Editor’s note: Due to the serious public health implications associated with COVID-19, The Daily Memphian is making our coronavirus coverage accessible to all readers — no subscription needed.

Eliza is a vibrant, exuberant and opinionated 4-year-old, according to mother, Rachael Boer.

She looks healthy, but she has primary ciliary dyskinesia, a disorder characterized by chronic respiratory tract infections and sinus problems, among other issues. She’s had it since the day she was born, the same day her parents adopted her.

Boer’s family of six has always been vigilant in keeping sickness away. Right now, because of coronavirus, it’s become more important than ever.

“She’s highly susceptible,” Boer said. “Even with a cold, she’s more at risk for developing pneumonia.”

Her family has always been fairly cautious and lived in a “heightened state of awareness.” 

“This is kinda taking it up a notch,” Boer said.

As the threat of the coronavirus continued to spread, she kept two of her children home starting a few days before spring break.

“We’ve been in pretty strict isolation,” she said.

The family has had groceries delivered. When they arrive, they are wiped down out of extra precaution.

“We are taking those extra steps to make sure this is a safe space for Eliza to live in,” Boer said.

Eliza realizes something is different. She wears a vibrating vest that shakes up mucus twice a day and uses her nebulizer more often. If children like Eliza get sick, the risk is less if they are as healthy as possible ahead of time.

Her parents are explaining to her on an age-appropriate level that many people are sick right now.

“We have just started talking about how a lot of people are getting sick. I don’t think she’s come to realization she’s probably not going back to preschool,” Boer said, noting it will “crush” Eliza.

Boer shared a picture of her daughter to Facebook recently, aiming to inform viewers that some who look healthy may in fact have underlying conditions.

“We tend to think about ourselves,” she said. “This is a unique time. We have the ability to possibly save lives by staying in our house.”

Boer said the message she is sharing is for the healthy to be mindful of those who may not be.

“The thing I’ve been trying to get across to my kids and family is – though the virus might not affect you, it’s about people who are more vulnerable.”

Dr. Muhammad Raza, who specializes in Hematology and Oncology, Internal Medicine at Baptist Memorial, said immunocompromised patients do indeed need to be more careful. 

One issue medical professionals are facing is the limited information about COVID-19.

“Obviously, this is a new virus,” Raza said. “The information about this is still evolving. It is fatal in older age populations and those with pre-existing medical conditions?”

He said while studies have not singled out those with pre-existing medical conditions and those who have weaker immune systems, they are much more likely to see aggressive forms of COVID-19 at any age. 

Good diet and sleep can help those individuals avoid infection. He recommends three to four servings of vegetables and those who can work from home, should.

“They should be extra vigilant about putting in precautions, limiting exposure, social distancing, washing hands, making sure they’re not in contact with known flu-like symptoms,” he added.

Caregivers and those living with the immunocompromised should take similar precautions, Raza said, limiting any potential exposure and possibly give the virus to someone with a weaker immune system.

“What we know so far is you can be a carrier in the first five or even 10 days and you may not have symptoms but you could be a source of infection for the suppressed patient,” Raza said.

Raza said he understands the concern people in the area have, but he remains hopeful that with the right precautions, Shelby County could see fewer cases than other areas of the state.

“I think the fear is genuine in this case,” Raza said. “I think there is fear for the right reasons. We may come out ahead of the curve, but I think it is hard to (eliminate) fear.

Doctors do not have specific information directed toward patients with suppressed immune systems, according to Dr. Elena Caron, a pediatric neurologist at Le Bonheur Children’s Hospital. Caron specializes in genetic and acquired neuromuscular disorders.

She recommends her patients follow the Centers for Disease Control and Prevention recommendations.

New information is released daily, but it is still limited.

“We are waiting on public health info and statistics to reassure or let people know this could last longer,” Caron said. “As that data comes out, we can disseminate that to our patients as to what they could expect.”

She said information should be tailored to specific areas, she said.

“We have to get more information for our community because that is what affects our region the most. ... Just to know what is in your community is important. That’ll have to be things we update on,” she said.

As a physician, Caron has seen health crises such as Sept. 11, 2001, when clinics were closed and more recently with H1N1 flu, but this is bigger than those.

She said those patients who may be more at-risk should stay at home as much as possible.

“If you are compromised (in health), you should not be a person going out,” she said. 

Parents or caregivers are advised to also limit their time out to prevent any potential exposure to children, she said.

If the primary caregiver must go to work or out in the community, she said another person should care for the child if possible.

“Within your own home, it’s a still a big deal,” Caron said. “If someone is interacting with the larger community, you want them to limit their activity with an immunocompromised (person).”

She said it’s necessary that the family of a child with a weak immune system is educated about the precautions already in place.

“We are working on educating them and empowering them,” she said.

CDC, University of Tennessee Health Sciences Center and John Hopkins University & Medicine are resources she is recommending to all her patients.

She said she is also watching what other communities are doing that may help lessen spread.

Often times, those vulnerable may have outpatient appointments at a hospital. Le Bonheur has advised patients to call ahead of time. If the appointment can be rescheduled, they may be. Also, video allow doctors to chat electronically with their patients using audio and video. 

Caron said while the electronic visit would not be as thorough as a routine exam, it does allow patients, caregivers and doctors to talk about possible concerns without going into the hospital, she said.

“Now it’s a bigger desire to limit people coming into the hospital for non-urgent reason,” she said, especially those at-risk.

“One of the biggest things is if there is a concern, touch base with the primary care physician. They can give direction on how to proceed,” she said.