The COVID-19 pandemic today is much different than it was in the spring of 2020, when St. Charles implemented a universal masking policy to decrease the risk of spread of the disease between caregivers, patients and visitors in our health care facilities. Over these past three years, the virus has evolved to cause less severe disease due to changes in the virus itself along with widespread population immunity and the availability of medications to reduce the risk of severe disease in those who are at high risk for developing severe disease.

As a result of these changes, and in alignment with the changing requirements of the Oregon Health Authority and Oregon’s Office of Occupational Safety and Health Administration, St. Charles will no longer require people to wear masks in public areas of the health system’s facilities beginning Monday, April 3. Masks will remain strongly recommended in our facilities as protection for the wearer and others. They will be required for people experiencing symptoms of a respiratory virus such as coughing and fever.

Also starting Monday, April 3, St. Charles will no longer require its caregivers to mask in most clinical settings. Caregivers will continue to be required to wear a mask in certain scenarios, including a request by a patient or if community transmission levels are high.

“Over the past three years, our caregivers have diligently worn masks in a selfless effort to keep themselves, other employees, and our patients safe. We are grateful to them for their care and their sacrifice, and we know the community is, too,” said St. Charles’ Chief Clinical Officer, Dr. Mark Hallett. “With OHA and Oregon-OSHA lifting their mask requirements, our team of experts has carefully considered the facts and feels comfortable that this is a safe step forward for our caregivers, patients and community.”

It is important to note that the SARS-CoV-2 virus that causes COVID infections continues to be a risk to the most vulnerable people in our communities. While transmission levels are currently lower than what they have been in the recent past, as future case levels may rise, so too will the risk of transmission to vulnerable patients and masking may be required during future outbreaks of COVID-19.

Positive COVID-19 cases have decreased in our community, and fewer COVID-positive patients are being admitted to St. Charles’ Bend hospital. The state of Oregon ended its indoor mask requirement on March 12 and, for many, it feels like we are finally starting to put this pandemic behind us.

It is important to remember, however, that COVID-19 is still transmissible, and it is still a threat, especially to unvaccinated people. Here are some things to keep in mind as we move forward:

• Masks are still required in health care settings. This is for your protection and the protection of our caregivers. Please be prepared to follow our masking policy when visiting any St. Charles facility.
• The mask mandate has ended, but people may still make the choice to wear a mask in indoor public spaces such as movie theaters, grocery stores and restaurants. Please be respectful of everyone’s individual choice and comfort level with masking. You never know when someone is immune compromised or simply feels safer with the mask on.
• We are in the process of reviewing our current visitor restrictions. For now, vaccinations are still required for most non-patients entering our facilities. Check our visitor restrictions page on the St. Charles website for the latest updates.
• The state mandate for health care workers to be vaccinated against COVID-19 has not changed. St. Charles will continue to follow state and federal law.
• If you have not yet been vaccinated or boosted for COVID-19, it’s not too late. Vaccination continues to be the most important tool in keeping people from being hospitalized or dying from the virus.
• If you are feeling sick, stay home. Guidance on COVID-19 testing continues to change as we have more access to COVID-19 treatments and home testing kits. Our St. Charles website has many resources that will help you determine when a laboratory test for COVID is necessary.

Thank you for doing your part to keep our communities healthy and safe. We appreciate your support of our efforts to do the same.

Starting this week, St. Charles Health System is offering three new outpatient treatments for people with COVID-19, but supplies are “severely limited,” said Dr. Jacoby Allen, one of the physicians working to operationalize the treatments.

“Studies are showing that these medications do have some benefit. They seem to be effective in preventing severe disease and hospitalization for those at high risk,” Allen said Monday. “It’s availability that’s the big issue. We are going to try to deploy them as equitably and appropriately and quickly as possible, but we’re not going to have enough on hand to treat our current surge.”

The three treatments are:

• Paxlovid, an oral antiviral treatment
• Sotrovimab, a monoclonal antibody infusion
• Molnupiravir, an oral antiviral treatment

Per National Institutes of Health recommendation, health care organizations should prioritize use of the three medications, starting with Paxlovid, followed by Sotrovimab and Molnupiravir, Allen said. That recommendation – along with the limited supply of each treatment – prompted Allen and a team of his colleagues to spend significant time devising an algorithm to determine who should be prioritized to receive a treatment and which one they should receive.

The treatment algorithm – called the COVID-19 Therapy Screen and Prioritization Policy – factors in a patient’s risk factors and how their current medications would interact with the treatment, as well as their access to other potential resources for treatment. St. Charles’ service area is approximately the size of South Carolina, which means ease of delivery is a factor that must be considered, Allen said.

The ultimate goal is to target the best therapy to the person with the highest risk, he said.

“Since the end of December, when we started receiving notification that we would have some of these, we’ve spent a lot of late nights developing this treatment algorithm,” Allen said. “So now that they’re here, we do have a clear process that we’re deploying this week that will guide patients through our system.”

That process allows for self-referrals as well as physician referrals and includes, for some people, a consultation with a provider to discuss medical history and current medications. A consultation is not a guarantee of treatment, Allen said.

High-priority patients include people age 65 and older, pregnant women and people who are severely immunocompromised or who have at least one high-risk comorbidity, such as obesity, chronic kidney disease, cardiovascular disease or a pulmonary disease.

“Our Incident Command team, our administrators and our clinical folks have put a lot of thought into this policy and trying to make it equitable to all the communities we serve,” Allen said. “It hasn’t been an easy conversation, but all along, we have been committed to following the science, and that means we’re really trying to objectively identify who needs the treatment first, and which one is right for them.”

Learn more about St. Charles’ new COVID-19 treatments on our website.

When Marilyn Cornelius woke up Aug. 16 with a stuffy nose, she thought she knew the cause.

“It was just after a particularly smoky weekend, so I figured it was the smoke,” the 56-year-old Sisters resident said.

But then she lost her sense of taste and smell, and Cornelius feared she had contracted COVID-19.

She was right.

“I went to get tested and that was the morning they were reopening drive-thru testing at St. Charles. They were literally setting up the tents when I arrived,” she said. “Sure enough, it came back positive, which was a bummer, because you try to do everything right but you still get nailed.”

Cornelius was vaccinated against COVID-19 in February, practices social distancing in public spaces and masks up when she feels she should. But by that night, she was isolated in her home, still not feeling terrible, but still without her senses of taste and smell.

The next morning, Cornelius received an email informing her that she had a new message in MyChart. It was a chart note from St. Charles Family Care Dr. Carey Allen advising her that she qualified for monoclonal antibody (MAB) therapy, a treatment for people with mild-to-moderate symptoms of COVID-19 that helps keep people from getting sicker and having to be hospitalized.

“I immediately started Googling it and went, ‘Oh yeah, I want this,’” Cornelius said.

Since July, St. Charles has provided MAB therapy for more than 900 COVID-positive people. Among those, just 2% were eventually hospitalized, as compared to an 8% hospitalization rate for all COVID-positive patients at the health system. And hospital stays are shorter for patients who’ve received monoclonal antibodies – four days, as compared to nearly seven for all COVID-positive patients.

“What we’ve found is that monoclonal antibody therapy, when administered at the right time, really works,” said Dr. Cynthia Maree, infectious disease specialist for St. Charles. “It’s the only outpatient treatment we have for COVID right now, but the good news is that it limits the severity of illness, keeps people out of the hospital and helps them feel better faster.”

To be clear, Maree said, MAB therapy should not be considered an alternative to vaccination. Getting vaccinated is still the best way to protect yourself and others against COVID-19, she said.

Cornelius is walking, talking proof that pursuing the treatment can make a difference. The day she learned she qualified for MAB therapy, she started having trouble breathing and her heart began pounding, she said.

“That’s when I realized, ‘Wow, this is how people die of COVID,’” she said. “I was really struggling that night and just felt so glad that I was vaccinated and that I had this treatment on the horizon.”

The next day, Cornelius spoke with her primary care physician, who referred her to St. Charles. (Patients cannot self-refer for MAB therapy. They must be referred by a physician.) And then one day later, she went to St. Charles Redmond to receive the infusion. Generally speaking, the treatment takes a couple of hours, including time after the infusion for observation and recovery.

Cornelius received her infusion on a Thursday evening. By Saturday, she said, she was feeling much better.

“If you didn’t know I’d had it, you wouldn’t have been able to tell,” she said. “And then on Sunday and Monday, my senses of taste and smell came back.”

Cornelius credits monoclonal antibody therapy – along with “therapeutic doses” of vitamins and elderberry, she said – with “getting (her) over the hump” and on the road back from COVID-19.

“I 100% think it boosts your recovery,” she said. “I don’t even want to think about what might’ve happened had I not seen that MyChart note and talked to my doctor about it. That one bad night I had was scary, and you see so many stories about people who think they’re getting better and then suddenly, they take a turn for the worse.”

With the Delta variant spreading rapidly in Central Oregon and more people contracting the virus every day, Cornelius has a simple message: “If you do test positive, don’t assume that you don’t qualify,” she said. “Ask your doctor and find out because it’s going to help you get better.”

Learn more about monoclonal antibody therapy at St. Charles.

This week, school children across Central Oregon are heading back to class, just as the highly transmissible Delta variant of COVID-19 is fueling a record number of infections and hospitalizations across the region.

And although Oregon Gov. Kate Brown has mandated vaccination for teachers and mandated indoor masking for kids, pediatric physicians at St. Charles say there is reason to be concerned about a recent surge in the number of pediatric COVID cases in the area.

In total, St. Charles has recorded 183 pediatric visits to the Emergency Department for COVID-19, including 45 in August alone – the most in any single month during the pandemic. Hospitalizations remain low – 35 total – but they seem to be rising, too, said Dr. Scott Olson, a pediatric hospitalist with St. Charles.

“Nationally, as the Delta variant has become more prevalent, we’ve seen the rate of hospitalization increase among children,” Olson said. “Early estimates placed pediatric hospitalizations somewhere around one in every 100 COVID infections. Over the past several months, that rate has jumped up closer to one in 50.”

Olson, a father of two young children, said he is personally concerned that the start of the school year could worsen the situation locally – both for kids and the community as a whole.

“I don’t know that we can define a trend, but we know from data in other parts of the country where school has restarted that they are seeing a significant increase in symptomatic disease in children,” he said. “On an individual basis, the risk of hospitalization for infected children is low. But infected children can spread the disease, and that’s a major concern from a hospital capacity standpoint.”

COVID vaccines are approved for children ages 12 and older but only about half of eligible kids in Central Oregon have been vaccinated. For kids under 12, Olson and another St. Charles pediatric hospitalist (and mother of three school-aged children), Dr. Suzanne Mendez, suggest these five tips for parents to follow to help protect their children this school year:

1. Mask up.

“Universal masking is key to preventing transmission of COVID in schools. All kids over the age of 2 should wear a mask that fits well over their mouth and nose when they’re inside,” said Mendez, “and also when they’re outside and within six feet of another person who doesn’t live in their household.”

If you’d like to read more about masks and kids, Mendez suggests reading this brief from the Centers for Disease Control, this article from the Washington Post and this information from medRxiv.

2. Go outside.

“Encourage your child to be outside when they’re playing with friends, when they’re eating lunch, and during recess,” Mendez said. “This is good advice anytime, but especially right now.”

3. Get vaccinated.

Children’s hospitals like the one at the University of California at San Francisco are finding that the children who require hospitalization are either older unvaccinated children or younger children who live with unvaccinated adults.

“If parents can be vaccinated, they should be. If they aren’t, they should get vaccinated, and they should get their kids who are 12 and older vaccinated, too,” Mendez said. “A recent study showed that more than 6.2 million people who received either the Pfizer or Moderna vaccines had no increase in serious health outcomes, with more than 11.8 million doses given.”

4. Practice COVID safety outside of school as well.

“You can tell your kids to do this or do that, but you want to make sure to model those behaviors for them, too,” Mendez said. “If you go out as a family, avoid large crowds without masks and eat outside whenever possible, especially if you’re eating with others who don’t live in your household.”

Parents should also carefully consider potential exposures their children have to other people outside of school, Mendez said, such as sleepovers, indoor birthday parties and indoor play areas.

5. Stay home when sick.

“Again, this goes for parents and kids: If you’re experiencing illness or your child is ill, please don’t go to work or send them to school. Stay home and call your primary care provider instead,” Mendez said. “We have seen a variety of presentations of COVID in children – from runny noses to headaches – so if you have a sick child, please keep them home and call your pediatrician to talk about testing for COVID if you are concerned.”

In general, symptoms experienced by young COVID patients at St. Charles include fevers, cough, nasal congestion, muscle aches, headaches, and labored breathing, Olson said. There are no pediatric ICUs in the region, so local children who require advanced care for respiratory failure or who develop a post-inflammatory syndrome after COVID infection are transferred to children’s hospitals in Portland or out of state.

Today, we have 17 patients at the St. Charles Bend hospital who are sick with COVID-19.

This isn’t the highest number of hospitalizations for the virus in Central Oregon, nor is it the lowest. But many of these patients have been quite sick, which is an important reminder for all of us about how important it is to continue avoiding catching or spreading COVID-19.

Case counts in all three Central Oregon counties are much lower now than they have been in recent months, but it is still absolutely critical that we continue to follow safe public health practices. Please be diligent about hand washing, masking and distancing – especially with new, more contagious variants of the virus spreading throughout the country. Vaccinations will also greatly help to reduce the incidence and severity of the virus, but access to vaccine supply remains a challenge.

To see how our St. Charles campuses throughout Central Oregon have pitched in to care for all patients throughout the pandemic, take a look at our latest video.

Vaccine news

In the latest on the vaccine front, our tri-county effort continues at the Deschutes Fair & Expo Center, where we are actively providing second doses to thousands of Central Oregonians. This morning, we opened up scheduling for 1,000 first doses to be administered Sunday, and by this afternoon, those were already completely full.

The good news is that the state has issued a new vaccine allocation plan and we will be adding new appointments to the schedule each week. Going forward, we expect Deschutes County to announce information on appointment availability on Fridays, with scheduling opening on Saturdays. To ensure you receive those announcements, we suggest connecting with the county's communication channels. And to be clear, this is a tri-county effort, so this information applies to residents of Crook and Jefferson counties as well.

I want to emphasize this: As they did today, these vaccine appointments will fill up quickly. If you miss out one week, please don't fret. More will open up in the following weeks. You'll have more chances to get an appointment. And we will repeat this process until everyone who wants a vaccine gets one.

If you are eligible to receive a vaccine, you can also check our St. Charles website for appointments at any time. If you need help registering online, refer to this video tutorial. A hotline is available for support from 9 a.m. to 5 p.m. Monday through Friday and 9 a.m. to 1 p.m. on Saturday. The number to call is 541-699-5109.

In addition, the federal retail pharmacy program is now underway. While St. Charles and our partners at the county public health departments are not responsible for this program, we do encourage Central Oregonians to regularly check the following websites for appointment availability:

• Albertsons/Safeway: http://www.safeway.com/pharmacy/covid-19.html
• Costco: https://www.costco.com/covid-vaccine.html
• Healthmart: http://www.healthmartcovidvaccine.com/

Each pharmacy is only receiving about 100 doses per week at this time, so appointments are likely to fill fast.

Finally, many primary care providers are now approved by the state of Oregon as vaccine administration sites. This includes our St. Charles Family Care clinics. This week we are administering 50 first doses to eligible patients through our St. Charles Family Care clinic in Madras. The clinic staff is reaching out to eligible patients directly to set up appointments. Please do not call the clinic to request an appointment as we do not want the phone lines to be overwhelmed.

As you can see, there is a lot of effort going into making as many vaccines available as possible throughout our region. Thank you, again, for your patience, understanding and willingness to help our health system fight COVID-19.

Sincerely,
Joe

Rachel North was on the other side of the parking lot lane at the Deschutes County Fair & Expo Center when an elderly woman started shouting questions at her.

“How am I supposed to get in this thing?” the mobility-challenged woman barked as she tried to maneuver into a golf cart. “I can’t get in this thing. I need a wheelchair!”

Her tone was either impatient and mean or simply firm and direct, probably depending on the disposition of the person to whom it was directed. In North, she had found the perfect recipient.

“We’ve got wheelchairs,” North said gently, with a big smile on her face. “You get back in the car and wait, and I’ll make sure we get a wheelchair out here to you.”

As she pulled away from the woman’s car, North laughed good-naturedly at the exchange. “I work for the Transportation Security Administration (in the Redmond Airport), and that can be a little rough, you know?” she said. “I’ve been seasoned. I’ve got days and days of stories. This is a piece of cake for me.”

It was a Saturday morning at the fairgrounds, and hundreds of people age 75 and older were arriving to receive their first dose of the COVID-19 vaccine. The weather was cold and unusually blustery, and patchy snow and ice on the ground made access to the large-scale vaccine site inside — operated by St. Charles and Deschutes County, with help from the Oregon National Guard — particularly tricky.

That’s where North and her fellow golf-cart drivers came in. Their mission was simple: Crisscross the parking lot looking for cars with their hazard lights blinking. That was a sign that someone inside (or standing nearby) needed assistance.

“Sometimes,” she said, “they might be waving their arms or honking their horn.”

North is just one of “several hundred” volunteers who have helped make the fairgrounds vaccination site a success over the past few weeks, said Trevor Janeck, a talent acquisition manager at St. Charles who is helping to oversee the volunteer effort. In addition to ferrying people from the parking lot to the door, volunteers are greeting people as they enter, registering patients and helping guide them through the process, among other jobs.

Their efforts have not only been a vital part of the operation so far, they’ve been inspiring, Janeck said.

“The response from the community on this has been incredible,” he said. “Everyone who has volunteered has been so kind and so willing to do whatever it takes to make this place work as smoothly and efficiently as possible. And almost every one of them says more or less the same thing: ‘It’s just so important that we get this vaccine to people, and I want to help however I can.’”

More than 1,000 people have signed up to volunteer at the St. Charles website and at Deschutes County’s website, which is more than the fairgrounds site can even use.

“We’ve had to turn people away,” Janeck said. “It’s just been overwhelming.”

One of those volunteers is Teague Hatfield, owner of the Birkenstock store in downtown Bend. On a recent weekend, he was stationed just outside the clinic, greeting everyone who walked by and funneling people toward the check-in area. He said he signed up after a co-worker volunteered and encouraged him to do so.

“I came out a couple days ago and, honestly, it was just a ball,” he said. “People were in good spirits and it felt like it was helpful, so I came back to do it again.”

Hatfield said he was impressed by the operation and planned to take a shift per week as long as volunteers are needed.

“We’ve all been sitting around waiting for something to happen, so this is exciting that it is happening,” he said. “And being out here, like 99.9% of the people have been friendly and appreciative and the whole bit. This is what I’ve done my whole life, just talked to people.”

On the other side of the clinic, Wendy Worstell stood near in the hallway between the vaccination area and the recovery room, where patients are asked to wait for 15 minutes to make sure they don’t have a reaction. Her job? To make sure no one wandered through without getting their shot.

Worstell is a retired registered nurse with a daughter who teaches for Bend-La Pine Schools. She is currently splitting time between Central Oregon and Eugene and said she came to the fairgrounds to do whatever she could to help.

“I just think it’s hugely important that when we have a pandemic like this, that whoever can step up steps up and helps get the vaccines out there,” she said. “This has been wonderful. I’m so impressed.”

Back out in the parking lot, North dropped off one woman at the front door and started backing her golf cart up to make another run into the sea of blinking hazard lights. With her knit hat pulled down to her eyebrows and her mask up over her nose, she looked like she could’ve been warmer at home. But that really wasn’t an option, she said.

“I volunteer for the Assistance League of Bend. I volunteer for the Nature Center in Sunriver. It’s what you do when you live here,” she said. “I just had the day off and I could sit inside and watch Netflix or I could come out and do a nice thing for people.”

In accordance with contact tracing guidelines from the Oregon Health Authority, door screeners are now collecting names and phone numbers of all visitors who enter any of St. Charles’ four hospitals.

The organization is committed to protecting the privacy of patients and visitors and will not use the information gathered at screenings unless it’s required for contact tracing.

Please note that this important new protocol could cause delays at visitor entrances.

The collection of contact info is a new addition to St. Charles’ visitor restriction policy as a result of COVID-19. Since March, door screeners have been following strict protocols to help keep St. Charles patients and caregivers safe and the health system functioning. These include:

• Requiring individuals to adequately sanitize their hands.
• Requiring all patients and visitors to wear a mask or face covering.

Read more about St. Charles' efforts to control access during the pandemic.

(Above, extra hospital beds sit in storage in the basement of St. Charles Bend's new patient tower.)

Earlier this year, in anticipation of COVID-19’s arrival to Central Oregon, St. Charles Health System set up a number of teams to prepare and support hospital operations for the possibility of a surge of sick patients at St. Charles Bend.

Under normal circumstances, the Bend hospital has 209 beds available for patient care, including 24 in the Intensive Care Unit, home to the most seriously ill. At the time, COVID-19 cases were spiking in Seattle and New York City, overwhelming hospitals in those areas.

So St. Charles' Incident Command team – a management structure used in times of crisis – tasked a group of caregivers with developing a “surge plan” to detail how the hospital could expand its patient capacity within the existing campus.

It was a monumental and multi-faceted effort that required collaboration and cooperation across the entire organization, said Jenn Clark, a manager on the health system's Value Improvement Practice team who was heavily involved in the work.

“The initial stage of the process was to assess our current resources so that we would be able to maximize our abilities in space, equipment, supplies, people and technology,” Clark said. “That assessment gave us a framework to design a surge plan in tiers, which would allow us to maintain a controlled execution of services.”

There are six tiers, from Tier 1 (normal operations) up to Tier 6, which projects capacity at 751 beds. More recently, better data and predictive analysis were used to create a special Tier 1.5, which would increase capacity to 283 beds (complete with privacy and infection control measures) and would be “easier” to launch if needed, Clark said.

The team increased the hospital’s capacity by doubling beds in rooms that are big enough to do so and combing the facility for areas where patients are not typically cared for, but they could be if needed.

“We looked at non-traditional care spaces such as family waiting rooms, conference rooms and office space and fabricated plans to transform them into viable places for patient care,” Clark said. “Our regulatory team helped draft these plans to propose for certification from Oregon Health Authority, and our workflows for patient care were redesigned to ensure functionality in this new environment.”

At the same time, Tony Arnold, manager of purchasing and strategic sourcing on St. Charles’ Supply Chain team, was working to secure the supplies needed to execute the surge plans, Clark said. When certain items became scarce because of competition, the team developed backup plans. All necessary resources are now on hand and triaged to allow the health system to serve a record number of patients.

“Some of the surge work you cannot see, such as the framework our IT team built, which allows us to leverage existing technology for patient safety measures,” said Julie Ostrom, senior director of perioperative and cardiovascular services, who was also involved in the planning. “The surge plans also outline when we would pull on state and national agencies for support if our system were to become overwhelmed.”

Ultimately, the surge planning process included all the key components that enable St. Charles to deliver safe and effective care, including food services and linens, demands on the health system’s laboratory and pharmacy, and, of course, staffing. Clark gave a special shout-out to Jessica Truson, a manager in the Information Technology department, for organizing the work to ensure all its moving parts worked together.

“The plan outlines specifics for each St. Charles hospital campus that will ease collaboration and benefit each of the communities we serve,” Clark said. “Education and cross-training were developed and executed to allow for blended nursing care models to support a potential surge.”

She continued: “We’re ready to turn this on if we need to.”

Even if they’re never needed, however, developing the surge plans was a “valuable exercise” for the organization, Clark said, and work to archive them for future reference is almost done.

“Through all this, I wanted to make sure our patients would feel like they were getting the same high-quality service and care that they would get on a normal day at St. Charles,” she said. “Our passion is our communities’ health, and it was inspiring to see our team come together to serve them in the face of an emergency.”

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After you are tested for COVID-19, your provider will 

• take samples and talk to you about next steps
• send your samples to the Oregon State Public Health Laboratory (OSPHL) or an authorized lab for testing

The lab will

• test for COVID-19
• give your health care provider and your local health department the results of your test

While you wait for your results, take steps to avoid spreading the virus:

• Stay home, except to get medical care
• Stay away from other people in your home
• Don't share dishes, cups, eating utensils or linens with others
• Cover your coughs and sneezes
• Wash your hands often
• Clean and disinfect common surfaces like phones, doorknobs and counters regularly

If your test shows you have COVID-19:

A positive COVID-19 test means you currently have or recently had the virus. Monitor your symptoms and seek medical help right away if you have trouble breathing, confusion or bluish lips or face.

• Your health care provider will decide if you are sick enough to be in the hospital
• Your county public health department will contact you
• You will be asked to stay home for a period of time
• Follow steps listed above to avoid spreading the virus

If your COVID-19 test is negative:

If your test is negative, the health care provider that ordered your test will contact you to let you know. If your test is negative, you probably didn't have the virus at the time of the test. But you an still get sick later.

• Follow distancing guidelines and wash your hands often
• Your provider may ask you to continue staying home.