I know this is a very difficult and challenging time for all of us and everyone has many questions and concerns. I’ve written this hopefully as a way to help address at least some of those questions and concerns about how Coronavirus is being addressed in my medical practice.
First, I and all of my staff feel extremely lucky to work in a Dermatology practice. We have the lowest risk patient population and do not see emergencies and are able to screen and ban any high risk patients. We all feel very fortunate that we do not work in primary care or Urgent Care or a hospital or university center where the staff is required to see high risk patients on a daily basis. We feel great sympathy and concern for our health care professional colleagues who are working on the front line and they are constantly in our thoughts and prayers.
Second, the economic devastation is likely to be worse than the medical crisis. Many businesses and industries are being forced to close down with their employees receiving no pay. Again, everyone in my office is extremely fortunate that we are in a business that is not being forced to shut down. And I will not be shutting down our office unless we were mandated by the government to do so. If that happened every single medical office in the country would be forced to shut down and the possibility of that happening is close to zero. The government would shut down everything else before they would forcibly shut down medical practices. But even in the medical field, I do know of clinics across the country in Hot Zones which have voluntarily closed down for various reasons (usually because someone on staff had been exposed to Coronavirus). But be assured, it is not going to happen in my office for the reasons I stated above. Because Dermatology is one of the rare medical specialties where there are no true emergencies and nothing barring me from restricting anyone considered even the slightest risk from the office. I believe because of the safety measures I have in place, that my office is one of the safest possible places right now during this crisis from a health standpoint.
Third, from the first moment I heard of Coronavirus, I implemented safety policies in our office way before any medical office had even started to be concerned about this as a public health safety issue. I want to remind everyone that I have an M.P.H. (Masters of Public Health) along with my M.D. and have extensive training and background in public health and epidemiology and research. I have also been keeping abreast of everything to do with the Coronavirus outbreak with my extensive network of doctors and experts at the CDC, public health departments, governmental agencies, major university centers and hospitals, physicians of every specialty around the world, and professional colleagues. I do not engage in casual conversation about this with the staff and patients but I want to assure all of you that I probably know as much about this virus and epidemic as any doctor in the world and am completely up to date and continue to be updated on an hourly and daily basis. So if you have any questions please feel free to ask me (probably email is the best format).
Our office is way ahead of the curve because I am so germophobic and have always insisted on sterilizing the counters and exam tables and doorknobs and sinks and equipment and requiring standards way above the norm in terms of how we clean and disinfect our office and also ban handshaking. We have always insisted that any patient who has an illness or cold symptoms stay away from the office.
The safety measures that I put into place from the start re: Coronavirus are as follows in terms of screening patients:
- No one with any symptoms of illness or cold or flu is allowed in the office.
- Patients are asked to consent to have their temperature taken with a touchless infrared thermometer as they enter the office. Patients that refuse may be asked to reschedule.
- No one who has traveled in the last 30 days is allowed in the office.
- No one who has been in contact with someone sick in the last 30 days is allowed in the office.
These are additional safety measures we are taking to minimize contact in our office:
- Patients will use single-use pens to fill out paperwork.
- The used pens will be sterilized at the end of the day.
- The clipboards are sanitized between uses.
- Front counters and furniture are sterilized every hour.
- All door handles and sink handles are sterilized between each patient.
- Medical tables are sterilized between each patient.
- No handshaking or hugs in the office. Patients and staff all advised keeping a minimum distance of 6 feet from one another.
- We have masks and gloves available to wear in the office for those who ask.
- We are completely set up for telemedicine. Telemedicine appointments are encouraged. Patients who are sick and/or want to avoid physical contact can still get their medical needs taken care of by scheduling telemedicine appointments over the phone.
- The late cancellation fee will be waived due to illness during this public health emergency.
Fourth, it’s important to know the presenting symptoms of Coronavirus and be able to distinguish it from cold, influenza, and allergies. Coronavirus can present with one or more of the following symptoms: fever, cough, or shortness of breath. The newest data just released 3/19/20 now shows that diarrhea and GI symptoms can also be present. It’s possible to have only one of the symptoms. Coronavirus usually does not involve nasal stuffiness or drainage, sinus congestion, sneezing, runny nose, anything involving the central face. So if you have a runny nose or sneezing without a cough, that is NOT Coronavirus. That is most likely common cold or allergies. There are too many people with cold, flu, or allergies who are wrongly panicking that they have Coronavirus and are wreaking havoc on the ER and hospitals by showing up unannounced and wasting their time and precious resources with these symptoms that have nothing to do with Coronavirus. People suspecting Coronavirus need to call the local hospital in order to be screened and provided instructions over the phone on how to get tested and not just show up unannounced at the ER or urgent care centers or hospitals or doctors’ offices.
Difference between Coronavirus and influenza is flu usually comes on suddenly and Coronavirus symptoms come on more gradually. Also, flu is usually associated with a runny nose or stuffy nose, sore throat, body aches and pains, and chills along with fever, whereas Coronavirus is less likely to have these other symptoms.
Now if you are like me and have asthma—I can develop a cough after I get a cold or allergies and the nasal drip and stuffiness start traveling down to my lungs causing bronchitis and pneumonia. So the main difference with Coronavirus is it starts with fever, cough, or shortness of breath. People infected with Coronavirus can also develop bronchitis and pneumonia as it travels from their throat down to their lungs.
However, if you are sick with cold or influenza you should also stay away from the office to avoid contaminating other staff and patients.
This is a helpful link that describes in layman terms some of the differences between Coronavirus and cold and influenza:
This is a table of Coronavirus symptoms compared to cold and flu (from WHO and CDC):
Hopefully, a vaccine will become available in a year. In the meanwhile, there have been good responses to a drug called remdesivir which patients can potentially access through clinical trials. (I’ve attached a post below from Dr. Diane Hanna, one of my doctor friends who works in infectious disease and the military). I also have knowledge of some drugs that are helpful in combating Coronavirus which many of us doctors are aware of but are not revealing in public because we fear there will be a run on these drugs if the word got out, therefore, causing shortage. But if you or any of your family members or loved ones get infected with Coronavirus please let me know and I will give you prescriptions for these drugs.
Most people getting infected with Coronavirus will have very mild symptoms and possibly never even be aware that they were sick. The reason there has been a public ban on travel and large gatherings and the President declared a state of emergency Friday over Coronavirus is to minimize the spreading of the virus in order to protect the elderly with preexisting illnesses and those who are at high risk for serious complications and dying from Coronavirus due to being weak and immunocompromised. It is also to prevent overwhelming our health care system from too many elderly people getting sick at once requiring ventilators. China and South Korea are already showing a slowing of the epidemic and recovery. Hopefully, by practicing social distancing, we will contain this virus from spreading like it did in the Hot Zones and it will slow down as the warmer weather approaches so that after April the danger of overwhelming our health care system will have passed.
Please let me know if you have any questions. Everyone stay safe and look out for one another.
Hopes rise over experimental drug’s effectiveness against coronavirus
Many see remdesivir as one of few drugs that has reasonable prospect of helping patients