UPDATE ON THE PANDEMIC 3/30/2020
The number of cases in the US is rising rapidly as testing has become more available. While the news seems to indicate that the number of people infected is doubling every few days, people need to understand that the number of positive tests indicates that the disease has been widely spread in some communities and we are finally getting a picture of where it is located and how many are infected. New York City is most severely affected now and is having a profound effect on neighboring cities and states. The measures which limit activities and travel should help reduce spread from New York. In fact, people traveling away from NY have been advised to self- isolate for 14 days upon arrival to their destination.
We will likely never know the total number of people infected by the virus because not all people will be tested. Dr. Bix from the coronavirus task force announced that more tests have been done in the last 8 days than were done in S. Korea in 8 weeks. Between 50-70k people are now tested per day, so expect the number of detected cases to go up significantly. One of the benefits of more testing is collecting enough data to reassure us doctors and you that the mortality rate is likely to be closer to 1 percent in the US. That is 1/3 the mortality rate estimated by the World Health Organization worldwide.
I’d like to point out that the utility or usefulness of testing is starting to decline. The US failed to deploy early testing which could have been used to identify and isolate the initial cases and their contacts. In many regions, we may be past the point where we can even perform effective tracking of cases and contacts due to sheer volume. According to the Fairfax County Health Department, they currently have the capacity to monitor positive cases and to trace contacts. They are taking steps to increase staffing for the expected surge of positive tests in our area and have a plan to prioritize cases if they can no longer trace every case. Clearly, community spread has happened, but most people (who have been told they can all be tested) may not need a test. Why?
- These are the latest testing guidelines from the CDC
- Testing healthy people who have minor symptoms will not change either their treatment or the appropriate recommendations. There is no treatment, as of yet, for COVID-19. If you are sick, doctors should provide in-office or tele-visit care and advise you to stay home and ask that you do everything you can to prevent the spread of the illness. You should assume that you could have COVID-19 disease even if cases in our area are low compared to other areas. Our office conducted 5 tests and all 5 tests were negative (please note that tests are taking over a week before results are reported). Our tested patients have been suspicious cases either by symptoms or contacts. The Bottom line- it is very important that people with symptoms remain at home (excluding essential trips) unless advised to have a doctor visit. For our office, that will be a video consultation to assess your need for an in-person visit.
- Testing is most helpful when a patient is severely ill and requires hospitalization. This helps the doctor decide how best to treat the patient. Treatment for common infections will be different from the treatment of COVID-19.
- Testing of medical personnel is important so we can keep our front-line health care providers and staff on the job. We need everyone working. The newly developed rapid tests should initially be reserved for hospitalized patients and providers as quick test results are essential for critically ill patients, their doctors and nurses.
- Testing of ill patients in assisted living, nursing homes, and institutional homes is important to identify, isolate and treat those most vulnerable.
- Testing of patients who have significant symptoms AND have health risk factors, including those over 60 years of age, is prudent. No one can predict how quickly a patient with risk factors can deteriorate so getting a test started early may help determine an action plan if the patient’s medical condition changes.
- We have also learned that INOVA has converted three urgent care facilities into testing centers where patients with a physician order can go for a test.
“But Dr. Shmorhun, “they” have been telling us that once there are adequate tests, anyone who wants a test can have one. Are you saying that is wrong?” No, but there are reasons why we should test judiciously now that community spread has been confirmed. Ironically, leaving your home to be tested may result in an exposure. While we may have enough test kits, we don’t have enough protective gear for those doing the testing. Masks, gowns and face shields are in very short supply and need to be saved for our Emergency Room, hospital and community medical staff. Depleting supplies of protective gear by testing low risk patients is not what we should be doing now. People with mild symptoms who are in a low risk group should simply stay home and recover. At Family Healthcare, we currently have enough protective equipment which, we hear, is not true in many offices. I believe that the supply should improve over the next few weeks and my hope is that supplies in the outpatient medical community are replenished soon. We also should consider limiting testing in low risk patients because the high volume of tests has already doubled the time it takes to get results for the sickest patients.
The medical community is focused on saving lives in the hospital and the rest of us need to focus on reducing community spread through social distancing and isolation of sick patients. Expect various forms of shut-downs and closures in our area. Do not travel. Limit social interactions. Wash hands frequently.
You know the drill.
If you are due for a visit for well care or medication refills – call us to discuss a visit. Some of you should have an in-office visit. We can decide together. Much can be done by a video visit and we will be scheduling those as regular appointments going forward. The process is simple. All you need is a computer with a camera or a smartphone. We send you an email or text invitation and you then click on the link to enter the chat room. Your provider will join you at the assigned time.
If you are sick, call for a video visit. We may need to see you at the office but many of our sick patients can be managed through a video visit. If you need advice about possible exposure and concerns, please schedule a video visit. These calls tend to be more complex and require as much time as an in-office visit so we prefer to treat them as a formal visit.
Note: The current emphasis on video visits is a necessity due to COVID-19. We hope to return to regular office visits, normal physical exams, appropriate office procedures, and timely blood draws as soon as it is deemed safe. Video visits are not optimal for the level of care Cathy and I provide.
You may consider delaying routine visits to specialists, physical therapy, radiology tests, colonoscopy’s, etc. but you must re-schedule those for June or July. These are recommended and important.
Yours in good health,