By Andrew Ellsworth, MD
 
When I come home from a day at the clinic and hospital, there is no better feeling than my children running up to give me a big hug. For the past couple of weeks, I have had to remind them to stop, and just do an air hug until I have had a chance to change clothes and shower. The idea is to wash away any germs and decrease the risk of getting my family sick after working with several patients and sick people during the day. Maybe these efforts are too much, or maybe they are not enough. 
 
The Covid-19 virus spreads through respiratory droplets, from talking, coughing, or sneezing, and appears to also spread via a fecal-oral route. The fecal-oral route is how the stomach flu often spreads, and many of us know how easily that circulates through families and daycares. Someone who has been to the bathroom may touch a doorknob or a serving spoon, which someone else touches before eating, and they may become infected. That’s why we need to wash our hands well and avoid touching our face and our food.  
 
Unfortunately, the virus can spread from people that do not have symptoms, or before they have symptoms which is why, I worry, I may not be doing enough to protect my family from the one person who puts them at the biggest risk: me. Some doctors and nurses are deciding to avoid their families altogether and live in the garage or the basement when they come home. I haven’t decided to do that yet, but maybe I should, or maybe I will. 
 
Pandemics and disease have separated families for longer than the history books can tell us. Before they knew the cause, our ancestors knew that if someone had smallpox, quarantine and fire were the only ways to help prevent the spread. People, houses, and entire cities were quarantined. Disease has arguably decided more wars than the battles themselves. During the 1918 influenza pandemic, soldiers from Fort Riley carried the disease to other American military bases and from there, to the battlefront in Europe.  
 
These lessons of history helped us learn about how to control disease. Advancements in infection control, medicines, and vaccinations have turned the tide and made many diseases a distant memory. For Covid-19, we do not yet have proven medications or a vaccine. However, we are learning more every day how to help those who are sick and how to better prevent the spread. In the meantime, my family and I will continue to practice social distancing and similar efforts to do our part to flatten the curve and slow the spread, to give us time to find treatments to combat this current scourge on humanity.  
 
Andrew Ellsworth, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.        

By Jill Kruse, DO
 
History has its eyes on you. That is a quote from the popular musical Hamilton, but as we are dealing with a global pandemic it also applies to all of us.  The year 2020 is going to be remembered someday in history books.  How it will be remembered is in part, up to us.  Will this year go down in history as a time of great selfishness – with people hoarding masses of toilet paper and masks?  Will this year go down as a time when we all came together to help our neighbors through this scary and uncertain time? 
 
There are heartwarming stories of people in Italy singing from their windows at night.  All these voices raised up together to bring hope and a small spark of joy.  Even though they are separated physically by the quarantine, they unite in spirit and in song.  In the United States there have been reports of neighborhoods that are connecting on social media to see who on their block needs resources.  They assign “team leads” to check in with each family to see if they need anything.  The “team lead” arranges for someone in the neighborhood to deliver groceries and medications to the doorsteps of the elderly or those quarantined. 
 
Families are home eating together each night.  Activities have been cancelled and the normal day to day busyness has gone away.  At my own home, board games are being pulled out of the closet, books are being read more, and family movie night is a regular occurrence.  There is no rushing to get out the door to this activity or that event.  In the midst of the fear and the uncertainty, I am trying to savor the quiet moments at home with those I love most. 
 
Now is the time to re-connect with family and friends that you “didn’t have time” to talk with.  Now is the time to send that text or email.  Don’t hesitate to make that phone call or Facetime someone who is important, but previously was not high on your list of things “to do”.  This past week I have had more phone calls and text messages from friends and family than I can ever recall before.  That has been a gift. 
 
Every day we write history.  Today we get to decide what people will remember about this year.  Let’s do everything we can to show how we can come together to save lives and overcome this disease.   
 
Jill Kruse, DO is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.        

By Andrew Ellsworth, MD
 
With the coronavirus causing school to be cancelled, my son brought his schoolwork home. He shared with us a Greek mythology worksheet about Pandora’s Box. If you aren’t familiar, the Greek god Zeus gave a wedding present to beautiful Pandora but instructed her not to open it. Like many of us, impatience and curiosity got the best of her and she opened it anyway which caused a lot of new problems.
 
Similarly, with Covid-19, this new virus is already out of the box. This is a global pandemic and we are being asked to be patient and conform to social distancing to help slow down the spread. This is our current challenge. Every day we hear about sporting events, concerts, schools, and travel plans being cancelled. This is the best-known method to slow the spread of Covid-19. The less we are mixing and mingling, the less the virus is spreading. 
 
When we slow the spread, we give our healthcare systems the best chance at having the resources on hand to keep up with the number of people who need help at any given time. In areas of the world where cases of Covid-19 were allowed to spike, the healthcare systems are overwhelmed. Some hospitals don’t have enough beds, enough ventilators, enough medicine to treat everyone that needs help. They don’t have enough masks and gowns to protect their staff. In these situations, doctors are having to decide who gets treatment, and who doesn’t.  
 
Thankfully, of those who become infected, possibly 80 percent will have only mild symptoms. Some may not have symptoms at all. However, we need to understand that some will become very sick and some will die. Unlike influenza, Covid-19 is a new virus. Therefore, none of us have immunity from the past or from immunizations. There is no herd immunity. 
 
That is why events are cancelled. That is why social distancing is urged. Since most people will only have mild symptoms and some people may not have symptoms at all, the virus can be spread easily without us realizing it. We all need to be patient and follow the instructions from health officials. By doing so, we can hopefully prevent a large spike of a lot of sick people at once and avoid a worst-case scenario.
 
My son’s main impression from his school lesson was that despite the sickness and problems that were released, Pandora closed the lid and held hope inside the box. I have hope that together we will contain this virus and, in the end, this, too, shall pass.  
 
Andrew Ellsworth, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.        

By Richard P. Holm, MD
 
Our nation has a large and growing public health problem called suicide. It is the tenth leading cause of death in the United States and it is preventable. The Centers for Disease Control indicates suicide was responsible for more than 47,000 deaths in 2017, resulting in about one death every 11 minutes and it affects all ages. Suicide is the second leading cause of death for people 10 to 34 years of age, the fourth leading cause among people 35 to 54 years of age, and the eighth leading cause among people 55 to 64 years of age.
 
While the causes of suicide vary, depression is often an underlying factor. Most of us periodically have what is called "situational depression," such as the understandable sadness that follows severe loss or death, but what is more typical of harmful depression is when there is no particular situation, no identifiable “reason” for it.
 
The diagnosis of depressive disorder is not easy. We suspect depression when people experience chronic pain, find it hard to concentrate, are without energy, have flares of temper, sleep too much or too little, have a loss of appetite or have over-eating binges, have unexplained crying spells, or become filled with anxiety for minimal reasons. Often people make things worse by covering-up depression with alcohol, sleeping pills, anti-anxiety medications, or substance abuse, and these all make the diagnosis even more difficult.
 
The challenging concern is that with or without a diagnosis of depression, suicide remains extremely hard to predict. We know that “talking about it” is probably our most important means to help someone who is planning suicide. Although two-thirds of the people with depression do not seek or receive help; of the one-third that do get help and follow-through with treatment, 80 percent are better in four to six weeks.
 
Whenever possible, it’s best to guide people for whom we have concern to talk about their feelings with a professional. However, the most important preventer of suicide is, in many cases, the loved one, friend or kindly neighbor who can give that person an ear, offer true compassion and call for help when red flags are flying. You may never know it, but you might save a life by listening and being a friend.
 
If you or someone you know is struggling emotionally, help is available 24/7. Call the National Suicide Prevention Hotline 1-800-273-TALK (8255).
 
Richard P. Holm, MD is currently living with pancreatic cancer. He is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.