Archives for AmySpeed


By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

I was never a Boy Scout, but have learned that the best chance at being successful in most things is to be prepared. Don’t leave home without using the bathroom and checking the gas gauge in the car. In medical training there is an old saying reminding one to be prepared…”If you see a bathroom, use it. A bed, sleep in it. If you see food, eat it.” For you may find yourself in a situation where it may be a while before you are able to do any of those things.

This past week we have been watching the number of COVID-19 cases across the country climb. The numbers have been creeping up in Iowa as well. As time goes on, more and more people will be infected with COVID-19 and it is likely that we will each be exposed to someone with the illness at some time.

What should we do if we are exposed to someone that has COVID-19? What happens if we get a call telling us that we have been exposed to someone that came down with COVID-19 after we had been visiting with them? Remember, someone may be contagious for up to 48 hours prior to having symptoms and knowing or suspecting they have the virus.

Per guidance from the CDC, if you have been exposed to someone with COVID-19 and are feeling well, you should stay home until 14 days after your last exposure. You should check your temperature twice a day and monitor for symptoms. You should contact your primary care provider and discuss testing options. If you become ill, you should also contact your provider. If you become short of breath, you may need to go to the emergency room for evaluation. Remember to call ahead.

If you receive a call from the Public Health Department to inform you that you have been exposed, they will direct you as to what to do next. This will likely consist of where and how to have testing done. It will also consist of quarantining for a period of time, possibly up to 14 days.

As a reminder, if you have been diagnosed with COVID-19, have symptoms or are awaiting test results, you will also need to isolate yourself. You should contact your health care provider to determine when you may discontinue quarantining or isolating yourself.

So, as you expose yourself to more people, remain prepared—wear your mask, wash your hands and maintain physical distancing. If you find that you have been exposed to someone with COVID-19, don’t panic, call your provider for guidance, directions for testing and be prepared to be quarantined.

Stay safe and be well. Remember, we are in this together. 

Keeping the Numbers Low

By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

The human body is quite a remarkable thing. It is simply amazing all of the things it does. We put in food, all kinds (fruits, vegetable, meats, dairy, eggs and various liquids) and in return we get bone, skin, hair and muscle.

The body has a very intricate defense system, other wise known as our immune system. The immune system is made up of many layers. There is the outer protective cover, better known as our largest organ, our skin. Then there are the innate and adaptive components of the system, fighters and protectors against invaders of our bodies.

It’s a very complicated system, but to simplify it, we have a protective outer defense (the skin) and multiple inner defenses consisting of a system that fights invaders and a system that can identify invaders and fight them more specifically. With some viruses, we develop an immunity, like a facial recognition system. Once we have been exposed, our body recognizes the infection and we can fight it off without getting ill. This happens when we have had certain viruses and other times it is because we have received an immunization.

With bacterial infections we can help our body fight intruders with antibiotics. With viral infections, they have to run the course, all we can do is treat the symptoms. With some viruses, this is ok to do. With other viruses, those that can be deadly, it is not enough to wait it out and treat the symptoms.

So what can we do?

We can prevent the virus from getting into our system by washing hands, avoiding close contact with others and avoiding touching our faces, (our outer layer of protection).

We can keep ourselves healthy by eating right, sleeping well, exercising and following up with our regular health care providers to make sure we stay well.

We can get vaccinated, (“Facial Recognition”) to identify the virus and more efficiently fight it.

COVID-19 is spread via respiratory particles. Coughing, sneezing and “wet talking” spews those particles into the air at others, spraying those germs/viruses uninhibited at others, at someone’s parent, someone’s grandparent.

Until we have a vaccine for COVID-19, that’s all we have. Stay home when you are sick, avoid large groups of people, social distance, wash your hands and wear a mask. It’s not perfect, but it’s what we have. It’s what we know works.

The mask may not be perfect, but it decreases the risk of spreading the virus significantly.

The numbers are low in Iowa. They are low in Clayton County. Lets keep it that way. But it will take all of us to do that.

We are in this together.

Guy McCaw, MD

Know Before You Go

By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

The state of Iowa has fewer and fewer restrictions to follow during the current pandemic. 

Being a rural state, we have been blessed with fewer cases of COVID-19 than most states. This makes it very easy to forget that we are still vulnerable to the disease. We are tired of being at home and are ready to get back to “normal”. But will we really ever get back to “normal”. Those that study pandemics and disease progressions, know that it is likely for COVID-19 to come in waves and be something we live with for a while.

What do we need to know before we go out? Especially as we watch an increasing number of cases, a second surge beginning, in some states.

Let common sense be your guide. Follow the recommendations from the CDC (updated June 15, 2020).

As we resume daily activities outside our homes, we want to do so as safely as possible. Remembering that the more closely we interact with others and the longer that interaction, the higher the risk of COVID-19 spread.

Being aware of the spread of COVID-19 in your community is important. Monitor the state website to know how many cases are in your county and the surrounding counties. If the numbers are climbing, you should be more cautious and consider changing your plans.

Think about how many people will you be interacting with. The more people you interact with raises your risk. Engaging with new people and people that aren’t physically distancing or wearing face masks increases your risk.

Where will you be? Outdoor spaces give you more space and more ventilation. Being outside makes it easier to physically distance. Indoor spaces can be more challenging when it comes to trying to avoid risks.

If you are going to be indoors, use or watch for visual reminders to stay six feet apart. Look for physical barriers such as plexiglass or windows for protection.

Continue to protect yourself by practicing everyday preventive actions. Monitor for symptoms and stay home when you are sick. Avoid touching your face. Wash hands often. Continue to physically distance. Wear masks when you can’t be six feet apart.

Though we need to physically distance, we need to be social. There are many ways to do that. If you are venturing out to be social, remember a few things:

  • know your community and if there are active cases by monitoring the state website
  • limit your exposure to large groups and to those you are not familiar with
  • maintain physical distancing
  • wash your hands frequently and/or use hand sanitizer
  • wear a mask when in public, particularly when it is difficult to stay six feet away form others consistently

The goal is to stop/slow the spread. Not to bring it home to those we love or to those in a high risk group.

Be safe. Make smart choices and remember, we are all in this together.

Protecting the Grandparents

By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

I was an adult before my grandparents passed away, I even had the privilege to know my great grandmother. To be in your 30’s and have the opportunity to know them as an adult, is a gift.

My great grandmother was born in 1900 and died in 1998. I often marveled at all of the things she had seen in her lifetime. Invention of the car in 1900, airplanes that fly cross the country and oceans to man landing and walking on the moon. Telephone, party lines with operators to cell phones. Calculators to computers that took up a whole room, to laptops. Inventions of radios, inventions of TV, black and white to color.

World War 1 started when she was 14. The Spanish flu hit as she was just starting to be an adult, she was 18. There were the roaring 20’s, and then, as she was in the middle of starting and raising a family, The Great Depression hit (age 29). At 39 World War II started. Along with it came food rationing, gasoline rationing, and as much metal as possible went to the war effort for ammunition, tanks and aircrafts. Cooking grease was even donated for explosives. There were smallpox and polio epidemics. The Korean War, the Vietnam War and the Cuban Missile Crisis.

79% of all COVID-19 cases are under the age of 65, while 82% of all COVID-19 deaths are over the age of 65. The current guidelines encourage those over the age of 65 to stay home if they don’t need to leave their home. But of course, they do need to leave their homes. They need to go shopping. They need to go to doctor appointments. They need to receive essential cares. And remember, many of them still work. In order to perform these essential functions, they will likely have to come into contact with someone under the age of 65.

By following the current guidelines of physical distancing, staying at home when we are sick, avoiding putting ourselves in high risk situations and wearing masks, we can avoid passing the disease on to someone that is over the age of 65. Many of those over the age of 65 are grandparents. I learned early on, that my grandparents taught me a lot. I treasure every year I had with them. Preventing those grandparents and great grandparents from getting COVID-19, allows them to pass on wisdom, stories and love to a generation that needs it.

So, as restrictions continue to be lifted, and we learn how to live with this virus, we all have a responsibility to make good decisions. We have to decide what is right for each of us, but should not lose sight that those decisions could effect others, even those we love.

After all, considering everything they went through in the 20th century, I think we can survive physical distancing and masks. We may even owe it to them.

We are in this together.


It Takes a Village

By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

It Takes a Village. I remember when I first heard this title/sentiment, I didn’t quite know that I agreed. But as I have grown older, I have found it to be truer and more important than I had realized. 

Growing up, your parents could drop you at the neighbors and know you would be taken care of if they had to run an errand or had an emergency, night or day. If someone’s home or barn burned down, everyone showed up with food and hands to clean up and rebuild. Cows even got walked down the road and milked by the neighbor if the milking parlor was lost. When a family member becomes ill or dies, food gets delivered, lawn gets mowed, snow gets shoveled, just because it is the right thing to do.

COVID-19 has brought it out in all of us as well. Masks are being made and donated. Food banks are getting filled and delivered to those in need. Companies are transitioning from making automobiles to respirators and masks. Nurses and doctors are traveling from their respective homes to areas of need, such as New York and LA to help, jumping in without hesitation.

Everyone made changes. We all stopped in mid stride. Plans changed suddenly, everyone holding their breath until things could be sorted out, until the ambush by COVID-19 could be assessed and a plan could be made. Now we wait with anxiety to move on. We have made plans and it seems to have worked for us in Iowa. Our numbers have been stable. We have not seen a peak that has been unmanageable. We seem to have flattened the curve. 

But our work is not done. We need to continue to slow the spread of COVID-19, with a goal of cancelling COVID-19.

The governor and her team continue to assess the situation and give guidance for opening up the state. We know that along with the need to keep everyone physically safe, we must also keep everyone emotionally and economically safe. We can’t have one without the other. 

So here we are, in the pickle of trying to do both. While those at most risk are in the older population, it is the younger population that is more frequently infected. 

If you are sick, with any ailment, mentally or physically, call your provider and seek an appointment and guidance. 

The best way to open the economy is to do it safely. Make stores and restaurants a safe place for all. By wearing a mask when you shop, you are letting everyone know that you care about their safety and well being. You care enough to help protect them. By wearing a mask when you work, you are letting others know you want your place of business to be a safe place for everyone to be. It is a simple act of kindness and respect. Wear a mask. 

We are in this together.

It takes a village.

The First 100 Days

By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

We celebrate and reflect on the first 100 days frequently. The first 100 days of the presidency, the fiscal year, the school year. We review what has been done and where do we go from here.

The first 100 days of COVID-19 has left us with 100,000 deaths. That’s 1,000 deaths per day in our country. During World War II America experienced 100,000 military deaths per year (400,000 over the 4 year involvement). 

In the medical world, we have learned much about COVID-19, and yet very little. We have learned how much is not known about it. We know it is a viral infection. It attacks our respiratory system. It attacks all ages and ethnicities. The infection does not respond to traditional treatments of respiratory illnesses. It affects the lungs differently. Like many viruses, it has to “run it’s course”. However, the COVID-19 course is much more complicated and grueling. 

The supportive care typically given in respiratory distress cases, does not seem to be as effective, and all that has been known about using ventilators does not necessarily work with this disease. It has been frustrating for lung specialists to learn that the normal treatment plans do not work and they are working hard on developing new courses of treatment. Multiple drug regimens have been tried, without much success. But scientists and doctors around the world are dogged. They will not quit until they find an answer or a treatment plan, but it will take more than 100 days.

There are those that say “It’s just like influenza”. Per the Centers for Disease Control and Prevention website, in a typical year our country will see 30-50,000 deaths from influenza. Iowa saw 100 influenza deaths last year according to the Iowa Department of Public Health, we have seen nearly 500 COVID-19 deaths in Iowa this first 100 days.

As with most illnesses, the less you are exposed to it, the less your risk of becoming ill with it.

The New England Journal of Medicine published an article stating that the coronavirus may stay in the air for three hours, however, the most contagious period is when in contact with the “larger” particles or viral load, of the illness. The load decreases with time. Less virus released into the air means less risk of contact with it and less risk of illness. Hence, masks being worn decrease the risk of causing illness.

The Journal also reported that the virus can live on surfaces like plastic and stainless steel, for up to 3 days. Cardboard, up to 24 hours. But, just as with air particles, the more time that passes, the less virus is present. Also, with routine cleaning of frequently touched surfaces, COVID -19 can be killed and removed. All it takes is soapy water or an EPA approved household cleaner.

What will our next 100 days look like?

We have been fortunate in Iowa, our numbers, in comparison to other states, have been low. I like to think it is because we have had the luxury of learning from others.

In the first 100 days we have learned that wearing a mask, cleaning surfaces frequently and avoiding crowds is valuable in preventing the spread of COVID -19. These are simple tasks that can protect many.

As restrictions are being lifted, you can be confident that clinics and hospitals are following these guidelines to ensure your safety as you return to them for your healthcare needs. 

What will the next 100 days say about us?

We are in this together. 

Masked shopper


By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health


That is how I feel. Having watched with bated breath for the new virus to arrive in our community, watching with great interest in what is happening in Italy, New York, California and now in the south, I am grateful for time. The time we have had to develop a game plan. Many game plans in fact. 

  • Plans for how to staff the hospital…
  • Plans on how to care for patients with a new disease without a clear treatment…
  • Plans on how to keep “well patients” from coming into contact with “ill patients”…
  • Plans for obtaining the needed supplies to care for the patients…
  • Plans to put together a county team, allowing the medical groups in the county to work together throughout the pandemic…
  • Grateful…for those I work with. For the doctors, providers, nurses, the ambulance crew, the cleaning staff, the kitchen staff, the office staff, the administration. All making changes in preparation to care for COVID-19 patients and to protect each other from it.

Grateful… for guidance via the World Health Organization, the Centers of Disease Control and Prevention, and the Iowa Department of Public Health. They continue to look for an answer on how to treat Covid, to learn how it works and how to prevent it, including coming up with a vaccine. 

It is becoming evident that we will be learning to live with this virus. There is no destroying it. 

For now, we know that there are three things we can do to prevent the spread of COVID-19 and protect ourselves…

  • physical distancing
  • wearing a mask
  • staying at home unless needing to go out for an essential function

Grateful… that we live in a rural area where it is easier to physically distance. Lets face it, in New York City, the population of Guttenberg could live one high rise apartment building. We know that physical distancing is one of the most important ways to avoid exposure to COVID-19.

Grateful…to live in a community where people are willing to help each other, where they care about each other. When someone is in need, your neighbors show up to help. There are multiple organization that provide support, there are our faith organizations, the Family Resource Center, the food pantries, the public health department and others. 

And finally, I am grateful for living in a community where we respect each other. We have been told over and over again that wearing a mask is important. While it may not protect us from COVID-19 on its own, it will protect others.

So when you wear a mask, you are letting others know that you care and respect them enough to do what you can to protect them from this virus. A virus that can be spread without knowing it, by someone without symptoms, and that someone could be you. 

Grateful…for all of you. Grateful…that we are in this together. 

Keeping Your Circle Small

By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

“So, if my child is in daycare and both of us work outside the home and around others, do we have to social distance when we are aren’t at work?”

“If we can go to the mall, why can’t we gather in groups of more than 10?”

Fair questions, which provoke answers that aren’t as difficult as they may seem once we break them down.

Let’s start with a fact that we hear frequently… “80% of the cases are mild and may not even show symptoms”…

And that’s the point, isn’t it? 80% of those infected may not know it. If you are part of that 80% and you aren’t aware that you are infected, how will you know to avoid situations where you may spread the infection to others, to those who could be the 20% who could become seriously ill or even die? 

Social distancing is the answer. Wearing masks is also part of the answer.

Social distancing decreases the risk of spreading the virus to others. The fewer contacts you have in a day, the less the risk you have of exposure to the virus. There are contacts you have to have everyday and can’t avoid, like work. And there are contacts that you can avoid. There are ways to manage those contacts. I like to call it “keeping your circle small”. The more people you include, the larger your circle becomes, bringing in risks from others “circles” and maybe even other communities.

There are essential and nonessential parts to our life. Food, clothing, necessities of life are essentials. Social, recreational and leisure events are considered nonessential.

Shopping for food and essentials for everyday life explain the need for grocery stores, pharmacies, restaurants and malls to be opened and accessible to us. Concerts, festivals, sporting events and celebrations fall under nonessential activities.

Some of us may feel that social activities are essential, and some of them may be. We are social creatures and we do need to interact with each other, but in groups of ten or less.

So, when it seems difficult to navigate the guidelines, try breaking it down into whether or not what you want to do is considered essential or nonessential. Social distancing and keeping your “circle” small will decrease your risk of contact with the “80%” with mild symptoms.

Remember, social distancing, washing your hands and wearing masks are the only tools we have to protect ourselves, those we love and each other, from this virus.

We are in this together. 


By Dr. Michele Dikkers, Physician at Cornerstone Family Practice and GMHC, Chair of Clayton County Board of Health

I like sweets. It comes honestly, I come from a long line of sweet tooths. So every year when Lent rolls around, it is time to give up sweets, some years I would narrow it down to something specific, like chocolate. Lent, the longest 6 ½ weeks of the year! Then, there it is, Easter morning…Easter baskets, full of chocolate and sweets! Yummm! It takes restraint to not eat everything in the basket, but I know better. I know what would happen if everything in the basket was eaten in one day. I would have regrets.

COVID-19 has overwhelmed us. We don’t know what day it is, each day blends into the next. We are stuck in our homes. The place that would typically be our sanctuary and haven, now feels like a prison. We have heard more about social distancing in the past two months than ever before. We miss our parents, brothers, sisters, nieces, nephews, in laws, friends, even those we work with. And just when we were about to think we couldn’t take it any more, we found our groove. This ain’t so bad, now adapting to “the new normal”.

And then…Governor Reynolds started talking about easing restrictions. Yahoo!

The recommendations are to do it slowly and responsibly. Continue to monitor the status of the state and make adjustments as appropriate.

The Governor’s proclamation is clear, loosening restrictions does not mean disregarding our social responsibility to each other. Planned gatherings of more than 10 people are still prohibited in the state of Iowa by State Code.

The COVID-19 virus is considered dangerous with unfortunate outcomes for some. The challenges of the virus are many, it doesn’t act like any virus we have ever seen, there are very few treatment options and it does not discriminate. It is true that the elderly population will have a more difficult time surviving, however, all age groups are at risk. Stories of healthy athletic 16 – 40 year olds becoming ill and suddenly dying are not unusual with this disease.

The proclamation from May 6 allows us to return to restaurants, as long as we sit at a table at least six feet from another table. We can head to the stores, there should be limits on the number of shoppers, no more than 50% of normal number of shoppers, wearing masks and staying six feet away from others.

We can go camping, with appropriate space between campers and staying at your own camp site, and staying six feet away from campers from other camp sites.

Hospitals and clinics are responsibly and slowly opening up services. Therapy departments are opening and keeping appropriate spacing between rehab patients. Masks will be worn in all departments.

As we move forward, the safety of the patients is of utmost importance. All necessary precautions will be taken.

Likewise, as members of your community, it is being expected by the Governor’s office, the Iowa Department of Health and the CDC, that we will continue to protect each other by following these simple guidelines:

  • stay at home if you don’t have to go out
  • wear a mask when you do go out
  • wear a mask when you work with the public
  • continue social distancing at least six feet from one another

So, though it is tempting, like the basket of Easter candy, practice restraint. It is a sure way to prevent regrets. 

Remember, we are in this together.

(of note, the time we have been under the COVID-19 restrictions in Iowa has been less than the length of a Lenton season)