This past week has been like no other I’ve seen in my 20 years in direct patient care. Last year I opened my own telemedicine business- LoginClinics- but didn’t imagine it would be used to screen people virtually for novel coronavirus symptoms. It seems telemedicine is at a tipping point right now as many federal organizations and healthcare institutions are strongly advocating for its use. Only a couple days ago President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (HB 6074) which allows Medicare to reimburse for more TeleHealth services. As a healthcare provider, my email inbox is flooded daily with COVID19 information and position statements from various healthcare companies, medical associations and boards. As a healthcare provider I’m told I need to encourage my patients to stay home and offer telemedicine services delivered via phone, tablet or computer.
Just to recap, the family of coronaviruses have been around for a long time and they are typically responsible for the common cold. The novel, or “new” coronavirus (COVID-19) has produced an epidemic that is similar to the SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) outbreaks of 2002 and 2015 respectively. Here are are the stats to date:
- SARS: 8,096 cases, 9.6% mortality
- MERS: 2,494 cases, 34% mortality
- COVID-19: 153,524 cases, 3.7% mortality (5,789 deaths)
Let’s Get Scientific… You can do it!
Two recent medical retrospective studies (called this because we can’t select our patient base, we simply look back to gather data) were published on March 11th about COVID19 patients in the Lancet and JAMA. These aren’t medical science gold standard, but it’s the best we have right now.
The Lancet looked at risk factors and the course of COVID19 disease of 191 Wuhan, China patients.
- About half the patients had another medical problem (48%)
- High blood pressure 30%
- Diabetes 19%
- Heart disease 8%
- Increasing age showed a higher risk of death and multi organ failure; kidney failure being the most common
- Contagiousness lasted on average of 20 days, but sometimes lasted up to 37
Since this virus is so new we need to figure out which way to test for it is the best and most accurate. JAMA analyzed over one thousand different lab specimens from 205 patients who were diagnosed with COVID-19. They looked at which types of lab tests would produce the most accurate result (in this case, a positive COVID diagnosis) in someone with the infection. In this study, they found the average age of persons to be 44 with the oldest being 67 and the youngest 5. Almost 70% of the specimens were from men and 19% were described as having “severe illness”. The results showed lung washings to be the most accurate at 68%. The rest were:
- Sputum: 72% accurate
- Nasal swabs: 63% accurate
- Brush biopsy: 46% accurate
- Stool: 29%
- Blood: 1%
- Urine: 0%
Other Scientific Updates
1- Care is supportive. Medications that help slow viral shedding like Tamiflu and Xofluza have not been deemed effective.
2- Trials are underway to test china’s anti-flu drug favilavir , the malaria drug chloroquine, the ebola drug remdesivir, and the HIV drug lopinavir/ritonavir.
CDC Prevention Recommendations Remain Static
- Stay home when you are sick with respiratory disease symptoms. At this time, symptoms are more likely from the flu than COVID-19
- Cover coughs and sneezes with a tissue, then throw it in the trash can
- Wash hands often with soap and water for at least 20 seconds; especially after going to the bathroom, before eating, and after blowing your nose, coughing or sneezing. (If soap and water are not readily available, use an alcohol-based hand sanitizer with 60-95% alcohol.)
- Environmental Health Action: Routinely clean frequently touched surfaces and objects
- Avoid handshakes
- Avoid touching your eyes, nose and mouth
- Cough and sneeze into your elbow, not your hands
- Avoid close contact with anyone who is sick
- Use hand sanitizer between washes
- Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe
When can I, and how do I get tested?
Currently, tests are in short supply and available on a limited basis. Broader testing may be available and recommended soon through drive though sites hosted at your local Wal-Mart courtesy of the Trump Administration. For now, however, the determination of who to test lies at the sole discretion of the treating medical provider. Priorities for testing may possibly include:
- Any recent travel to a country with a CDC level 2 or Level 3 travel health notice for COVID-19
- Any persons, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed4 COVID-19 patient, or who have a history of travel from affected geographic areas within 14 days of their symptom onset.
- Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes.
If you’re not sure what kind of symptoms you’re experiencing, or if you don’t have a medical provider, you should use a telemedicine platform like LoginClinics to start. LoginClinics is providing our local community members with $10 Coronavirus Screenings through the end of this month. Simply call, text or schedule an appointment online here.
Steps to take if you feel “flu-ish”:
For the time being, if you feel “flu-ish” you should make the same decisions about seeking medical care as you would normally. Determining whether you have a cold, the flu, bronchitis or pneumonia is important, but this determination needs to be done in the same way as you did before you heard of the COVID epidemic.
Ask yourself this question:
“If I knew nothing about COVID, would I seek medical care right now?”
If your answer is “yes”, then call your doctor. If your answer is “no”, then continue on as you would any other day. We must be careful healthcare consumers right now. We cannot allow ourselves to be motivated by panic and driven by anxiety. We must remain smart and careful and know the resources that are available to us. LoginClinics is here to help with any questions or concerns you may have about your bodily health, your mental health or your risk of having the novel coronavirus. We can guide you and give you recommendations on what to do and how to proceed. If we feel you need to be tested for the virus, we can facilitate that too.
Author: Jaclyn Qualter, Founder, Nurse Practitioner and Healthcare Mentor