Pillar PC update March 16th, 2020

A lot has transpired over the weekend.  Here’s a quick update to start the week.

SARS-Cov-2 the virus that causes the illness called COVID-19 has been found in nearly every state.  As of this writing the Tennessee Department of Health has only reported one case in Knox County.  Most of the cases are clustered around Davidson and Williamson Counties.  However, I believe these statistics are misleading to the general public because of the widespread lack of testing ability among community physicians and the narrow criteria for which testing has been offered thus far.  We just don’t know the incidence in the community yet.  Given that the incubation time is 2 to 14 days with a median duration of just over 5 days and that most people have mild symptoms, it is very possible this illness is much more prevalent in our community than we realize.

What does COVID-19 look like?
Much like many other viral respiratory tract infections.  Sore throat, body aches, chills, cough, and shortness of breath are the most reported symptoms, but some have diarrhea as well.  SARS-CoV-2 infects both lung and GI cells.  This give it two modes of transmission: respiratory droplets and fecal-oral route.  Therefore, wash your hands, don’t touch your face, and stay home or at least 6 feet away from other people.

What should I do if I have symptoms?
Let me know first before you do anything else (unless it’s an emergency, of course).  Mild symptoms are not going to warrant anything other than staying home in self quarantine.  Over the counter medications like Tylenol and ibuprofen can be used as can cough medications and decongestants if they are helpful for you.  If you have underlying asthma or COPD, make sure you use your breathing medications as prescribed. 

If you have more severe symptoms, then we’ll need to talk about escalating your care.  If you need extra oxygen, have severe shortness of breath such as to require breathing support, or other emergent issues, then you’ll need to go to the hospital, by ambulance if necessary.

There will be some people in between those two scenarios and, frankly, we’ll just have to figure out who needs what when it happens.  Most people will only need time and over the counter medications.

What about testing?
Often a test result isn’t going to change what needs to be done for you.  If you’re positive and your symptoms are mild, then you’re still going to need to stay home a few weeks in quarantine using whatever medications to manage your symptoms as are appropriate.  If you need emergency care for severe symptoms, then you still need to go to the hospital emergently. 

For those in between folks, knowing the test result will help them return to work or allow us to manage their illnesses in other ways.  As soon as testing is available in the office, I’ll offer it as needed.  Currently, the Knox County health department, or your local county health department, would be the place to be tested if we think your symptoms warrant it.

Are there other tests that could help?
Maybe.  It’s often good to make sure symptomatic patients don’t have influenza or other much more common respiratory infections.  Currently we only test for the influenza virus in the office and the presence of a cough and shortness of breath would effectively rule out strep throat.

Additionally, we are starting to see that COVID-19 produces a pretty unique clinical scenario in patients.  While nothing is as good as the direct RNA test from a nasal swab, certain lab values tend to be abnormal in characteristic patterns.  Advanced imaging like chest xrays and CT scans can be helpful at times.   A word of caution though, it can be dangerous to send symptomatic patients to get advanced imaging for both the patient going, other patients getting other tests, and the staff.  We should carefully consider the risks and benefits of outpatient testing before we order it.

Can COVID-19 look like other more common illnesses?
Yes.  This time of year, allergies, influenza, and the common cold all have overlapping symptoms.
1. Allergies: itchy eyes, itchy nose, runny nose, sneezing, often worse in particular environments like being outside.  Doesn’t provoke a fever.  Usually doesn’t cause shortness of breath unless there is underlying asthma or COPD.  Treated best with antihistamines and nasal spray steroids.
2. Influenza: Sudden onset fever, cough, and chest congestion.  Upper respiratory symptoms like runny nose, nasal congestion, and blood shot eyes are common which are not typical with COVID-19.  Treated best with supportive care most of the time with medications for high risk individual.
3. Common cold: Rarely a substantial fever but with a runny nose, cough, congestion, sore throat, and diarrhea depending on the virus.  Short lived lasting only a few days until clear improvement is seen.

What are the best things I can do right now to make a difference?
1. Wash your hands.
2. Don’t touch your face.
3. Stay home unless necessary.  Practice good social distancing to slow down the rate of spread.  We need to space out those who will get sick so as not to overwhelm the resources we have such as hospital beds and ventilators.  Here’s an example of what social distancing can do: https://bit.ly/2IQzmXm
4. Check on your neighbors, safely.  If someone needs help, go help them.  Make life during social distancing easier for the elderly, if you have that ability.

Let’s get really practical for a minute….
I’ve asked my mom to quarantine herself for a few weeks.  I’ve called my dad and stepmother and told them not to allow any visitors in to see my step-mother’s mother.  I’ve contacted my in-laws and asked them to stay home.  I contact each one every day to make sure they are doing that and to see if they need anything that I can safely go get for them.  Given the current mortality rate of COVID-19 in people 70 years and older, if those six people get infected, statistically speaking, I’m going to lose one of them after a 17-day battle on a ventilator.  I’m not willing to roll that dice.  Wash your hands.  Don’t touch your face.  Stay home.

How can I expect other updates?
I’ll be sending out more emails as it seems appropriate.  Make sure you follow the practice Facebook page at https://www.facebook.com/pillarpc/.  It is where I put the most up to date information.  I also post to the practice website and blog at https://pillarpc.com/blog/

What’s the office schedule going to be in the next few weeks?
I’m not sure.  I would recommend as many patients as possible who don’t need to be seen in person reach out by phone, email, or text.  Let’s work something out to keep as many people home as possible.  I will be able to see patients in the office if needed this week and Marci and Mary are in the office Tuesday and Wednesday too.  Again, we want to keep well people out of the office until COVID-19 settles down.  I can do a lot of medicine remotely.

If you are symptomatic, please contact me first to let me know prior to showing up at the office.  Feel free to email, text, or call me.

Again, now is the time to act.  If we put other’s needs before our own, wash our hands, don’t touch our face, and stay home, we can save lives.  Those lives will be the lives of our family and neighbors.  https://bit.ly/2INxS03

Dr. McColl

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