Weekend conferences on COVID19

Here’s some of the very latest information available from reliable sources, including answers to the questions doctors are asking. Yesterday I was in on several long phone conferences with many of my fellow lady docs in addition to other colleagues. One was hosted by our very own Dr. Rebecca Katz, who is the Director of the Georgetown Center for Global Health Science and Security. The other was courtesy of MedChi, our state medical society in conjunction with the Maryland Public Health Service. There are many very dedicated and bright professionals working on our behalf behind the scenes. Here’s what we know:

• We are not sure about the trajectory this virus will take, but the experts all agree, the situation will get worse before it gets better. As you have probably heard many times, 80% of those affected have mild to moderate symptoms, anywhere from a sore throat or cough to significantly worse but not requiring ICU care.
• Please watch for guidelines as they become available – they are updated as we know more. Currently, we are being advised to use social distancing, trying to stay at least 3 feet, and preferably 6 feet from others. Since people can be contagious before they have symptoms, these guidelines are in place for everyone. Those who are out of school or work are advised not to have social gatherings in their newly acquired free time. The incubation period is 2-14 days after exposure, average 5 days, during which time people can appear well but spread infection. And some people can appear well throughout their contagious period.
• For offices, anyone who can work from home is encouraged to do so to decrease the ‘density’ of people in the office.
• The goal of all the recent restrictions with commercial venues closing, social distancing, etc are to ‘flatten the curve’, i.e., to avoid surges in cases so that our medical system is not overwhelmed at any one time. In the background, efforts are being made to increase availability of test kits and ICU beds and ventilators.
• If you are ill, please call your doctor’s office and DO NOT show up unannounced. This would place the physicians and their staffs at risk for exposure and may require offices to close, leaving fewer physicians available to see patients with acute illnesses, or follow-ups for their ongoing issues.
• Testing should become more available this week at most local hospitals and some physician’s offices. Again, call your primary care physician (PCP) for advice before going anywhere. While COVID is a major concern, think of flu, strep, the common cold, and other illnesses that are much more common at this time. It is unusual to have co-infection with flu and COVID so if you test positive for the flu, then coronavirus is unlikely. We will try to keep this in perspective.
• There can be false negatives for COVID testing – people may be harboring the virus but have a negative test. It depends on the timing of the swab, the technique, burden of virus, etc. So if there is a respiratory illness but the test is negative, a 14 day self-quarantine should still be practiced. The difference is that the person’s contacts would not have to be traced and notified about a possible COVID exposure.
• There has been some mention of possible re-infection. This seems not to be the case. The initial infection can last 2-6 weeks, so the ‘second’ infection is really just the tail end of the first. Even after people recover they may still shed virus. We’ll have to stay tuned for further info on this as we get further away from the initial infections. That info may also inform us as to how long to self-quarantine after an illness.
• There has also been information about those taking certain blood pressure medications being at higher risk for COVID – that seems not to be an issue worth acting on.
• Please be vigilant at home about washing hands with soap and water – this is the first choice, over using hand sanitizers. Wash for at least 20 seconds, touching all surfaces of the hand, with some friction. Be aware that there are counterfeit sanitizers being sold for ridiculous prices – soap is better! Hand sanitizer is good as an out-of-house option. Wash up with soap and water whenever you come into the house.
• Wipe down surfaces with disinfectants. Active virus particles can remain for 48 hours on stainless steel, 24 hours on cardboard, etc. Almost any disinfectant will work, but you can check at EPA.gov for specifics.
• Masks should be used by those who are coughing to avoid spreading respiratory droplets to those around them, they should not by everyone on a regular basis. The typical paper masks you see are ‘single use’, effective for about 20 minutes. After they are humidified by our breath, they are not helpful. The thicker N95 masks are for those exposed to others who are ill and need to be in close proximity. They need to be fitted well in order to be effective. They are very difficult to breathe through and generally can’t be worn by most of us for more than 15 or 20 minutes or so. Forget the masks unless you are someone who should be wearing one.
• Expect to see more about telemedicine visits – with audio and visual components – to keep some people from having to have in-person visits. Our own lady docs are divided about having patients come in for their routine visits or not, so please check with your doctor.
• Also expect to see more drive-through testing sites and other situations in which patients may be asked to swab their own noses and throats for samples, with clear directions provided.
• The fatality rate seems to vary in different areas, possibly due to different reporting rates, but those 65 and older and those with chronic illnesses including high blood pressure, heart disease, diabetes, kidney failure, chronic lung disease, etc, are at increased risk of complications. Our goal is to minimize illness in all of us which will help to limit illness in those who are most vulnerable to worse outcomes.
• Those over 80 years old are advised not to be traveling unless it is essential.
• I’m proud to say that as an off-shoot of our phone conference yesterday, some of us, under the able guidance of Tali Elitzur, are planning to support others through this potential mental health crisis. Tali is a therapist who is very experienced working with trauma survivors, and will help get us all through this stressful situation.
• Consider meditation if it’s not already part of your routine. A site that comes highly recommended by Dr. Mindi Cohen is Ten Percent Happier, which I’ve just subscribed to. Let me know if you think I seem happier!

• For more information about COVID, visit health.maryland.gov.

• That’s all for now. All of us at lady docs are here, riding out the storm with you!