Coronavirus Update #2

To My Patients and Friends,

Here’s an updated summary of the latest information regarding the coronavirus outbreak.

  • The prevalence of the virus will continue to increase in our region (and elsewhere) over the coming weeks.  Expect more precautionary school and business closures.
  • It remains evident that the virus is transmitted primarily via respiratory droplets (from coughing and sneezing).  We do not yet know with certainty whether or not it can be transmitted via oral secretions.  One study did demonstrate that the virus can be shed from the stool.  There is still no evidence that infected women who are pregnant will transmit the illness to their unborn children.
  • Wearing surgical masks is of little benefit, as they are designed primarily to prevent people who are sick from transmitting respiratory droplets to others; for those who are not sick, they provide little to no protection.  Unfortunately, due to public perception that these masks are protective, supplies have dwindled to critical levels, and they are not easily available to those who most need them, i.e., hospitals, practices and those who are already sick.
  • Although it has been demonstrated that viral shedding can occur up to 14 to 21 days after developing an illness, the risk for transmission decreases significantly once symptoms have resolved.  Similarly, if you happen to have been exposed to someone who is high-risk or recently ill but who is not exhibiting any symptoms, your risk for contracting COVID-19 remains low.
  • Behavior modification measures remain the best means by which we can prevent the spread of coronavirus.
    • Wash hands very frequently (best with very warm water and soap with vigorous scrubbing of the fingers for at least 20 seconds, or hand sanitizers containing at least 60% alcohol when soap and water are not available).
    • Avoid coughing or sneezing into your hands (best to do so into the crook of your elbow or into a tissue, followed by handwashing.
    • Avoid touching your face.
    • Stay home when ill and minimize your exposure to others who are ill.   The risk for transmission of most respiratory infections, including COVID-19, is significantly reduced once symptoms have resolved.
    • It makes sense to try to avoid travel to high-risk destinations, densely crowded environments and large social gatherings when possible.  This is especially important for those at higher risk, i.e., the frail or elderly, those who are immunocompromised, and those who have chronic conditions like diabetes, cancer, heart disease or lung disease.
    • There are are no firm recommendations for low-risk individuals to cancel plans for travel to low-risk destinations at this time (although this may change).  This stage, this remains a matter of personal preference and risk tolerance.
    • Use only your knuckles (or covered hands) to touch light switches, elevator buttons, etc.
    • Use gloves or paper towels (or a closed fist) when flushing toilets, using door handles, turning water faucets, punching keypads or lifting gasoline dispensers.
    • Clean surfaces with disinfectant wipes whenever possible (as these can harbor respiratory secretions).  And handshaking needs to be a thing of the past… please try to employ other means of greeting one another, including waving, “elbow bumps,” etc.
  • Please remember that for most healthy people, the illness is self-limited and poses little threat.  In fact, it is certain that many cases (both domestically and abroad) go unreported.  Therefore, the true prevalence of COVID-19 remains unknown.  That said, we must do all we can to protect those among us who are most vulnerable to complications (i.e., the frail and elderly, those with diabetes, cancer, pulmonary disease and heart disease) via the strategies discussed herein.
  • It is reasonable for otherwise healthy people to consider restricting travel and exposures to high-risk environments (large gatherings, religious ceremonies, business meetings, public transportation and the like).  Ultimately, these decisions come down to personal choice and risk tolerance.  There are no hard and fast rules at this stage.
  • Schools and businesses should begin implementing contingency plans in the event that temporary closures are necessary (if they haven’t already).
  • It remains unlikely that medications to treat COVID-19 (or a vaccine to prevent it) will be available in the foreseeable future.  For now, treatment is primarily symptomatic and avoidance measures remain paramount.
  • If you are concerned that you may have COVID-19 illness, please stay home and call your doctor or local health department for advice before leaving the house.  Those who are considered to be at high risk for exposure to the virus are those with cough and/or fever who (1) have traveled to high-risk countries (i.e., China, Iran, Italy, Japan, South Korea) or (2) have been in close contact with someone with laboratory-confirmed COVID-19.
  • Testing is becoming increasingly available, although testing supplies remain limited.
    • Per CDC guidelines, there is no role for testing those who are asymptomatic.  If testing is requested simply because of concerns about possible exposure to coronavirus in the absence of illness, the request will be declined.  If you are concerned about a possible exposure but are currently well, the recommendation is to call your physician or local health department for further guidance.
    • For those who are exhibiting symptoms (cough and/or fever) and who may be concerned about possible COVID-19, please stay home and call your doctor or your local health department for further guidance.
    • For those who are severely ill with difficulty breathing, an emergency department visit may be necessary.  For those who are severely short of breath, dial 911 ASAP.  For those who are experiencing more mild symptoms, seek initial guidance via telephone as above.
    • In the interest of minimizing community exposures and of keeping our healthcare workers healthy and available to those those who are most in need, expect that you may be screened via telephone prior to being asked to schedule an office visit.
    • As testing has limited utility in terms of treatment decisions (only symptomatic care is currently available), and as a means of limiting transmission within the healthcare and general communities as discussed above, there is movement toward a protocol wherein voluntary isolation is recommended in lieu of testing.  Stay tuned on this.
    • We have all been bombarded with lots of information and opinions via media outlets.  In my experience, most of the information disseminated via mainstream media has been accurate. However, it has been flavored by a sense of urgency, which has triggered a great deal of angst within the general community.  Although I disagree with those who dismissively suggest that this coronavirus outbreak is not a big deal (it most certainly is), it’s also important to remember that the vast majority of us will fare very well if infected.   So please don’t panic.  The primary goal in trying to contain the spread of the virus is to protect the most vulnerable among us.  Additionally, we must do all we can to avoid overburdening our healthcare system.  It’s for this reason that- while we all must take this pandemic seriously- it’s important to maintain a sense of balance and perspective… after all, it takes a village.
  • And lastly, please remember that influenza is still here, has affected millions of people, and can also be life-threatening to those who are most vulnerable.  And the usual nasty winter bugs are still circulating as well… so although these may add to the extant confusion, all of the above recommendations apply.  While I understand that it can be logistically challenging and/or inconvenient, it’s important that you please stay home from work or school and minimize exposure to others when you’re sick, even if you are not concerned about COVID-19.

I hope this is helpful.   I’ll continue to keep you updated as more information becomes available.