Covid Update January 18, 2021

Covid Update January 18, 2021

First, thank you to all of you who sent lovely notes and thoughts to me when I retired. I am fine and very busy helping with the remote schooling of 2 grandsons. However, I continue to be involved with the office, providing support when possible.

Pneumonia vaccine note: People 65 and over should receive 1 dose of pneumococcal-23 vaccine (Pneumovax ). We would ask that you get this at  the office, not pharmacies, as several of our patients have gotten doses at the office and then at pharmacies. You only need it once. Pneumococcal -13 (Prevnar) vaccine is no longer routinely recommended. If you get vaccines done at another facility (flu, tetanus, etc.), please send us a note or portal message so that we can document the vaccine and date in your chart.

COVID INFORMATION- this is a long blog, in sections: vaccine, treatment, isolation recommendations, prevention.

Vaccine:  The vaccine is safe and effective and I strongly urge you to get it when available. Dr. Aggarwal and I and almost all of our patient-facing staff have had the vaccine. The best hope for returning to normal life is for as many of us as possible to get the vaccine as quickly as possible. No vaccine is perfect but these are over 90% effective. It is also important that as many people as possible get it to give what is called “herd immunity”. You cannot get the vaccine if you have had another vaccine within 14 days before. You will need to stay on-site for observation for 15 minutes after receiving the vaccine and 30 minutes if you have a history of anaphylaxis after vaccines.

At this point (1/14/2021), Montgomery County has had the highest per capita immunization rate in PA. Only Allegheny County (Pittsburgh) has given more doses, but to a smaller % of people. If you are a patient-facing health care worker (dental office, physical/occupational/speech/respiratory therapy, EMT, etc.)  and have not received the vaccine, you can email Main Line Health at communitycovidvaccine@mlhs.org about getting the vaccine. Walgreen and CVS pharmacies and hospital systems are supposed to make 10% of their vaccine supply available to private health care providers.

The Montgomery County Dept of Health is now signing up people 65 and over for the vaccine. Visit their website at https://www.montcopa.org/3660/COVID-19-Vaccine.

The office has applied to the Dept of Health to obtain the vaccine. If/when we get it, we will do our best to notify everyone and give the vaccine as quickly as possible to as many people as possible.

Treatment:

If you get Covid, stay hydrated, especially if feverish, and drink enough to keep your urine a light-yellow color. Move around or in bed as much as possible to decrease the risk of blood clots, which occur more with Covid. There are some studies that suggest it may be safer to use acetaminophen (Tylenol and others), rather than NSAIDs like ibuprofen (Advil and others) or naproxen (Aleve). If you become mildly short-of-breath, call us for advice. If you become moderately or severely short-of-breath, go right to the ER. If you have a pulse oximeter at home, measure a baseline pulse ox when you first get sick and then daily. If it starts to drop to 94%, call us.

Monoclonal antibody treatment (an IV infusion of antibodies to lower the COVID viral load) is available on a limited basis at Main Line Health for patients at high risk who have been diagnosed with Covid within the prior 10 days and who are not hospitalized. Criteria for possible inclusion include BMI 35 or over; immunosuppression; age over 79; age over 64 with another condition like diabetes, kidney disease, stroke, peripheral vascular disease, hypertension, or COPD; over 54 and on dialysis, history of heart attack, stroke, bypass surgery, heart failure, or insulin-dependent diabetes; or age 12-17 with other specific health conditions (please call us if you feel you might be eligible). If you are diagnosed with COVID and fall into one of these groups, call for an appointment to discuss a possible referral for this treatment.

For hospitalized patients, dexamethasone, oxygen in various forms and prone positioning have been shown to be effective. Remdesivir may be helpful for some patients. There are some other treatments that may be helpful. Convalescent serum is probably not that helpful.

Isolation/Quarantine:

People with mild to moderate Covid-19 are infectious for no longer than 10 days after onset of symptoms, although it may be possible to detect non-infectious virus particles from their nose longer. Severely/critically ill or severely immunocompromised Covid patients may remain infectious up to 20 days after symptom onset. So isolation and precautions can generally be stopped 10 days after symptom onset and resolution of fever for at least 24 hrs without fever-reducing medicines and with improvement of other symptoms. Almost always, immunity lasts at least 90 days and the person should not be re-tested during that 90 days.

Those who are in close contact with someone with Covid-19 (excluding those who have had Covid within the last 90 days), should self-isolate.

 Close contact means being within 6 feet of a person with Covid for 15 minutes or more over a 24-hr period, starting 2 days before that person became ill or, for asymptomatic patients, 2 days prior to testing positive. Close contact also means having direct contact (hugging, kissing) with someone who has tested positive for Covid patient, sharing eating or drinking utensils, providing care at home for a Covid patient, or if a Covid patient sneezed, coughed or somehow got respiratory droplets on you.

Stay home 10-14 days after your last contact with the Covid patient or 7 days, if you get a negative Covid test on the 5th or later day of isolation. If you end isolation before 14 days, continue to watch for symptoms and self-isolate and get tested if you have symptoms. Also, wear a mask, socially distance, wash your hands often, and avoid crowds during the 14 days. 14 days is still the safest but the CDC approved the shorter guidelines in recognition of how hard it is to quarantine 14 days.

Children appear to be less infectious, probably because they breathe out smaller volumes of air and are closer to the ground so their droplets fall sooner. However, they are still susceptible and should wear masks if possible. Teenagers are as infectious, if not more so, than adults.

Quarantined patients should, if possible, have their own bedroom and bathroom, separate waste basket with a disposable bag, and wear a mask on the rare occasions they come to common areas. If they must share rooms, they should clean toilet, sink and door handles and other touched surfaces with disinfectant after use. Anyone who touches the sick persons dishes or other contaminated surfaces should wash immediately afterward with soap and hot water for 20 seconds. Opening windows, using air purifiers, bathroom fans, air conditioners and their fans may help remove viral particles.

Prevention:

A quickie- some studies have shown that having higher blood levels of vitamin D decreased the risk of developing Covid or having severe illness. There are not, and won’t be, large, good studies for this, but since we’re having a gray winter anyhow, and you need vitamin D for bone health, consider taking 2,000 iu. vitamin D3 daily (800-1000 for kids).

One study of masks showed that most masks are about equally effective at filtering particles, and only so-so. The most effective was to wear a mask and then put a length of nylon stocking over the mask, from the nose bridge to the neck. The next best, and almost as good, was to wear a medical-type mask with 3 rubber bands around the mask and over the head, at the level of the nose, chin and neck.  If you wish, try to see pictures on the Journal of the American Medical Association, Dec. 10, 2020, E1-7.

I still think using face shields in addition to masks is a good idea but there is only 1 (though very well done) study about this.

Wash your hands 20 seconds (as per CDC guidelines- https://www.cdc.gov/handwashing/when-how-handwashing.html) any chance you get. If you must use hand sanitizer, wash as soon afterward as you can.

Stay at least 6 feet away from other people if at all possible, even when outside. If you must be closer, minimize the time you spend that close. If someone is coughing or sneezing, try to stay 20 feet apart.

The Pennsylvania Department of Health has an app for Android and Apple phones, called COVOD Alert PA that alerts you to exposure to COVID-19 without compromising your privacy or personal information. The app also provides Pennsylvania numbers and Covid information.

This can be a lonely, stressful time. If you are having trouble, please call the office. We can help or refer you for virtual counseling.

Author
Margaret S Lytton Physician

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