Coronavirus Update

Bay Area End of Life Options is fully open, accepting new patients and continuing to provide services to all of our patients without restrictions. To expedite our new-patient intakes, we do initial visits promptly by TeleHealth video-conference and/or telephone. We follow that with in-home visits with infectious-disease precautions. Please do not hesitate to contact us with any questions.

Coronavirus avoidance recommendations for our in-home terminally-ill patients:

  1. Distance – all visitors need to give the patient a 6-foot radius. NO touching (so sorry).
  2. Nobody, from family members to friends, with ANY symptoms (fever, runny nose, cough, aches pains, diarrhea) in the last 14 days should enter the patient’s home.
  3. Nobody with close family members who have ANY symptoms in the last 14 days should enter the patient’s home.
  4. No visitors with any known risk of exposure in the last 14 days, should enter the patient’s home.
  5. Upon entering the patient’s home:
    Remove shoes outside.
    Go straight to a sink and wash hands with soap and water for 20 seconds, dry with paper towels that get thrown into a covered garbage can.
  6. Food handling:
    Food and beverages should be prepared and served using a fresh set of disposable gloves, or by washing hands directly before preparing and serving.
  7. disinfect Surfaces:  countertops, doorknobs, bathroom appliances, bedside tables, couch side tables, light switches, phones, garbage lids, sink and faucets handles should be wiped down with disinfectant after visitors, or daily if no visitors.
  8. Wash hands with soap and water frequently. All family present in the house, and all care providers:
    Wash hands upon re-entering home, before any and every meal or snack, after every bathroom visit, and before touching patient. If the patient is touched by anyone, the patient should also wash their hands immediately after.
    Use an alcohol-based hand sanitizer in between as needed. (Especially if touching money, or credit cards, or door handles).
  9. Obviously, all should cover their sneezes and coughs, either into their elbow or a tissue.
  10. Walking outside is fine, but keep a 6-foot radius whenever possible

To make a bleach solution, mix:

  • 5 tablespoons (1/3rd cup) bleach per gallon of water
    OR
  • 4 teaspoons bleach per quart of water

https://www.cdc.gov/vhf/ebola/pdf/cleaning-handwashing-5percent-liquid-bleach.pdf

The basics from the CDC:

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

Addendum, April 8, 2020: 

Covid-19 policy for the aid-in-dying day of our patients: 
  • First and foremost, our practice has to protect our other patients, their families, and in the case of the nursing homes we enter to provide care, all of the patients and staff there. It is essential that we do not contract Covid-19 and spread it.
  • Many of our patients have large families who travel from various parts of the country (and other countries) to be with their loved ones on the day of their death. We cannot add to our already busy practice by screening every family member for their risk factors.
  • Public health policy has clearly stated that to delay or halt the spread of the virus, strict isolation is imperative. For “essential care” (including us), contact with anyone other than the patient has been highly limited in all settings. While it seems cruel, many patients have died alone in hospitals so as to limit the number of people in that setting. Our practice is certainly not insisting on that, but we are insisting that no more than two family members are present in the home when we attend a death. (If additional family members have been in that house sheltering in place, they do not have to leave but should be, as much as possible, in a different section of the house than the one we are working in.)
  • Some families have noted that their house is large and therefore safe. There are two problems with that:
    • Our less affluent patients with smaller houses will not have the same privileges as our more affluent patients. We do not want to contribute to such inequities, so we have established a uniform policy independent of house size. We also cannot devote time to evaluate the floor plans of each home to decide how many people it’s safe to have there. (The answer: The fewer the better, always.)
    • Even in houses with physical space, the chance of surface, droplet and aerosol contamination increases with each person present.
  • On a more personal note: Lonny Shavelson is 68 years old. He’s had cancer recently, as well as two episodes of pneumonia, resulting in significant scarring of his lungs. Thalia DeWolf has asthma. We are putting ourselves at significant risk by seeing patients in their homes. We hope that all families will be considerate of that and follow the rules we and public health authorities have established.
So with apologies and our deep understanding of how difficult these times are, especially for families of dying patients–our practice cannot evaluate every house and every family member to judge safety. So we’ve made a decision to have a uniform policy:
  • The only people in the house when we arrive will be the patient and two family members. (If additional family members have been in that house sheltering in place, they do not have to leave but should be, as much as possible, in a different section of the house than the one we are working in.)
  • Any other family members are welcome to say their goodbyes and be present up to a few hours before we arrive. But they must leave the house before we arrive.
  • Please wipe down the exposed surfaces we’ll be in contact with before we arrive. This includes the kitchen or bathroom we’ll use to mix medications, and the bedside areas around the patient.
  • Family members should wear face coverings or masks when we are present in the house. We will do the same.
  • After the patient dies and we leave the home, of course all family members who wish to be together in the house can return at that time. We urge, though, that you consider public health recommendations to limit such gatherings.
Thank you for your understanding, and we wish you all the best.
Lonny Shavelson, MD
Thalia DeWolf, RN, CHPN