MARCH 10, 2020
Dear Patient of FOWH,

Here is some medical information and advice from us about the coronavirus and steps to take to help prevent infection or prevent spreading the infection to others.

Coronavirus is the name of the virus that is causing an illness called COVID-19. The illness usually starts within 2 days of exposure but can take up to 14 days to show up. The symptoms are fever, cough, and often some shortness of breath. People can progress from mildly ill to severely ill in a short time, sometimes just a few hours.

Steps to take to help avoid becoming sick
1. Wearing a mask when you feel well is not helpful.
2. Wash your hands with soap and water (20 seconds minimum) or use sanitizer gel before and after using the restroom, eating, or touching common public surfaces such as door handles.
3. Make your own sanitizer gel: 1 cup Isopropyl alcohol, ½ cup Aloe Vera gel, a few drops of scented oil for aroma, small amounts of Vit E oil for extra skin softening, small amounts of water to thin the gel mixture.
4. Avoid touching your eyes, nose, and mouth with unwashed hands.
5. Use Lysol or Clorox spray to wipe down counters and door handles.
6. Avoid airplane travel and cruise ships. Avoid large crowds.
7. Try and stay 6 feet or more away from others.
8. Avoid being near anyone who is coughing or appears ill.
9. Telecommute if this is an option.
10. Check the CDC website for updates:

Steps to take if you think you might have developed a COVID-19 infection
1. If you develop a cough, wear a mask if near others and stay home until you can determine if this is a cold or is COVID.
2. If you have been in close contact in the past 7 days with someone who you later found out definitely has COVID, then self-quarantine if possible until 14 days from when that contact took place. If no symptoms by then, you should be okay.
3. If you have been in close contact in the past 7 days with someone who you think might have COVID, then self-quarantine if possible until you know for sure if they tested positive or negative.

When to seek medical attention and when NOT to
1. If you have a fever > 100.4 degrees and a cough, this could be COVID or could be a cold. Do not go to a medical office or ER unless you have trouble breathing as well.
2. If you feel more than a little sick, call our office at (626) 304-2626 and ask for a nurse or medical assistant.
3. Unless you are severely ill, do not go to an ER unless instructed to by medical personnel. ER’s are becoming overwhelmed with patients, many of whom do not need to be seen.
4. Despite what is being said by the media, testing for the virus is NOT widely available. Most ER’s can test you if they determine it to be necessary, Few doctor’s offices if any have testing available.

General facts about the virus
1. It is possible that a many people have been infected with such a mild case that we do not really know how severe the illness is. We only know that about 2% of cases of people severely ill enough to become hospitalized are fatal. 
2. For the US 2019-2020 flu season, 18,000 people have died and 30 million became ill. There are a few hundred cases of COVID in the US and a few dozen or less deaths so far. 
3. After 2 months, the number of new cases in China and South Korea is decreasing. This suggests that millions of people have probably been exposed to the virus and have become immune without getting very sick.

COVID and Pregnancy, Breastfeeding
1. There has been no evidence of any harm to the fetus if a pregnant woman gets COVID. This virus has no relation to Zika.
2. Based on limited case reports, while adverse infant outcomes (e.g., preterm birth) have been reported for mothers positive for COVID-19 during pregnancy they are no higher than expected.
3. In limited case series reported to date, no evidence of virus has been found in the breast milk of women with COVID-19. Based on this we suggest that breastfeeding continue. If you are coughing, wear a mask.