Corona virus update 7/4/2020

COVID-19 Update – July 3,2020

I have not written in awhile as there seemed little new or different to report but we are entering phase 2 and so an update seems warranted.

Prevention- Pennsylvania numbers are increasing  again. Masks, social distancing and constant hand-washing are still primary. I would again like to urge considering wearing face shields when you are around people, except at home. As “proof” of this recommendation, I recently sneezed while wearing a KN95 mask and a face shield. My sneeze particles massively penetrated the KN95 and completely covered the inside of my face shield. Sneeze particles can aerosolize up to 7-8 yards so wear a shield with your mask to protect your upper face, your mask and to remind yourself not to touch your face. Carry a chopstick to reach under the shield to scratch or rub when needed. Wash the shield at least daily in soapy water and wash your hands afterward. Our medical supply dealer now has shields available and we can sell them to people for $5, depending on his supply. Call the office if you are interested- we need enough demand to buy a box of 100.  

Office protocols- we are testing our patients who need it at the back door. If you have symptoms, call and, if screening warrants it, we will have you come to the parking lot, call us, and we will have you self-swab for a vial that we will leave for you on the window sill outside the back door. A staff member will observe from the doorway to make sure you do the test properly. If you are mildly ill, we would prefer that we test you before you have an office visit. If you are sicker, we will see you in our isolation room, without prior testing, to make sure you get proper care quickly.

We screen all patients by phone before arrival at the office, so please don’t enter unannounced. We ask that you wear a mask if you have one. If you don’t have one, we will provide one. We will also try to provide a face shield for your use in the office if we have any available. If we have extras, you may purchase 1 or possibly enough for your family.

Vaccines- for a list of vaccines in development, see the NY Times, 6/16/2020, page D8.

Treatments- Dexamethasone and Remdesivir seem to clearly be helpful in very ill patients. An interesting study from Greece, published in the Journal of the American Medical Association, showed benefit from colchicine, a commonly used drug, in very ill patients. Prone (facing down) positioning is helpful in improving oxygenation in many people. The trend is to try various methods of providing higher amounts of oxygen without entubation. COVID often causes an increase in blood clotting so higher doses of preventive blood thinners are being given in hospitalized patients.

Social responsibility- if you are ill, have been exposed or have been tested, pending results, self-isolate. If you are well but want to visit family, self-isolate for 14 days before. Before visiting family, you can have a negative test but still be incubating the virus so the 14 day self- quarantine is the safest way to protect family before you visit. If you must travel, use a mask and shield and wash hands frequently. While traveling, avoid eating food other than what you take with you, unless you wash your hands and utensils first and have hot food or food right out of a machine, untouched by anyone’s hands. If you must fly, try to take a very, very early flight and sit as close to the back of the plane as possible (aerosols spread at least 3 rows forward). Consider wearing a hood to protect the back of your head and torso and remove it carefully, without touching your face, after you de-plane. Avoid “hot” States, but wear a mask and shield wherever you visit.

If you have the virus, self-isolate. If you share a bathroom, clean the faucet and toilet handles, door knobs, toilet seat and lid, etc. after using. A bleach solution (1 tsp bleach in 1 cup water) is fine. Try to have meals delivered to you  in your room by family members but come out to put your dishes in the dishwasher without touching anything (have a family member leave the door open and racks pulled out). If you do your dishes by hand, wash your hands before starting the task and then bleach the counters and sink handles afterward. Wear a mask and shield when you leave your room and wash your hands first. If you become short of breath with minimal exertion or if you have a pulse ox  meter or if your insurer provides one (Keystone First, some Blue Cross patients) and your pulse ox drops below 93%, please call us. .Stay mobile in your room as much as possible to avoid blood clots.  Stay in isolation until 10 days after the onset of symptoms and at least 3 days after symptoms resolve. Health care providers must follow different isolation durations.