Valerie Ebel, MD is a family medicine doctor for Humboldt Open Door Community Health Centers. In a phone interview with the Outpost yesterday, Ebel shared some of her experiences with laboring and pregnant women and other patients during the pandemic and discussed how she recommends people protect themselves from COVID-19 and manage their anxiety during this stressful time.
The following is segments from the conversation which have been edited for grammar, clarification and length.
Have you performed any deliveries recently, during the pandemic? Is there any different protocol for pregnancy care and for performing deliveries?
Yes, I was on call last weekend and had a couple of deliveries and a C-section.
As far as people allowed in with the woman who’s laboring — as of now, they can have their partner or a support person with them. But they can’t have multiple people with them, and that person can’t change. So, it can’t be that your husband comes in with you and then an hour later he tags out and your mom comes in. Also that person can’t have traveled from a different place. They have to be local. The only exception to that is that sometimes we have patients from outlying counties — like Trinity or Del Norte — so, obviously, that person’s significant other or support person would be from the same place.
Anybody going into the unit has their temperature taken when they walk in the door and they’re asked screening questions for respiratory symptoms like cough or shortness of breath. If anyone has a cough, shortness of breath, or a mildly elevated temperature, they’re not allowed on the unit.
So we’re taking precautions that are not draconian, but they’re protective and appropriate at this time to protect ourselves, the laboring women and babies that are born there.
Is the environment of the clinic or the birthing center different these days? Is the stress prevalent?
I would say yes, things have changed. I spend 90% of my time in the Open Door clinics. I’m on call for labor and delivery with the hospitals. But it’s not where I spend the majority of my time.
In the clinic the sense of camaraderie, common purpose, dedication and willingness to be flexible and do our jobs in a different way has just been an incredible experience. Everyone is giving everything they’ve got. Yes, everyone is stressed. But they’re committed, and it’s really inspiring to see everybody is so dedicated and willing to do whatever it takes to help one another and to help the community.
Have you been getting a lot of calls from patients, a lot of people wanting to come in?
People are calling a lot, appropriately, to get guidance on any kind of symptoms or questions they might have. People may have symptoms and they don’t know whether they should be tested or not, or whether they should isolate or not. We welcome those questions so that people are informed and know what to do.
Some people would rather not come in for regular visits. So we’ve changed nearly all of our visits to telephone and video visits.
The important thing for everyone to know is that Open Door Community Health Centers is still open for business. We’re still very much taking care of everyone’s medical needs. People don’t need to sit around their house with a medical problem that they’re afraid to go to the doctor for.
Just call your home clinic and tell the front desk staff that you want to schedule a visit with your medical provider. Then we decide who needs to be seen in person, who should do a telephone or video encounter and how frequently we need to follow up with that person.
But are pregnant women still generally going to be seen in person for most of their visits?
It’s completely case-by-case because that’s a special population. So we are seeing pregnant women in person. But not at the same frequency we would normally. That goes for postpartum visits as well.
If someone has a healthy pregnancy without any complications, then we are stretching out the visits. Once they’re full term, we’re still having people come in every week. That’s important because that’s when some complications can develop.
I think it’s been very difficult — finding a safe strategy that makes good sense in this population, compared to the general population. You know, because everybody’s pregnancy is so different.
How do you feel like changes brought on by the pandemic have affected your patients?
I think pregnant women are really afraid of things escalating, with community spread. In some other places where coronavirus has been overwhelming the healthcare system and contact is so rampant, hospitals are not allowing support people in with laboring women. So I think women are just afraid of that happening here and it’s making them concerned and anxious about having to labor alone.
That’s not what’s happening here yet. And if we can keep things under control here, I don’t anticipate it happening. But we have to keep it under control. People have to socially distance, wash their hands, not touch their face and wear masks.
It’s been my experience as a primary care doctor in this community that a number of people really don’t know what they should be doing, and what they should and shouldn’t be afraid of. And that’s really anxiety-inducing. That’s what’s so hard for people these days. That’s why everyone’s suffering so much. That’s why I’m getting countless requests for benzodiazepine prescriptions, anti-anxiety medications. People are melting down because they don’t know what to do.
So what have you been suggesting to your patients to help with alleviating stress? What do you say when people ask for Xanax and things like that?
It’s not a good idea to rely on medication to alleviate your anxiety through this period because, for one thing, they’re habit-forming. And we don’t know how long this is going to last. We’re not talking a day or two. So we need to find better coping strategies for the new reality that we’re living in.
One of the things that I find most helpful to people is informing yourself about how to protect yourself and your family from contracting the virus. Because it alleviates some fears of the unknown. And it’s the fear of the unknown and the uncertainty that drives anxiety for most people in any circumstance in life.
The other thing is there are many apps that are useful for coping skills for managing anxiety. Anxiety about leaving your house, childcare, your job, your finances or paying rent, — those things that are out of your control right now. Being anxious about the loss of control is understandable. But it doesn’t do you any good. The only thing you can do is control your response to the situation. Learning some coping strategies via apps which are widely available and free can can really help what you can control which is your response to the situation.
That’s a good suggestion. And what about suggestions for protecting yourself?
When community spread starts to happen, assume that you have COVID, because some people do and it takes a couple days to develop symptoms. When we’re dealing with a very infectious disease and some people in the community have it, if you have been out of your house once, you could have it.
I think social distancing is paramount. But I think when you do have to go out — and there’s some of us, like myself, who have to go out everyday and go to work — wear a mask. There’s people working in the grocery store, people working in the post office, the people doing food preparation and pick up, doing deliveries. Everybody has to go out here and there to go to the grocery store.
Wear a mask in public to protect yourself and to protect those around you. There’s very good evidence that in countries that advocate for community mask wearing they have significantly lower rates of COVID infection.
There have been some mixed messages about wearing masks. What is it about wearing a mask that you think is beneficial? Does it really provide that much protection?
From what I’ve read the best evidence that we have from studies of the spread of the virus is threefold: Simply wearing a mask reminds you to not touch your face. So, that’s the first thing. I mean, I’m wearing a mask right now when I’m talking to you.
Secondly, there are differing levels of filtration of masks to keep nano particles from crossing the mask barrier. Even a polyester blend, or a cotton blend t-shirt filters like over 70% of viral particles. I mean, it’s a heck of a lot better than nothing, you know?
And then thirdly, if you’re wearing a mask in public, you will reduce the particles that are emitted from your mouth. Let’s say you have COVID-19 but you don’t have symptoms yet, and you’re at Safeway, and you have your hands on your mouth, in a typical human fashion, and then you touch something, then the next person about five seconds later and touches that. You have just transmitted that virus. If you’re wearing a mask, you’re reducing the risk that you are going to do that.
And I think that it’s a very simple thing that we can do. There’s so many people in the community who are rallying to make homemade masks. Everybody’s offering to make masks and give them to the hospitals and clinics. And I think that’s great. But also, wear one yourself.
I really appreciate your time. Is there anything else that you want to add?
I think it’s a weird and scary time for everybody, but we really don’t need to be afraid. We just need to do some things for this time in our lives to protect ourselves. The medical community in Humboldt County is being very responsive. All we really need is everybody to do what we asked them to do, and we’re gonna be okay. I’m trying to really pass along a positive message because a lot of what people are hearing from our media is very, very discouraging and frightening and doom and gloom and it doesn’t need to be that way.
Also, turn off your damn social media. Turn off the never ending stream of COVID news. It’s fear and anxiety inducing. Go for a walk. Read a book. Play Scrabble. Learn how to cook something you’ve never cooked before. Use this time in creative and innovative ways to better yourself.