s important to get the message across.

Hoke said if people think they are exhibiting symptoms of coronavirus — fever, tiredness and a dry cough — they should first call their primary health care provider, who can advise who requires acute care and who can be served by telemedicine or phone conversation. The goal is to not overwhelm emergency rooms.

“If you look back on the spring of 2020 and you think of it a as a really boring time when you watched too much Netflix, that’s a much better reality than contracting coronavirus or worse yet, losing a loved one to the disease,” Hoke said. “That’s what people struggle with being able to grasp. What we’re asking people to do is terribly tedious.”