The Tennessee lockdown appears to be ending on April 30 – this Thursday – while Greene County restaurants started allowing customers to dine within their facilities on April 27 on a limited basis. 

Of course, that doesn’t mean that the coronavirus will magically disappear on that date.  It is an arbitrary time set by our politicians to start opening the economy to allow people to work, since poverty can cause health problems as well (along with a lot of misery).  I don’t envy our politician’s task of trying to balance the health threat and the economic threat of the coronavirus at the same time.  I come down on the side of freedom over coercion, allowing people to be responsible when they are in public following the 5 W’s of Wise mitigation.

Wide berth – give people at least 6 feet

Wear a mask

Wash your hands regularly

Wipe down counters, doorknobs, sink handles, and cell phones

Watch what you touch, especially your face

Since my last email on April 7, it appears that rural areas like ours can loosen up more than can hotspots like New York City and other hotspots near our busiest international airports because our hospitals have not been overwhelmed with coronavirus victims, and are not likely to given the relatively small number or people who have tested positive so far. That is not much consolation for my friend and colleague Dr. Dan Lewis who still is in the hospital and spent about 10 days on a ventilator. Infection with the coronavirus can be serious and even deadly.  You would be foolish to ignore the 5 W’s listed above for yourself and for others you might seriously infect even though you might have been so mildly infected that you didn’t even know you had it.

By last Friday afternoon, Greene County (with a population of 69,000) had 41 people test positive for the coronavirus, 2 deaths from it, and 25 recovered. By comparison, nearby Sullivan County (with a population of 158,000) had 47 cases, 1 death, and 41 recovered. Although Greene County is doing much better than the “hotspots” such as New York City, we are doing much worse on a per capita basis than Sullivan County.

Until now for your sake and our sake, we have been practicing social distancing as much as we possibly can while using N95 masks when near patients whether we are delivering their medications and prescriptions to their cars or performing simple exams and administering regular injections such as testosterone or methotrexate behind the shed in back of our building. Thus far, most patients have preferred not to enter the building to make sure they are not exposed.

Thus far, we have brought probably fewer than 10 patients into the upstairs part of the building during the lockdown and only to perform procedures such as repairing lacerations, draining abscesses, and giving IV fluids and medications (such as IV medications for serious pain and serious infections).  Now that our basement is finished, we will start treating patients one at a time down there.

The Centers for Disease Control (CDC) has stated, “Healthcare facilities are having difficulty accessing the needed PPE and are having to identify alternate ways to provide patient care.” We have had difficulty obtaining N95 masks, but we have enough in stock for 6 more weeks due to purchases we made years ago, a friend generously dropping off masks to us, and one of our medical suppliers getting some for us.  We are pursuing other avenues right now as well. We are sterilizing them and reusing them.

You should also know that the laboratory that we use – Quest – started offering antibody tests for the coronavirus yesterday, which will cost you $60. If you have antibodies to the virus that means that you have already been infected, which means that you probably have some immunity and maybe complete immunity to the virus. We just sent labs off on all of us to see if we have immunity.  I have heard that some people have had the coronavirus more than once, which means that we will continue to be cautious even if we have antibodies. I was pretty sick in early March with horrible aching, fatigue, nausea, and chills – no cough or shortness of breath.  It is possible that I was infected then.  If I have antibodies, I will still wear my mask in case I could still give it to others and to prevent re-infection to me, but I will be less anxious in the future because even if I get infected again it will probably be mild. There are still many things that are uncertain about this virus, so until things become more certain we all need to follow the W’s listed above.

We still are not offering the swab test to see if you are infected right now. I’m still not confident that it is useful because I’m concerned about the accuracy of the test and the time it takes to get the results back.  In addition, Quest has not given us a price on the swab test yet.

Bottom line for now – we will continue to practice social distancing as much as we possibly can as we have been doing to protect you and to protect us since there appear to be many people “carrying” the virus without showing any significant symptoms.  The biggest advantages of our membership practice to you during this time are:

  1. I am still available to you virtually all the time.  If your problem is routine, you should contact me during office hours either by calling the office (639-9970), texting me on my cell phone, calling me on my cell phone (the number for which you should already have and if you don’t please call the office and we will give it to you), or emailing me at There still are a few patients who are not in my contact list so please leave your name as well for now.  I don’t usually respond to texts or calls not on my contact list (I wouldn’t get much done if I did). For the most part, you members have been very reasonable and considerate of my time and have not contacted me for routine problems outside of clinic hours, and for this I am extremely grateful.
  2. We will do everything that we can to see that you are not exposed to the coronavirus under our care.
  3. We will continue to help patients stay out of the ER and hospital as much as possible, not only to reduce your chance of exposure to the coronavirus but also to substantially reduce your healthcare costs.  We are still saving patients sometimes thousands of dollars per episode of illness or injury by doing this (just read my clinic “snippets” on the blog of our website for examples of how we do this

These are the clinic’s current mitigation policies for the coronavirus:

  1. If you don’t need to see or talk with me at all and just need a refill of your medications, just call our office at 639-9970 and we will call them in for you.
  2. If you get your medications here and / or you prefer to pick up your prescriptions here, call beforehand and we will get everything ready for you to pick up outside the building, so you don’t have to wait.
  3. If you need to pay us for lab tests and medications and you pay by the month, we will withdraw funds from your account through Hint, the same service that is providing your automatic bank draft. If you pay by the year and the amount is $20 or over, we will accept cash, credit card, or check.  If it is less than $20, we will put it on account until it is over $20 and settle it later.
  4. If you just need a brief exam for simple problems like an injured ankle or a rash, I will examine you at your car behind the shed (weather permitting).  In case you didn’t already know, we have an arrangement with Health Express where you can get an X-ray for $50 which includes the reading.  Usually you will bring the disk back to me, and if there is an abnormality, we will look at it together. A radiologist will fax me his official reading several hours later.
  5. If you need a more detailed exam, we will examine you downstairs in the now finished basement one patient at a time. Because of this, you should make an appointment ahead of time to reserve the downstairs and our time for an exam.  Patients with appointments will get priority over patients who don’t. If you don’t have an appointment when you arrive and the downstairs is free, you will be seen right then as we have done with walk-ins in the past.  If you don’t have an appointment and there are people ahead of you on the appointment given one on your arrival.
  6. If you have an abscess or a laceration, we will take care of you in the upstairs procedure room where we have excellent lighting and all procedural supplies (one patient at a time).
  7. Since we are practicing social distancing, I am receiving a lot more emails, texts, and phone calls throughout the day, which is what we want.  But some people expect me to respond right then.  If I’m not taking care of another patient, I do.  But sometimes, I have several calls that I am trying to juggle at the same time (my cell phone and 3 land lines here at the clinic). I deal with the most urgent problem first and handle the others in turn.  Sometimes, I will tell my office staff (Nancy, Shelia, Blair, and Katya) that I will have to call you back as soon as I am able.  Please be patient as we try to adjust our workflow process to this virus.