Tuesday, March 17, 2020

COVID-19 Information from LFM Physicians


Hello,
We are writing to address some common concerns we have been hearing from you about Covid-19, this Spring’s unwelcome guest.
Our goal here is to provide some information about the illness itself, how to prepare, what to look out for, how to manage illness symptoms, and how to interact with our office and our greater community. It is our hope that this information will provide some peace of mind. In this letter, we will be rendering some of our own opinions about COVID-19, as well as relaying expert opinion and government policy. Information is also available at www.coronavirus.gov . Here are some key starting points:
1.     We believe the death rate is less than what has been commonly reported and likely under 1%. This is what has been shown in South Korea. Their death rate there was 0.66% as of March 6. The reason their death rate is lowest is because South Korea is doing a good job of identifying cases of COVID- 19 in people who have mild illness by doing extensive testing. Other countries doing less testing are only testing people who are really sick. People with mild illness are not being detected or counted which falsely inflates the death rate. This means that the vast majority of people who get this COVID-19 will recover.
2.    The hospitalization rate in China was reported to be 18%, we also believe this to be inflated for the same reason, and in our opinion it is likely well under 10 %
3.    The purpose of social distancing and closures is to slow down the spread of this illness so our hospitals do not get overwhelmed. If everyone gets this illness quickly and all at once, there won’t be enough hospital beds and ICU beds to manage the community’s needs.
4.    Don’t panic. Take reasonable precautions as recommended by infectious disease experts and other people with expert knowledge on how to handle a pandemic. This will allow us as a society to persevere through the problem with as little physical and psychological toll as possible, and also make us stronger as a community once this is behind us.
What can you do to prepare yourself and your household from a medical point of view?
1.   Follow Department of Homeland Security advice regarding having a 2 weeks supply of food and certain essential items on hand in case you are quarantined and can’t get to the store. Unfortunately people have misunderstood this advice and have been hoarding. This is not necessary, and creates needless panic.  https://www.ready.gov/pandemic
2.      Where possible have your prescriptions filled in 90 day increments, again, to have enough in case you are quarantined. Drug makers have redundancies in their supply chain. Shortages anytime soon are unlikely. We are accustomed to temporary shortages of medicines even in normal situations in cases of manufacturing problems (remember zantac?) and there are always workarounds. Again, don’t panic here. 

What should you do to prevent illness in yourself and others?
1.    Follow the social distancing guidelines. Avoid family gatherings, worship from home, try and stay 6 feet from others, avoid crowds, avoid shaking hands
2.    Get enough sleep:  The immune system functions best when you get 7-8 hours of sleep as an adult. Children need 9-11 hours per night depending on age.
3.    Manage stress properly:  It is well known that excess stress weakens the immune system. Engage in healthy stress relievers that work for you.
4.    Avoid excess alcohol:  Alcohol is known to weaken the immune system. Our recommendation is to limit to 1 alcoholic unit per day maximum. (1 unit is 12 oz. beer, 4 ¼ ounces of wine, or 1 ¼ ounces of hard liqueur.)
5.      Avoid touching your face.
6.  Keep your hands clean:  Washing them when needed, consider wearing gloves when touching frequently handled surfaces like public door handles and shopping carts.
7.      If you feel sick, even if it is a minor illness, STAY IN YOUR HOME. Do not leave your house unless you need to get medical care. Stay in one part of your house away from other family members.
8.    Practice good cough and sneeze hygiene by coughing into your arm or into a cloth or tissue. Wash your hands if you cough into a tissue.
Which groups of people are more vulnerable to COVID-19?
1.    Much like the flu, advanced age is a risk factor for death with COVID-19. Also people with coronary artery disease and worse illness on presentation to the hospital had higher risk of death. The CDC reports that after age 60 is when death risk starts increasing.
2.    In a published study of a group of 191 people who were hospitalized, which is a pretty small study, having high blood pressure and diabetes seemed to be risk factors for hospitalization. Interestingly people with smoking related lung disease were not statistically more likely to die or be hospitalized. They did not assess for asthma. We think this study is too small to generalize from.
3.   Children are much less likely to get sick from COVID-19 and it is unknown if they can transmit it to others without being sick.
When you should suspect COVID- 19?
If you have temperature over 100 and a significant cough and . . .
1.      You have close contact exposure to confirmed case of COVID- 19 or a Person Under Investigation
2.     You should suspect it with a low grade fever and cough when other more common illnesses like the flu are ruled out.
Who should get tested?
1.   The health department will test people with symptoms who are close contacts of a confirmed case, symptomatic cases at a long terms care facility (like a nursing home) and symptomatic health care providers and anyone who is severely ill.
2.    Call the COVID-19 Screening hotline at 616-394-2080. This is available seven (7) days per week 7:00 a.m. – 7:00 p.m.


What are some common illnesses and diagnoses this year that people are asking about that are not COVID-19?
1.    Allergies:  We have had an early tree pollen season. We are seeing lots of people with throat irritation, mucus production, throat clearing and flares of known asthma. Some traits of seasonal allergies are below:
                a.     Varying symptoms depending on how much exposure you have to the outdoors, be it time outdoors or open windows.
           b.  With allergies people do not feel achy or feverish although some people can get fatigued in peak pollen season.
                 c.     If you are known to have allergies or asthma this time of year before worrying about COVID- 19 try allergy medications that normally would work for you.
                   d.     Claritin, Allegra, and Zyrtec  are  good for sneezing, runny nose, and post nasal drip
                  e.     Flonase is good for sinus pressure and stuffy nose but keep in mind it normally takes about 5 days of daily use to kick in fully.
                    f.     Prescription azelastine works same day for stuffy nose and sinus pressure lasting about 12 hours.
                  g.     If you have asthma try an albuterol inhaler to see if symptoms improve temporarily. If they do, then track how often symptoms occur. If they occur twice a week or more contact us to work on a plan to control the asthma.
2.      The common cold: Symptoms do not normally include a fever in adults, people feel tired, run down, and usually have mild to moderate sore throat, with runny nose, stuffy nose and mild cough.
                     a.     It is possible that COVID-19 can present like this in some people which is why you should practice social distancing with even common cold symptoms, even though you yourself do not need to be frightened.
3.      The flu (Influenza):  The flu is still spreading widely in our area
                     a.     Symptoms generally come on strong and quickly where people get sick over the course of half a day to one day. Symptoms are fever 101 or higher, body aches, chills, very run down feeling, and mild cough. People feel like they have been hit by a truck.
                     b.     These symptoms are stronger than what is described as the initial presentation of COVID-19, however people who have had a flu shot earlier in the season can get a watered down version of the flu. This “watered down flu” could feel like a low grade fever 100-101, mild cough, body aches and more mild fatigue than we typically see.
4.      Getting care when you are sick
                     a.     If you are sick and you are not sure what to do, you can obviously reach out to our office.
                     b.     We will be trying to handle more things by phone and portal to limit unnecessary spread of any kind of illness to other patients, staff, and myself. If our staff or myself are quarantined or get sick with COVID-19, our ability to help you will greatly diminish or even be gone.
                     c.     If you have symptoms of a common cold we will not recommend coming into the office as it can be managed at home. We will let you know what to expect in your recovery and what to look out for that would indicate you need to be seen. Colds generally hit a peak on day 4 and resolve by day 7-10. Sometimes they go on for 14 days.
                     d.     If you have chest symptoms we want you to be evaluated.
                                i.     If the situation is severe, like you have difficulty breathing or an outside observer notices that you have difficulty breathing, then you need to go to the emergency room
                               ii.     If it is during business hours and symptoms are not severe enough for the ER, we will recommend an appointment in the office.
                              iii.     If it is after business hours and symptoms are not severe enough for the ER, then you should go to urgent care
                     e.     Etiquette in the office:
                                i.     We will allow only the patient in the office. One adult may accompany a child or disabled patient.
                               ii.     We will have separate hours for well visits and for sick visits.
                              iii.     Wear a mask if you have had temperature over 100 in the last 7 days (or felt a fever if you don’t have a thermometer) or if you have a cough. We will provide one as long as we still have them available.
                              iv.     Please don’t offer a handshake and we promise we won’t offer you one either.
                               v.     Please do not request extra supplies of medications beyond a 90 day supply. We won’t be able to do this.
                              vi.     Please do not request antibiotics just to have on hand
                            vii.     Please don’t call in requesting antibiotics for colds. If you have had symptoms for only a few days it is almost certainly NOT bacterial. It usually takes 10-14 days to develop a bacterial infection unless one has an unusual underlying condition, which we would have already talked about.
Thank you so much for making it to the end of this long letter. We hope you find this helpful. And we hope it gives you some peace of mind. We are all in this together and we will get through it!
LFM Physicians and Staff

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