As applies to most medical issues, time is a great benefactor when it is applied to knowledge about any medical issue. The Coronavirus has proven to be no exception to this case, as the past 10 days since my previous memo regarding the virus has witnessed a broadened and sharpened knowledge of how this virus works, whom it threatens most, and how best to manage a medical catastrophe which literally seemed to appear “out of the blue”. Yet again, in this memo, it is strongly urged that certain patient populations take particular note that they are at increased risk for adverse outcomes should they contact the disease. In short, this means that this portion of the population should take particular and specific steps to avoid contracting this virus (see advice on how to do such following). Specific high-risk groups that need to be particularly cautious are:
- Age, namely those who are age 65 or older. While this is not always a hard and fast criterium as the general health of people in this category varies, it is still true that over age 65 tends to bring more chronic illnesses and diminished immune systems and hence, greater susceptibility
- Those who have existing cardiovascular disease (CVD—such as heart attacks, strokes, stent and by-pass type surgeries, angina, acute coronary syndrome, arrhythmias and the like)
- Those who have existing chronic obstructive pulmonary disease (COPD, emphysema—note that asthma is excluded as the risk has not proven to be particularly increased in this group)
- Those who have diabetes mellitus (DM—this has proven to be somewhat of a surprise to the medical community, but a significantly increased risk appears to be for real)
- Those who have existing immune compromising diseases (using immunosuppressant drugs, depressed immune system secondary to cancer treatment, and the like)
The good news is that the death rate in those afflicted with this virus appears to be less than 1% if you don’t belong to one of the preceding groups—good news in the sense that the death rate was previously predicted to be in the 3 – 4% range (it goes without saying no one wants any death rate).
Although it is probably becoming repetitious, everyone, but particularly the high-risk groups, should follow certain prevention tactics that do help in both preventing the spread of the disease and in protecting one’s personal health.
- Wash your hands well and do so frequently (soap and warm water, 20 seconds or so). No kidding, this works best of most anything you can do. The key is to avoid transferring the virus from your hands to one of the openings on your face—eyes, nose, mouth.
- Try to avoid touching your face with your hands (a difficult habit to break, I recognize)
- Avoid crowded places (this is important). Crowded refers to being in close proximity (contact) with other people, not so much the number of people (this is why you hear variations on numbers from 10 to 50). Try to keep about 6 feet apart when with others—it appears the droplet transfer of the virus is generally in the 3 feet, give or take, range.
- Limit excursions outside the house to the very essential—you will still need food (you can have food delivered by the grocery, restaurants, family, friends—all readily available now), essential medical services (do not let your chronic illness go unsupervised and not managed—most routine care can now be handled at your home over the telephone; call the office and make arrangements for the service), emergent issues that impact your home (electricity is out, sewage problems, and the like), and loved ones in dire straits (but it should be an emergency, not just “missing you”). Before you make that trip outside your home, ask yourself, “Do I really need to go out to do this, or can I get along without it, perhaps with some inconvenience, but not harming myself or someone else?”
- If you have concern about symptoms you are currently experiencing that are respiratory in nature (cough, sore throat, difficulty breathing, chest pain that seem to becoming worse with time) or fever and malaise (dumpy), all of which are now reported to be associated with the Coronavirus, particularly if you have been in contact with someone known to have the virus in the preceding 14 days, call the office. Screening has now been geared up and is readily assessable, but arrangements must still be made, at least at this point in time.
- Stay calm—no matter what the fear mongers (particularly from the media) may say, the nation’s response to this viral attack has been swift, dramatic, and effective. Many of the estimates of the severity of this pandemic have originated from one spurious report out of Great Britain which even the original author is now revising downward—dramatically downward. The concept of needing 30,000 respirators for New York City alone was largely based on those original inflated figures and assume that all 30,000 are needed at one time (which would require about 1 million people being ill with the virus at one time in NYC alone, given the known respirator use rate at this time). Yes, make no mistake about it—this is a very serious disease. Do proper prevention and rest assured, this nation is fully gearing up to defeat this virus.
Medically speaking, hope abounds. Keep the following in mind.
- Maintain your current medication program for any chronic illness(es) you are treating. Do not alter a chronic illness treatment program without discussing it with your physician. As previously stated, telephone consultations are now readily available so you can receive the help you need from the comfort and safety of your home.
- Monitor yourself for symptoms characteristic of the COVID-19
- Fever (usually above 100.5°F, often in the 102°F range, but can be normal)
- Cough (usually some sputum, but not always)
- Shortness of Breath (difficulty breathing)
- Chest Discomfort (yes, anxiety can produce this symptom too)
- Sore Throat (usually mild)
- If your symptoms are severe enough to raise the physician’s concern, you will be directed to a hospital setting where appropriate care is available and capable people will be ready to help you. If your symptoms are mild enough, they can be handled at home (please, this helps prevent an overload of our hospital systems)
- Stay inside—self quarantine! Avoid contacting other people. People in the household living with you should self-quarantine for at least 14 days. Keep in mind the virus is transmitted at least 24 hours prior to one developing symptoms, and the virus is usually passed for 5-7 days, but it can be up to 14 days. More is being learned about the habits of this virus everyday (listen to public health officials, not politicians).
- Get plenty of sleep (7 hours minimum, 8-9 better).
- Emphasize fluids—do not become dehydrated.
- Eat healthy foods that help the immune system—fresh and colorful fruits and vegetables are particularly helpful. Zinc 50mg daily and Vitamin D 5000mg daily may be helpful.
- Treat fever with the product you have found effective for you in the past. Acetaminophen has definitely been shown to be safe and effective. Aspirin is suspect only because it has been shown to be associated with Reye’s Syndrome with other viral illnesses, albeit it is unknown what its ill effects are with this virus, if any. NSAIDs, such as ibuprofen and Aleve, have been suggested by one study to possibly make matters worse but the evidence is very sketchy regarding this.
There is great reason to be optimistic about the use of hydroxychloroquine and zithromycin for the prophylaxis/treatment of this disease. It is true that controlled studies have not been done as of yet, but both of these medications have been available and used regularly by the medical community for many years. They are known to be safe and their proper use is well understood. Unfortunately, the Governor of Michigan has added our state to a list of three (that I am aware of) prohibiting the use of these medications “off-label” at the threat of the State taking “administrative action” (threatening license to practice medicine). Medications are used by physicians “off-label” for numerous maladies that afflict patients (it is estimated about 20% of scripts are such), but the threat of losing one’s ability to practice their profession is a great deterrent. I do not see this as being an issue of safety—in fact, I don’t understand the logic behind this at all. The good news is that studies are being done and thanks to President Trump, the time for their completion is being shortened to a few weeks, rather than the usual two years. Let’s all hope that one or several of the drugs being tried now will work successfully.
Two more salient points:
- The virus, to date, is not mutating! This is great news as it means effective immunization is highly likely to become available (with time, usually about a year or so).
- “Herd immunity” is likely to help bring this virus under control. This occurs when a significant number (usually about 60% of the population) has been infected with the virus and developed immunity against it. What makes this promising is that it appears there is a significant number of people who respond to infection with Coronavirus with very few symptoms or very mild ones. Hence, these people contribute heavily toward the necessary 60% or so. As the percentage grows, there is fewer people for the virus to infect and it “starves itself out” for new victims, so to speak. Good news ultimately!
If you are advised to come to our office, FMOM has enacted measures to help minimize the possible spread of the virus to other patients and to our staff. We are strongly urging that you call and make arrangements for “Telehealth” so you have the possibility of taking care of your problem from the safety of your home. However, we recognize that there are medical issues that just need to be seen to be taken care of properly and if you are in that situation, we are open and handling such cases as usual.
Keep in mind, we will make it through this viral attack, just as we did with the more recent outbreaks of Swine (H1N1) flu (70,000 deaths in the U.S.), Severe Acute Respiratory Syndrome (SARS), Ebola, and Hong Kong Flu (to name some) and, long before our time, Spanish Flu and the Black Plague (killed up to 50 million people), not to mention small pox, undoubtedly the worse “killer” of all times, amongst many others. Be wise, be confident, and practice good epidemiological control measures.
I am agreement that the media has made this health concern much worse than it should be.