Physicians Choice interviewed their Medical Director, Dr. Joel Bessmer, about the COVI-19 virus and its impact on geriatric care. Part of the interview is directed to healthcare workers, and other parts are directed to the families caring for elderly parents.

The interview was conducted on 3/26/20 and the information is accurate as of that date.

UNEDITED TRANSCRIPT

Interviewer:                Perfect. Yeah, they definitely trust you more they trust than they trust me for sure. So why don’t you go ahead give us a little bit of background about yourself. Who are you, Dr. Bessmer? 

Dr. Bessmer:               So, I am the medical director for Members MD and Strada healthcare. I’m actually a native Nebraskan. I grew up in Plainview, Nebraska. Went to college at Kearney State College at the time. Graduated from there and started medical school at the University of Nebraska Medical Center. Joined their primary care program, which means I skipped my fourth year of medical school, and started residency program in both internal medicine and family practice a year early. So I did four years of residency at the University of Nebraska Medical Center.

                                    I finished training in internal medicine and did a chief residency year in 1996-1997. And then the first, roughly, 15 years of my career, I was on the faculty at the University Nebraska Medical Center. 

Interviewer:                Okay. Good. And then with Physician’s Choice, what is the role of the medical director as it relates to Physician’s Choice? 

Dr. Bessmer:               Sure. So think about it as one more person that’s on the team from a standpoint of it allows both the owners of the business, the people working in the field, and those kinds of things, to have a resource for questions. And, if at any point in time, one of the nurses is in the field and having trouble getting a hold of a provider, I’m the one that fields the questions.

Interviewer:                Okay. Perfect. So, the topic at hand is Covid-19. And your point of view, what is Covid-19. 

Dr. Bessmer:               And so Covid-19 is a coronavirus infection. Coronavirus, in and of itself, is a very common virus. It’s one of the common viruses that causes the common cold. But, as I am sure many of you are aware by now, this Covid-19 is not our typical coronavirus. So Covid-19 is just a specific coronavirus that refers to this one that is going around right now. 

Interviewer:                Okay. And, in general, how is it affecting the geriatric population?

Dr. Bessmer:               So it really appears as though this virus is most dangerous in our geriatric population. I think much of what you see going on in America right now is happening simply to help protect and save our geriatric population. It appears most individuals with a healthy immune system, i.e. less than the age of 35, who have this infection, it’s really only about .1 of them that have a bad outcome. 

                                    When we look at this involving our geriatric population, those numbers go as high as 20 to 25 percent. So, when you see us trying to stop the spread of this, there are a number of things going on there, right. We are trying to, what we call, bend the curve. And what that’s really about is trying to spare our hospitals and our ICUs from getting an onslaught of patients all at once. 

                                    Meaning that this virus is very easily transmitted, and if we just let all the public go out and spread amongst each other, we would have a great majority of the population all getting sick at once. Our goal in what you’re seeing right now in that population control and distancing of ourselves, and trying to limit our human-to-human contact right now is about trying to very much limit the spread of the virus. 

Interviewer:                Okay. So then what – if we’re around the vulnerable, this geriatric population, what are some of the things that we should be doing in addition, I guess? 

Dr. Bessmer:               Yeah, sure. No, that’s a great question, Greg. And I think the group that is involved in their care needs to take some extra precautions. So you’ve probably heard, as of today, in Blair, Nebraska in Washington County, there now is an assisted living facility where they think a care provider brought the virus into the assisted living, and there are a couple of people [inaudible due to audio cutting out]

                                    So, from that standpoint then, some extra things that care providers can be doing to try and keep that from happening, I think, we, in and of ourselves, need to take the precautions outside of work to an extra level. Meaning, I think, if you’re working with at-risk population, you should very much be spending your time with your own direct family in those usual contacts you have, but, you, yourself, trying to limit any other outside contact. 

                                    Above and beyond that, I think you should also be checking your temperature twice a day. One of the things that’s clearly different with Covid-19 than just a routine cold, or, right now, what we’re also seeing a lot of is seasonal allergies. And what’s different with Covid-19 than the rest of that is the fevers that developed with Covid-19. So, one of the things that we can be asking our care providers to do would be to check their temp every morning and every evening, and take extra precautions as far as using sick time and time away if they are at all ill.

Interviewer:                Very good. And then we’ve seen a lot of the facilities are starting to limit access from outside people? What do families do when their loved ones, for instance, in Blair? 

Dr. Bessmer:               mean, it’s gotta be a helpless feeling. This is just the heart of the difficulty. You know, not related at all Covid-19, I lost a nursing home patient yesterday. And we knew probably four to six hours prior to that nursing home patient’s death that he was going to pass. And prior to that, he’d been in the nursing home for a couple of weeks out of the hospital. 

                                    And, of course, with the new rules right now limiting visitation, his family had not been able to see him. And so it is a very difficult time for this. And so when we talk about that, it really is because of those extra steps that we are trying to take to protect that population. And it’s not easy, and I get that, but it is well worth our extra efforts and a little bit of time away from our loved ones right now to try and make sure that we don’t carry that in. 

Interviewer:                That’s good. And then what about that recommendations, or do you have any recommendation, where people – in this mode, we get into this stockpiling mode because we want to do something; medication, supplies, nonperishable foods, if we have elders. 

Dr. Bessmer:               Sure. I don’t see a lot of reason to be stockpiling right now. I certainly think if you’re shopping, you know, I’ve noticed on my neighborhood app and the number of those other things, the number of neighbors, and others offering to go out and do shopping for elders that might be quote/unquote “shut in” right now or any of those at risk. And I would look for those opportunities for somebody to go do that for you. 

                                    If you find yourself in the high-risk category, meaning above the age of 65, also with some extra comorbid conditions. Meaning maybe I have heart disease. Maybe I’ve had cancer in the past, and received chemotherapy, or maybe I do right now and I’m receiving. You know, those are our really high risk individuals, and I think those individuals want to do everything they can to limit their outside contact right now, and taking the opportunity to have somebody else go do that shopping for you is a good idea. 

                                    Those are really about the only people, I think, we might all stockpile for. If you’re just on a routine individual out there and you’re home with your family right now, I don’t know understand, at all, stockpiling. Our grocery stores are not closed. They are not going to be closed. I can certainly understand that you want to take a little extra time and maybe prepare your shopping for the week. My wife and I have a number of kids, so we’ve always been good at creating a menu and knowing exactly what we need when we go to the store, hopefully, for the week. 

                                    So, I would just recommend a few things like that, but I really don’t see the need for stockpiling. This is not something where I think, all the sudden, the grocery stores are gonna to be closed and we’re not gonna be able to get there. It’s just that if you are shopping for that population, try to limit that contact with them. I could certainly see stockpiling some things for them.

Interviewer:                Okay. 

Dr. Bessmer:               Some other things that you might want to have available to you, right now, that you might not think as much about, otherwise, about the only thing I can think of there would be, you know, possibly zinc lozenges. There’s a question as to whether or not if you were to develop coronavirus and get that sore throat, maybe a little bit of a fever, when we look at some data in other coronavirus infections, it does look like zinc is toxic to this virus. Now, understand that does not mean you can just swallow zinc as a supplement. It really is a matter of sucking on it. 

                                    So it’s the Cold Ease or the Zicam lozenges, or there are a number of other generic alternatives to those, or they also have effervescent tabs. So having those around, I think, is a very reasonable thing also. And then other than that, it’s maybe a little bit of extra cleaning supplies or antiseptic stuff for your hands. 

Interviewer:                Okay. That’s good. What advice do you have when – well, and you’ve kind of addressed with the neighborhood app. But when family or friends, or a normal caregiver, is unavailable, what advice do you have for the families or the people trying to provide care for those? 

Dr. Bessmer:               Yeah. If you are not presently on a neighborhood app, actually, I mean I would try to do that, or, otherwise, it’s a time to reach out to a neighbor that maybe you’ve met before, and maybe you haven’t asked him for favors. But, you know, most of the people, right now, are really looking for opportunities to help people. It’s the beauty of the American way. 

                                    I see so much of that coming through, and it’s always in these times of trials and tribulations, it seems like in our country, that we get to see our greatest sides. And you can not only help yourself by doing that, but by allowing somebody else to help you. I’m telling you, you are helping them. 

Interviewer:                That’s good. That’s interesting information. What about, what if you’re in an assisted living facility and staffing is low? 

Dr. Bessmer:               Well, and I think we really could see that from a couple of different perspectives. Maybe, some of the staffing, themselves, having to be quarantined for one reason or another. And, I think, if that’s the case and you’re in an assisted living facility, it is a great time to be able to reach out to your family to say, “Hey, can you help out a little bit from this standpoint or that standpoint?” 

                                    It doesn’t have to mean any further true direct contact. It’s very simple to have somebody go shopping for ya and leave stuff sitting outside your door, and knock on the door when it’s all been dropped off. One of the things, you could think about utilizing right now, are just a little gloves that you see us use as healthcare providers. And so if somebody were to go shopping for you, the recommendation would be that you wash your hands before you go pick up those groceries and put them all away, and you wash your hands again after you put the groceries away.

                                    It leads me to one extra comment, and that is I see a lot of people wearing masks today. Not so much in our community, but constantly what I’m seeing in the news and other cities. And I want people to understand, if you’re not wearing an N95 mask, it’s not offering you protection from the coronavirus. And I wouldn’t want you to think it is. But I do want you understand, they are protective. So they’re protective in that so many of us inoculate ourselves. 

                                    So I refer to washing your hands after you put your groceries away. So, remember, we know that this virus can live outside of the human host for a limited amount of time. And on most of those surfaces, it’s four hours to less than 24 hours. So if you think about somebody had just touched some things, maybe it’s a door handle, maybe it’s the food stuff that’s protected and you’re just putting it away on the shelves. The reason you wash your hands after or you wear gloves during that is to wash away the virus. 

                                    The reason you wear those masks that are not going to protect you from breathing in the coronavirus is because it keeps you from going up and touching your nose or touching your lips unknowingly, and that’s really the protection that the masks offer. 

Interviewer:                Okay. That’s good to know. [Laughter]. Okay. What about – oh, this – somebody had bumped into this where they coming out of rehab, their Medicare was up and they were going to be transferred to a new facility. But the next facility wasn’t accepting any outside patients. What are some options for weird situations like that? 

Dr. Bessmer:               Yeah, that is a weird situation, and, in all honesty, probably the best thing there is to work through the social worker at the site where you presently are. My understanding is Medicare, right now, has truly loosened a number of these issues when it comes to reimbursement and payment. And the reason why is they completely understand why one facility is on lockdown, and you are stuck in another. And I would not expect any surprise billing out of that. I think that’s all gonna be something that the facilities will be able to handle. 

Interviewer:                Yeah, that makes sense. Other questions. What happens if you think that you’ve been exposed to Covid-19? 

Dr. Bessmer:               So if you think you’ve been exposed to Covid-19, we are really asking you to self-isolate, and that’s really how we will bend the curve. So self-isolation would be you trying not to expose yourself to anybody, but your direct family, and really even trying to limit your exposures to your direct family. And the time of quarantine that we’re speaking of, there is roughly 14 days. Most patients, if exposed to Covid-19, would develop signs or symptoms around days 3 through 7, with a majority of those by five days. But we certainly have seen cases where they developed after what we think a contact of 14 days, and that’s why you see that recommendation. 

Interviewer:                Okay. Symptoms, are they different, or do they appear earlier for the elderly? 

Dr. Bessmer:               That’s a great question. We don’t have a lot of data on that right now, but it certainly appears as though they are getting sicker with the lung involvement, meaning they’re more likely to develop pulmonary complications, and, specifically, because more in that group have more of those comorbid conditions, right. The longer you live, the more likely you are to get one of those. So that certainly may be a part of that. But, otherwise, at the onset, the symptoms appear to be relatively similar. And that is this typically presents with runny nose, cough, congestion, sore throat, and a fever okay. 

Interviewer:                Okay. So there’s been a lot of talk about testing. Once testing is more widespread, will it be older adults they get – that are the first to be tested? 

Dr. Bessmer:               I don’t know about the first to be tested because regardless of whether or not they were positive or negative, it would not honestly change a lot we would do with them unless they were symptomatic. So, I think, more than likely, it’s more than likely, the first people to be tested when this becomes much more available are your health care providers. Because what we really need to know is who, in the healthcare providing world, might be positive right now and caring for patients, number one, which we hope that’s not happening, but we know it can. 

                                    And, number two, which of those have already been exposed, had it, and cleared the virus, and, obviously, are at no risk at all from this virus. So if we could start to identify some of those things, it would really help, I think, make our care stuff much easier. So I really see kind of the healthcare providers being the first rollout of testing. And then after that, when it becomes widely, I think, quite honestly, I think every American needs to be tested. 

                                    Because I personally believe, and I think you’re hearing from a number of medical experts, this virus is likely to come around again. And so we’re going to want to know the next time it comes around, did you already have it? Because if you’ve already had it, we don’t think you’re going to be at risk again, very similar to many other things. 

                                    Like when you get EBV mono once, it’s very, very unlikely that you’re going to get EBV mono again, or Epstein-barr virus. This virus is similar, right. If you develop antibodies to it, we don’t expect the virus to win the second time.

Interviewer:                Yeah, that’s interesting. Okay. Healthcare professional questions. There was this one, which you kind of addressed, but how should healthcare professionals/caregivers protect themselves? And I thought the take their temperature twice a day fits in. Is there is there anything else that –? 

Dr. Bessmer:               No, I think, the temperature twice a day fits in there very well. And then, once again, I just can’t emphasize enough, you know, we, in healthcare, are taught normal precautions to keep this from happening. And those are the things we’re supposed to be doing day in and out. Just like I don’t want to give anybody even the common cold when I’m seeing them. So it really is, if we just take those normal general precautions that we’ve been taught as healthcare providers, they work. 

                                    Some extra things I would ask you to think about, though, is you’re right. I think, we, as healthcare providers, should be checking our temps in the morning and in the evening. And if we are to run a temperature, that’s the time to take a little extra time away to say, “I need to see what’s going on here. Is this just may be a common cold or is there something else going on with this?” 

                                    And then, also, I think we can be doing a better job with wearing gloves, maybe wearing a mask to help ourselves, and remind ourselves more, right. When you see those gloves and you take them off, it’s easy to then, all the sudden, think about washing your hands. But, sometimes, otherwise, we forget. So some of those things like wearing the mask and gloves are also just about reminding, hey, I need to be cautious. 

Interviewer:                Yeah, good point. What about like family caregivers who are not trained in some of the things that healthcare professionals are? 

Dr. Bessmer:               One of the most important things are, really, protecting yourself when you’re coughing and sneezing. I’ve seen a lot in the press about how to do that, but basically it’s trying to do it into your elbow. But consider that area of your clothing now contaminated. So if you now touch that later on, you know, in the next hour or so with your hand, you have just contaminated your hand, right. So it is understanding. 

                                    Although, we talk about doing that, that then can become a reservoir for the virus. So be careful about where you’re doing that and touching that, number one. Number two, this is really where hand washing comes in, wearing gloves, thinking about a mask, and all of those things, especially applied to our caregivers. 

Interviewer:                That’s good. A couple of family-oriented questions. Is it safer to keep my parent – this is where this was coming from. Is it safer to keep them in the facility they’re in or move them back home with me, or –? I don’t know what to do. What should I be thinking about? 

Dr. Bessmer:               That’s a great question. And this is one of those, Greg, where the right answer is going to depend upon the family. If you have a loved one in a care facility, and they’re, quote/unquote, what I would call “easy to care for”, meaning relatively independent. And in your home, they’re going to get less exposure to people then they will in the facility, you’re decreasing their risk. 

                                    Meaning, let’s say it is a husband and wife and they’re bringing one of their parents into the home, and they’re the only ones in the home. They don’t have any children. That’s going to be a lot less exposure than that family member would get in any facility. So I can see that as a safer option. However, if your loved one is in a facility and may need some cares on a daily basis and some things that you would be uncomfortable doing it, and maybe a wound care. or some rehab, or those kinds of things, then they’re probably much safer in the facility. 

Interviewer:                Okay. That’s good. What about if we live with an elder who’s got some chronic health issues, how should we be protecting them or what should we tell our kids if we’ve got kids around? 

Dr. Bessmer:               Right. If kid are around, too, this is really where you pull the kids aside and say, “Hey, listen, I want you to know we are going to be taking some extra precautions.” And just explaining to them why, whether it’s grandma or it’s grandpa, whether it’s an aunt, an uncle. Maybe it’s somebody else in the family or just even a family friend. But explaining to the kids why things are different now. And kids will pick up on that and they’re really good about it. They will still need reminders, but I think you’ll find it they want to help, too, and want to be a part of it. 

                                    And, no doubt, if you have an elder living with you and you have kids, and that elder has some of the chronic health conditions that we talk about increasing the risk, be it lung disease or immune status, or some of those things, you will want to take extra precautions to protect them. 

Interviewer:                Yeah. That’s good. What about alternative ways to visit loved ones when we probably shouldn’t be around them?

Dr. Bessmer:               Boy, can you imagine if we had to go through this without our cell phones? 

Interviewer:                [Laughter]. Right. 

Dr. Bessmer:               I just can’t even imagine what this would be like if we did not have cell phones and a way to do that. But there are a number of things. If they don’t have a cell phone, it’s a great time to buy them one as a gift, and to be able to show them an easy ability to call, and, yet, share the picture of their loved ones. So that they can still feel like they’re seeing somebody and talking to people, and those kinds of things. E-mail and Skype, and all of these other things that are now available, I think, make this so much easier. 

                                    And it just warms my heart to see all those pictures that we’ve been seeing on the news and in the paper, where it is somebody, standing outside a loved one’s window, sharing with them through a window. All those things are safe and easy to do. 

Interviewer:                Yeah, that’s good. Let’s see. Can food or drinks be dropped off for an elderly person? Is that dangerous? 

Dr. Bessmer:               So as we’ve talked about before, no, that’s not dangerous at all. It’s just trying to make sure that they understand, that food has been touched by many people, maybe even the same day you’re purchasing it. And I’m referring to the packaging, of course, there. And, so, once again, I say take extra precautions about that. 

                                    So if it’s an elder person at risk, I think, the best way to do that a shop for them, leave at their door. Knock at the door to let them know, or call them and let them know, “Hey, I just dropped off everything outside your door.” And then for the elder person, their job would be to wash their hands prior to getting those groceries, put the groceries all away, and wash their hands again. 

Interviewer:                Very good. Let’s see. What about if an older adult or their family members need assistance with long-term care, Medicare/Medicaid advocacy? 

Dr. Bessmer:               So there are a lot of different agencies that would be available to do that. Many of those – 

Interviewer:                And they’re still up and running, right? 

Dr. Bessmer:               They are still up and running. I was just gonna mention, you can’t go to many other offices right now, and I probably wouldn’t even try without calling ahead and them giving you a direct appointment. But I know that all of them have added extra phone lines, and many of those people that would otherwise be seeing you in the office, are instead screening phone calls. So you can call a number of different agencies there for help.

Interviewer:                That’s good. What about if my parent is in a facility, what are some of the questions that I should be asking of the facility? 

Dr. Bessmer:               Well, I think it’s just what are your extra precautions right now, and is there anything that I can be doing to better help my parent through this? So, the facility, themselves, may have some limitations, and they may need more help from family now than they’ve ever had before. So, I think, reaching out to the facility and saying is there something that, we, as the family, can do more to help, you, the facility, as well as is there something more we can be doing to help our parents or loved one who’s there. That facility is gonna know best what they need. 

Interviewer:                Yeah. 

Dr. Bessmer:               It might asking you to even do some sewing and make some masks for them or do some laundry for them. Or maybe even the facility is running out of something that you could go shop for or help facilitate them finding. I mean, I think, there are a number of ways you can help. 

Interviewer:                Yeah, and they’ll ask, right, if you offer to help. 

Dr. Bessmer:               Yeah. I think if you ask, I think they’ll find something for you.

Interviewer:                [Laughter]. That’s good. What about if I have my older adult that refuses to believe that they are at risk for whatever reason? 

Dr. Bessmer:               You know, it’s – I guess, it depends on how far you want to push that. You could start sharing with them some pictures hospitals out of the hospitals in New York or Italy. Or you can talk specifically about what’s – I can tell you having communicated on a number of different, almost three nights a week and two mornings a week, I either end my day or start my day on a Zoom call with groups of physicians. And I can tell you heartbreaking stories out of both, well, specifically out of Italy, where they do not have enough ventilators.

                                    We’re worried about that happening in America. And you are asking doctors then, when you are an older adult at risk, to decide. Do you get that ventilator or do I give that to somebody who’s younger and healthier? And these are decisions healthcare providers are having to make. So the thing I would say to that adult is don’t make me make that decision for you. Please, take the extra precautions. 

Interviewer:                Yeah. 

Dr. Bessmer:               [Crosstalk] mortality rates out of Italy, in the elderly population, 20 to 25 percent. 

Interviewer:                That’s terrifying.

Dr. Bessmer:               That is terrifying. So it’s real. 

Interviewer:                It is real. Is there anything else as you’ve been through this? This is super helpful. Thank you. 

Dr. Bessmer:               Um…boy, I don’t think so. We really touched on the gamete of it. 

Interviewer:                [Laughter]

Dr. Bessmer:               No, I can’t think of anything else we’ve been talking about. You know, the only other thing I kind of talk about with my own individual patients with some of this is – and you’ll get different recommendations from different providers. But one of the things I try to make sure that people understand is we believe this virus is temperate. What does that mean? We believe this virus has a coating around. And when it gets warm, it swells, and it can’t function well and it’s easier to kill it that way, or it dies sooner.

                                    I encourage my patients not to treat their fevers. Right. We seem to be a society that constantly reaches for something to fix a problem. And I want you to understand, if you think you have Covid and your temperature is 101, and it’s not specifically bothering you in any other way other than the number, I personally would not recommend you treat that fever. 

Interviewer:                Interesting. Yeah. 

Dr. Bessmer:               Let that fever do what it is trying to do inside your body and that’s kill the virus. So, and once again, you can find some different recommendations. And I’m not saying that if your fever is causing you much night sweats, those kinds of things, dehydrating you, then, absolutely, you should probably treating your fever. If it’s making you uncomfortable with body aches and a headache, you absolutely can take some Tylenol. 

                                    But I would emphasize, Tylenol is the safe thing if you think you’re being dehydrated, and you should not be using things like Advil, Ibuprofen, Aleve. Because those are excreted through your kidneys and need water to be flushed. And when they isn’t enough water there, they actually damage your kidneys above and beyond otherwise. Tylenol is safe for almost all of us. We’re safe to take up to three grams of Tylenol or 3,000 milligrams in a day. And other than that, you need to be careful. 

                                    But, once again, I come back to the fact, if you have a fever, and the way you know you have a fever is because you checked, it does not mean you need to take something for it. 

Interviewer:                Good. that’s good. What about, in Nebraska, we also deal with this urban rural. Is there anything different there with the population clusters to consider? 

Dr. Bessmer:               Well, I think, one the reasons why you see this, quote/unquote, clustered in cases where it is, is because of how dense the population is. So, in all actuality, although, healthcare might be a little bit more difficult in that they may not have as many ICU rooms. You may not have the volume of healthcare providers. You might actually be better off today not being in one of those dense populated areas as far as the risk of acquiring. 

Interviewer:                Yeah. Interesting stuff. Okay. Thanks. I think we’ve taken up as much time as we had asked you for is there. If there’s anything else, now’s the time. 

Dr. Bessmer:               I don’t think so. I wish everybody luck. It’s a great time to hunker down, learn how to play cards and games again. It’s a great time. to spend time with family. 

Interviewer:                Yes. All right. Thanks a lot. 

Dr. Bessmer:               Thank you, Greg. Enjoy your day. 

Interviewer:                You, too. I’ll talk to you later.

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