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SARS-CoV2 Coronavirus (COVID-19) and Sick Protocols

Updated March 21, 2019


Hello Personal MD members and patients,


We know some of you are very concerned about this outbreak while others are wondering why this virus has caused so much panic. Regardless of which side of this issue you fall, everyone has had their normal routine upended.  As your medical provider, we are making changes to try and keep you and our staff as safe as possible. I created this page to help answer many of your questions as well as keep you updated as more information about the virus becomes available.


What is COVID-19

Just like there are car companies that make different cars (Toyota makes a Camry and a Prius), we categorize viruses into families and then label each individual viral strain with a unique name. Then to make things even more confusing, we give the disease that strain causes a name. Here are a few examples: In 2002, there was a Coronavirus strain called SARS-CoV. That disease was called SARS (Severe Acute Respiratory Syndrome).  In 2012, there was a Cornoavirus strain called MERS-CoV. That disease was called MERS (Middle Eastern Respiratory Syndrome). In 2019, we have labeled this strain of Coronavirus SARS-CoV2 and the disease is being called COVID-19 (COrona VIrus Disease - 2019).


The Coronavirus family is mostly found in animals but it occasionally mutates and can attack a human.  When it does, it is generally like most other simple viruses and our bodies just shake it off, however, occasionally, the virus finds a weakness that is hard for our bodies to fight and it can cause unpredictable disease. That is the case with this particular strain of Coronavirus.  Unlike some viruses like influenza which we see every year and can predict how it will behave, we currently know very little about this virus, what keeps it from flourishing, and most importantly how to treat and prevent it. As a result, new information regarding COVID-19 seems to be changing rapidly. Some of this information is being created by hysteria, but much of the information is useful.  Our office is closely following several trusted sources to stay updated and we will pass along that information on this page and our social media outlets.  


Nobody is certain how quickly this virus will spread throughout the country, but there is a high chance there will be a fair number of cases in our community at some point. As of this morning, there have already been multiple cases confirmed in Collin County (including McKinney), Dallas County, the Ft. Worth area, and throughout Texas. If we follow the patterns that have been seen in other parts of the world, this disease has a few months before we see it run its course. Here is map where you can track COVID-19.


Is the Coronavirus another version of the flu?

No!  Most respiratory viruses cause similar symptoms such as congestion, cough, headache, and body aches. As a result, it can be difficult to differentiate between these different viruses and in fact, it is usually not critically important to make a differentiation since the course of these viruses tend to be similar.  However, the COVID-19 seems to be much more contagious and to be much more aggressive, especially in the elderly, which is why we are taking this infection so seriously.


Here is a graph that will help you visualize why COVID-19 worries so many doctors.


Who is considered to be in a high risk group?

COVID-19 is causing the worse symptoms and most mortality in those people who fall into a high risk group. This group includes people over the age of 60, people who take medications that weaken their immune system, people with lung disease including asthma, people with diabetes, people with heart disease, people who smoke, people with kidney disease, people with chronic liver disease, people with blood disorders, people with metabolic syndrome, woman who are pregnant or have recreantly been pregnant. For a full list see page 2 of our screening protocols.


What is PERSONAL MD doing different?

Inevitably, some of you will get sick with some type of respiratory infection in the coming few months; most of those will be from a common viral illness (common cold, influenza, etc.). But, given the potential of COVID-19, we will be taking extra precautions to keep you and our staff as healthy as possible.


We have created a protocol on how our office will be screening individuals that are sick and concerned he/she may have COVID-19. We have also acquired space in an empty suite of our office building that has a separate entrance from our main office.  This area will be dedicated to screening and evaluating any sick patient that needs to be seen.  This will allow us to separate our well visits that can not be done by telemedicine (procedures, EKG’s, injections, prescription pick-up, etc.) from our sick patients.  This is very similar to how we handle possible flu cases, but instead of dedicating one of our exam rooms to sick patients, we are dedicating a whole separate suite for this purpose.

   

Does PERSONAL MD have COVID-19 test kits?

At this time we do not have any kits to test for COVID-19.  We are hoping kits become available so we can test patients in our office instead of having to send people to a dedicated testing site.  Trust me, when we have kits we will post it.  


What to do if you feel sick

Regardless if you have been tested, if you are concerned you have been exposed to COVID-19, it is advisable you contact us and isolate yourself as much as possible for 14 days from the time of exposure, especially if you have any symptoms. For example, try and stay home as much as possible and if you have to go out, avoid areas where you can’t control your distance from people, and especially avoid those people who are at higher risk (see above).  Here is a link to the CDC Home Care instructions.


If you have URI/LRI symptoms WITHOUT a fever.

If you have symptoms of a respiratory infection (congestion, sore throat, sinus pressure, headache, fatigue, body aches, or shortness of breath) and NO fever that is less than 7 days in duration, we will likely recommend home care and that you NOT come in for an in-person visit at our clinic and instead, will be offering telemedicine visit if warranted.  Most people can find relief by drinking plenty of fluids, resting, and taking over the counter medications designed for the symptoms you are having.  For example, Mucinex is one of my favorite medications to loosen mucous when you have congestion or a productive cough.  Delsym is another one of my favorite over the counter medications that helps calm down a cough. Here is an extensive list of guidelines for home care instructions from the CDC.    

If you have URI/LRI symptoms and a fever but no SEVERE symptoms.

If you have respiratory symptoms (listed above) and/or a fever WITHOUT signs of severe illness (namely severe cough or shortness of breath), we recommend you call our office and speak to one of our staff.  We may have you schedule a telephone visit with me or with Molly, or we may have you schedule an in-person visit if it is warranted. If we determine that you need an in-person visit, we are happy to see you.  As I noted above, we have set up a separate office suite in our office building where you will be seen so please DO NOT come to our normal office.  Call us from your vehicle once you arrive to our parking lot for instructions on where to go.


If you have URI/LRI with FEVER and/or SEVERE symptoms.

In healthy people under 60, the odds of severe illness or death are very low with COVID-19 infections. Regardless, if you have a fever and severe lower respiratory symptoms such as shortness of breath or severe cough, we recommend you go directly to an emergency room or hospital. Note that most cases that have developed into severe illness started with the common URI symptoms and quickly progressed over the first 7-9 days. This type of progression is much more common in those higher-risk people I listed above.


What is a fever?


Why don’t we just test everyone that doesn’t feel well?

The main reason is because most people get better.  In fact, 85% of Americans seem to only have mild or moderate symptoms and recover within 1 week.  If you don’t feel well and follow the social distancing guidelines, you will keep from spreading whatever bug you have and keep everyone around you healthier.  


Second, you can have a negative test today and a positive test tomorrow.  Our lab test for Coronavirus measure something called viral load (how much virus do you have in your body at a given time).  If we test you before you reach a the threshold (usually before you have symptoms), you could be walking around shedding the virus thinking you are not positive. Again, if you are worried you have been exposed, follow the social distancing guidelines.  


Last, there are simply not enough high quality test around at this time.  Many of the test that were originally created had a high false positive or false negative rate.  In other words, they were unreliable.  We are working daily to get better test out to the public so please be patient.  


If we follow the guidelines, we will be able to make the most of the high quality test that we have and be able to help those in need.


Who needs a SARS-CoV 2 test?

There are many things that can cause URI and LRI symptoms besides COVID-19, namely the common cold, strep, and the flu. To rule out these issues, we may recommend a nasal swab for influenza or throat swab for strep. These lab tests can be done at our office if deemed necessary by our staff.


The people that should get a Coronavirus test are:


1. Any non-high-risk person who has been in direct contact with a laboratory positive SARS-CoV2 person AND is having moderate symptoms including shortness of breath, difficulty breathing, blood in sputum, or if you have symptoms that last longer than 7 days.  People with mild symptoms such as runny nose, cough, or fatigue do not have to be tested even if they have been in contact with a positive person. Simply assume you are contagious, use the symptom tracker I have created and use the CDC guidelines to determine when you can release yourself from self-quarantine.  


2.  Any Healthcare worker or first responder that has mild or moderate symptoms and has been in contact with a positive or possible positive patient should be tested.  The sooner the better to avoid from infecting healthy patients, especially those at high risk.


3.  Any high-risk (see page 2 of our protocols to see a list of who is considered to be high-risk) person that has moderate symptoms regardless if you have been in known contact with a COVID-19 person.  If you are high risk and having mild symptoms, you can simply take general precautions and track your symptoms day-by-day.  If you symptoms are progressing, especially the development of a fever, make sure to contact your primary care provider early or seek care at an emergency room.


If you do not fall in the any of the above categories and feel you need a test, speak to your primary care provider to discuss your situation.



Avoiding the emergency room

Emergency rooms are not going to perform on-demand COVID-19. So, unless you are having a real emergency, please avoid them at all costs. Overburdening our hospitals and exposing yourself to lots of sick people due to anxiety of COVID-19 is not wise; trust me!  We are happy to help guide you so feel free to call us first.


SOURCES WE LIKE

Centers of Disease Control including the Center of Disease Control detailed info about COVID-19.

New England Journal of Medicine Covid Page

American Academy of Family Physicians


FINAL THOUGHTS

We have put together this page with information and our guidelines to try and educate our patients and let you know how we are approaching this unique illness. We appreciate your understanding, patience, and effort to keep everyone in the Personal MD family healthy.

Sincerely,


Dr. Simmons


Copyright 2019 Personal MD Family Healthcare , P.A.

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