coronavirus information - Integrative Family Medicine of Asheville

Coronavirus Information and Resources for our Community

In this time, we all need information that we can trust.

We have assembled answers to your common questions. We are updating the page regularly from sources that we have professionally reviewed and confirmed. You may submit further questions here, and we will respond to the most commonly asked questions.

You may also visit our community resource page, community health coaching page, Facebook page or our calendar to access further resources we are providing during this challenging time.

Click on the buttons below for your answers:

What is the Coronavirus and the disease called COVID-19?
  • COVID-19 is the disease caused by the new coronavirus that emerged in China in December 2019. The virus’s name is SARS-CoV-2.
  • The most common symptoms of COVID-19 include cough, fever, shortness of breath, and fatigue. Less common symptoms include muscle aches, sore throat, and unexplained loss of taste or smell. COVID-19 can be severe, and some cases has caused death. However, most people have mild to moderate symptoms. 
  • The new coronavirus can be spread from person to person.
  • There is no coronavirus vaccine yet. Current prevention involves social distancing, frequent hand-washing, coughing into the bend of your elbow and staying home when you are sick.
How do we stay safe and avoid spreading the Coronavirus?

Wash your hands

Proper handwashing technique from the CDC (and a video here):
Follow these five steps every time:

  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

Don’t touch your face, particularly your mouth, nose and eyes

The virus that causes COVID-19 gets into the body through your the orifices of your face (mouth, nose, eyes). By recognizing your triggers for touching your face, and taking precautionary measures to avoid these triggers, you will have better success in staying healthy. Article: 4 Tips for not touching your face.

Clean & disinfect frequently-touched surfaces regularly

Remember to wear gloves, and using approved cleaning materials (dilute bleach or 70%+ alcohol-based products), make sure to focus on high-touch areas like: tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, sinks, etc. For a comprehensive guide on how to clean and disinfect your home, read this.

Practice Social Distancing and avoid close contact with sick individuals

“Social distancing” is the term our government has used to encourage individuals to stay home unless absolutely necessary, limit gatherings between households and when in public maintain a 6-foot or more distance between yourself and non-household members. This has been shown to reduce the community transmission of the virus: when we are less mobile, the virus has fewer opportunities to spread.

Wear a mask in public

Further, the most recent recommendations by the WHO and CDC recommend individuals WEAR CLOTH MASKS when in public. There are many tutorials online for making your own, which can be done even if you don’t have a sewing machine. Here is a video of the Surgeon General explaining different types of easy home-made mask options, and another video for how to sew or cut your own from a T-shirt.

What should I do if I feel sick or have medical questions/concerns?
If you are short of breath, go to the ER or call 911. Otherwise, make an appointment with us. We are available for you, either via phone or video. Our front desk staff are very helpful in getting video consultation set up on your phone or computer. Whether you are having symptoms consistent with COVID-19, seasonal allergies, belly upset, headaches, or any other ailment that you would normally see us for – make an appointment! Together, we can decide what the best treatment steps are for you.

This CDC resource clearly outlines what to do if you have fever, cough, sore throat or any respiratory symptoms and are concerned you may have COVID-19.

What about testing?

Since testing is now readily available, CDC and State guidelines encourage us to test all patients who may have active COVID infection.

  • If you think you may have COVID-19, you must assume that you are positive and isolate yourself.
  • Please make a virtual appointment with your provider.
  • If you appear to have symptoms consistent with COVID-19, we will provide PCR testing as described below. Results are usually available after 48 hours from receipt at Labcorp.

As always, if your situation deteriorates with shortness of breath and difficulty breathing, we will refer you to the hospital and call ahead to let the ER know of your arrival, or you can call 911 directly.

 

Our staff will help you determine the right kind of test, and we have options to meet your needs:

  • We will test active infections via a PCR nasal swab test. We will either send you a home-collection kit via FedEx, or provide testing outside of our clinic on Depot St.
  • Past infection testing, also referred to as Antibody testing is available after 10 days of symptom onset for asymptomatic patients.  These tests can be drawn at Labcorp directly and their new patient app allows you to wait in your car rather than their lobby. We are also beginning testing at our clinic

Please do not seek testing at our clinic without consulting staff, and please do not go to Labcorp if you are symptomatic.

 

Other local clinics have testing available as well:

  • Range Urgent Care (Merrimon Ave), Mission My Care (Biltmore Park) and Mercy Urgent Care (several locations) continue to do COVID-19 testing and they generally require an appointment in advance and an extensive screening telephone interview before they will approve you for testing.
  • Health Department – the local health departments are doing testing, but only for the most severe or high risk cases. If you qualify for this testing, we will make the appropriate referrals.

 

Cost of testing:

  • In keeping with our DPC model, all tests will be payable at time of service to IFMA.
  • The federal government has made clear that they will pay for the cost of Coronavirus testing, both PCR (active infection) and antibody (past infection.) We do not currently know if reimbursement will be made for only select tests or all tests for a given individual.
  • If you have insurance, we will give you the appropriate forms to seek reimbursement from your insurer.
  • If you do not have insurance, we plan to seek reimbursement from the government directly and will pass any reimbursements back to you.
Should I be tested?

Now that testing is more readily available, we are able to expand testing in our community. Buncombe County has created a symptom checker to help you determine if you should be tested for active infection. Follow this link to the COVID-19 self-checker and if testing is recommended, then contact your medical provider to determine the best type of test for you.

If you believe you have already recovered from COVID-19 and would like to get antibody testing, please reach out to your provider through the patient portal or contact our clinic at 828.575.9600. We are able to offer antibody testing from ABBOTT provided through Labcorp.

To qualify for antibody testing you must:

  • Be assymptomatic
  • Fever free for 3 days
  • 10 days from the onset of symptoms (the IgG antibodies do not reliably develop prior to 10 days)

Prior to seeking testing, please review the toggle below entitled ‘What do my test results mean?’ No test is perfect, and scientists are still learning a lot about this virus as well as our potential for lasting immunity. 

 

What do my test results mean?

We realize that there has been a lot of confusion about testing in the media. In part, this is because tests, PPE, and testing materials were intially in limited supply. There was a rush to increase access, and tests were allowed to market under an Emergency Use Act without being fully vetted.

At this point, the PCR and Antibody tests that we are using from Labcorp have been cleared by the FDA. However, this does not mean that any test is 100% accurate and reliable. These test are quite good, though the PCR test can have false negatives, and the Antibody test can have false positives. And so, what do your test results mean?

  • If you have a negative PCR test, you ‘most likely’ do not have the novel coronavirus SARS-2 that causes COVID-19. You should still monitor your symptoms, and if symptomatic continue to self-quarantine. If there is worsening of symptoms, contact your medical provider or seek emergency attention.
  • If you have a positive Antibody test, you ‘most likely’ have contracted the novel coronavirus and developed antibodies. This does not guarantee immunity, and so you should proceed with recommended precautionary measures (mask, hand washing, etc.)

You can review a summary table here. You can also visit this website for additional guidance on interpreting results.

How can I prioritize health and develop healthy routines?
A common theme we hear in clinic is that there is “not enough time” to focus on self care. During this period when many of us have more time at home, we would love to inspire each and everyone of you to find new ways in which you can help yourself and your family establish some new healthy habits. Who knows, you might even develop a new skill or hobby!

Please see this page for a comprehensive outline on How to Prioritize your Health and Develop Healthy Routines.

In summary, the main components include:

  • Moving your body
  • Getting adequate sleep
  • Managing stress
  • Eating a healthy diet
  • Connecting with your community
  • Getting outside
  • Practicing creativity
What can I do to support my immune system?
  • Wash hands frequently as described above
  • Keep your hands away from your face and mouth
  • Stay rested and hydrated:
    • Aim to drink ½ your body weight in ounces daily
  • Use a neti pot or nasal saline twice daily
  • Minimize sugar, sweeteners and alcohol
  • Reduce stress as best as possible. See this post for tips to help with stress and anxiety during this atypical time period.
  • Consider taking the following supplements:
    • Vitamin C: 2000-3000mg daily (Vitamin C at high doses can cause loose stools, and so divide the dosage if needed, and use a ‘buffered’ form)
    • Zinc: 25-30mg daily
    • Elderberry: as directed on the bottle
    • Quercetin up to 1000 mg daily
    • Vitamin D: 4000-5000 IU daily

Please see this article “Integrative Considerations during the COVID-19 Pandemic” published by the University of Arizona, Andrew Weil for Integrative Medicine.

What about Hospitals, Elective Procedures, and Visitation?
Hospital Care

  • Area hospitals remain the absolute best place to go if you get sick with COVID-19 and can no longer safely isolate at home. They have ICU (intensive care units) and ICU doctors, along with the largest concentrated health-care workforce including nurses and respiratory therapists. They are also struggling to obtain enough personal protective equipment (PPE) but have the best inventory of ventilators, respiratory equipment, medications and other supplies. They are doing medical staff updates to keep everyone up to speed.

Elective surgery and outpatient procedures

  • Per government guidelines, almost all elective surgeries have been canceled or postponed. Surgical teams are managing their own procedure schedules on a case by case basis.

Visitation

  • Most hospital visitations are cancelled, but some are allowing case-by-case end-of-life visits by a single designated family member. Even then, anyone entering the hospital must be screened for fever or COVID-19 risk before being allowed to enter the building. If you have a loved one in the hospital or at a nursing care facility, call directly to find out their protocols.
What do I do about groceries and food safety?
Food safety

Below are updates and recommendations regarding food availability, procurement, and handling. All information included within has been corroborated by the USDA, CDC, and a recent article released by Harvard School of Public Health. There have been no confirmed reports of spread or transmission of COVID-19 through imported goods, through food, or through packaging.

The following precautions should be observed if you are receiving goods or are entering stores to purchase supplies. Please note that the CDC acknowledges the greatest risk of viral transmission is through direct interaction with delivery personnel, store staff, or other customers within a shopping area. Secondary risk, they explain further, is viral transmission from touching contaminated public shopping carts or baskets.

  • The bottom line: have groceries and supplies delivered, if that option exists.

Should I wash my groceries and delivered goods?

According to this article, precautions for washing groceries and delivered goods may not be necessary for most people. If you are older than age 60, have chronic medical conditions or have a compromised immune system, then you might consider washing groceries and delivered goods if you are wanting to be 100% cautious. To be clear, there have been ZERO cases of COVID-19 cases known to be transmitted from groceries or delivered goods.

Grocery store: If entering a grocery store cannot be avoided, please observe the following:

  1. Glove prior to entering the store. Completely avoid touching your face during this time.
  2. Prior to shopping, sanitize the basket or cart with a sanitizing wipe and dispose immediately. Alternatively, you may bring your own large reusable bag.
  3. To check out, use the self-check line, sanitize the scanning screen, touch screen, and belt prior to and after use.
  4. Bag your own items both at the self-check and at the regular check-out line.
  5. Use hand sanitizer upon leaving the store.
  6. Wash hands for at least 20 second with soap and water after handling goods and prior to eating.

Delivered goods

  • For both grocery items and other delivered goods, our recommendations are as follows:
  • If the item is non-perishable, you may leave it outside for 24 hours. The Coronavirus was found to not live more than 24 hours on cardboard.
  • If the item requires refrigeration:
    1. Open the packaging and dispose in a receptacle or garbage bag outside.
    2. Wash hands with soap and water for at least 20 seconds.

 

This video shows some basics about handling incoming groceries, especially if you are caring for someone at high risk for severe illness from COVID-19. **PLEASE SEE THE NOTE ABOVE THAT THESE STEPS ARE LIKELY NOT NECESSARY FOR MOST PEOPLE.

 

Prepared food delivery

  • This is an attractive option for many individuals and families looking to take a break from cooking or to show support to the local economy. Keep in mind that the risk of viral transmission is increased with direct contact with delivery personnel. Things to decrease risk of viral transmission are the following:
    1. Pay over the phone and request contactless delivery.
    2. Receive packaged meals, open the packaging, wash hands.
    3. Remove food, wash hands.
    4. Dispose of packaging, wash hands.

Recommended cleaning agents:

We are going 'stir crazy' during the stay at home orders... What can we do?
My family and I are getting a little stir crazy. What can we do?

  • First, a kinder way to think of this time is as “sheltering at home”
  • Call 2 friends or family members every-single-day. Or better yet – FaceTime them – every day. They’ll appreciate the check in, and it keeps you connected.
  • Create a Zoom Book Club or do it on another platform, like Google Hangouts. You can see each other on Zoom, interact, and hang out there for a long time. Daily even.
  • Try the app House Party – it allows you to gather a group online, play games, and hang out.
  • Netflix also has a feature where you can simultaneously watch a movie at a distance – and chat while you’re watching
  • Create small online AA, religious, or other meetings to keep connected with the support networks that have been your glue
  • Create a friends and family Facebook page – share funny photos from home, videos, and commit to staying connected several times every day.
  • Do therapy online if you’ve been working with someone
  • For kids, old enough, create a Zoom or Google hangout, teach them how to play Scrabble, chess, double-solitaire, or another game online with a friend – or a grandparent who is at home at a distance and would love that!
  • Listen to books on Audible with your kids – it’s also a sneaky way to get some work done while hanging out with them!
  • For parents who are trying to homeschool or need some additional resources: www.amazingeducationalresources.com
North Carolina Reopening Plan
Check here to learn more about the current phase of our state’s re-opening process, as well as upcoming information: https://www.nc.gov/covid-19/staying-ahead-curve. Buncombe County’s website also has a resource hub with daily updates, a COVID symptoms self-checker widget and more: Buncombe County takes COVID-19/Coronavirus Action.
Status of Local Parks and Trails

During May 22 – June 26, 2020 we are in “Phase 2” of a three step approach to lift restrictions in the state of North Carolina. This marks a transition from a “stay at home” order to “safer at home.” Regarding trails and public parks, Phase 2 allows for outdoor gatherings of up to 25 people (10 for indoor gatherings). However, public playgrounds will remain closed. All other closures appear to remain in place. To learn more about the differences between Phases 1 and 2, go to the NC.gov web page outlining the details. To help make it easier for you to get outside and enjoy the spring sunshine, we have summarized the facts below:

Buncombe County Parks: 

Open: All City of Asheville parks including dog parks, outdoor courts, fields, boat accesses, and the Azalea fishing pond are open. Group gatherings are limited to 10 people and physical distancing guidelines are still recommended for everyone. 

Closed: Playgrounds, all buildings located in parks, restrooms, community centers, recreation centers, and the WNC Nature Center are closed. All picnic shelter reservations are cancelled through 6/30/20. Asheville Parks & Recreation programs are cancelled. Community centers and recreation centers are closed until further notice. For more detailed information, please visit this City of Asheville webpage.

For hiking trails in the Asheville area:

Between May 9- May 22 the following information is up to date:

Open: The walking trails of the Arboretum, NC State Park trails, sections of parks and the Blue Ridge Parkway, most public restrooms, and some boat ramps are open. The National Park Service encourages visitors to avoid crowded trails and parking areas. Now is a good time to explore less popular trails. The National Park Service lists trails here and here. Don’t forget these hiking safety guidelines

Closed: Campgrounds, cabins, beaches and designated swimming areas, museums, exhibit rooms, auditoriums, classrooms, group camps, snack bars, and retail centers are closed. On the Blue Ridge Parkway, all facilities, restrooms, portable toilets, visitor centers, campgrounds, picnic areas, concession operations, Pisgah Inn, Otter Lodge, and all backcountry campsites are also closed. Here is the active map showing which sections are open or closed along the parkway.

Please note that while many trails are open along the Blue Ridge Parkway, large sections of the Parkway itself are closed to through traffic. See below for a listing of those closed sections. To find trails that you can access, look for trailheads on the “open mile markers” that you can reach. This webpage has a listing of trail mile markers: https://www.nps.gov/blri/planyourvisit/nc-trails.htm.  The National Park Service is encouraging people who visit the parkway to adhere to CDC guidelines, and to continue to practice “Leave No Trace” principles. 

Specific sections of the Blue Ridge Parkway that are currently closed [per the National Park Service website]: 

  • MP 292 – 294.5 Road closed near Blowing Rock, including Moses Cone Parking Area and Hwy 221 Bass Lake Parking Lot.
  • MP 294.5 – 296.4 Road closed, including Price Park Picnic Area
  • MP 298.6 – 305 Road closed through Grandfather Mountain area, including Rough Ridge and Linn Cove Viaduct
  • MP 305 – 308 Road closed
  • MP 316.4 Linville Falls Spur Road closed, including parking at Linville Falls trailheads
  • MP 334 – 342 Road closed, including Crabtree Falls Area, near Little Switzerland, NC
  • MP 355 – 375.6 Road closed from Mt. Mitchell to Ox Creek, including Craggy Gardens
  • MP 377.4 Parking areas closed at Craven Gap (Town Mountain Rd) for MST Trail access
  • MP 384.7 Roadside parking closed at MST Trailheads at US 74A Parkway access ramps
Resources for Grief

Grief and loss are difficult to navigate under “normal” circumstances. However, in the midst of COVID-19 precautions everything is different. Caring for loved ones who are seriously ill is different. Honoring and grieving for those who have passed away is different. We gathered the resources below to offer support for navigating the grief of a loved one passing away. Many of us are also wrestling with the loss of normalcy, jobs, stability, or the sense of a dependable future.  We have included articles and resources below that address this kind of grief as well.

 

  • Resources pertaining to the care of a seriously ill loved one, or for those who are grieving the loss of a loved one: