As Gail Collins of the NY Times might say, “Folks, it’s been a wild ride this week.” Lots is happening. We will try to update you quickly.
Recent comprehensive posts
We provided you our initial discussion of the new coronavirus infection (now called COVID-19 or Covid-19) at the end of January, Coronavirus 2019-nCoV Status: Do Not Panic. We gave a substantive factual update last Tuesday, Covid-19 (Former Coronavirus 2019-nCoV) Spreading in US, covering the increasing spread and our concerns about testing and further advice about how to protect yourself. And in an additional post last Wednesday I explained why my wife and I canceled our scheduled trip to Los Angeles to visit with our grandchildren, Travel in the Time of Covid-19.
For this update I will try to compactly organize and summarize the most significant new information, or possibly underline important decision variables where we still have insufficient information, as well as remind you of major reliable public sources of health information that you should be looking at with some regularity (I expect most of you are). And we stand ready to reply within a day to questions or comments you submit on these blog posts so all of you in Orchard Health Care have up-to-date scientifically accurate and practical advice. I am moderating the questions or comments daily. The earlier posts covered lots of ground on the disease, its range of severity, and basic self-care issues. Please refer to them if you haven’t previously.
Epidemiology, updated extent of spread
- The causative “novel” coronavirus itself was officially renamed 2019-nCoV for simplicity. The disease it causes was named COVID-19 or Covid-19 for those who find all caps to be a bit excessive. I conflated the two a bit in my prior post.
- Covid-19 continues to spread world-wide. The WHO and many others fear it is on track to be a pandemic, or epidemic that involves every country. It is likely that many of the countries not yet reporting any Covid-19 have simply not tested for it or possibly not reported their tests.
- In this country it is likely, but not yet certain, that there is “community spread” underway in a number of locations (such as Washington state), which means that there are too many infected but not yet symptomatic people to fully contain the infection, and these carriers represent a reservoir that will continue to infect others. Dr. Anthony S. Fauci, the esteemed head of the National Institute of Allergy and Infectious Diseases, said as much on Sunday morning talk shows today (I saw him on Meet the Press).
- Based on current trends, you can plan that the extent of spread will be worse as March progresses. If we had better testing capabilities, we could eventually be more precise.
“Social distancing” protections to employ
We are seeing many corporate actions to restrict meetings and business travel and to work from home, i.e., “social distancing.” Partners Healthcare has banned attendance at any large meetings and wants to restrict meetings to 30 or fewer, for example. Biogen, having recently had several of its employees become infected at a large corporate meeting with participants from many locations, now has most everyone working from home. The same is true for tech companies in California (read Google, Apple and others). We should pay attention to these decisions.
Summary advice from multiple sources is to avoid any large meetings (likely 50 or more) and postpone nonessential airplane travel. I think it is logical and necessary to expand this advice to increase social distancing to our own behavior. And all these concerns apply even more strongly to everyone over 70 or so, whose immune systems may not be as vigorous as they were a bit ago. In other words, reduce your potential exposure to Covid-19 through social distancing:
- We should consider carefully whether to attend normal indoor entertainment events (concerts, plays and so forth) beginning now or certainly within a few weeks.
- Avoid air travel unless essential. Postpone nonessential visits to hospitals for elective tests (e.g., routine colonoscopies).
- Hard community choices will likely follow. Whether certain communities need to close schools for a time may well be at issue this spring, not to mention thinking carefully about traditional town meetings. My home town of Lincoln has a Town Meeting the end of this month, which typically includes 500-900 people in one auditorium for 6-8 hours. What could possibly go wrong? How could we ever make such a meeting biologically safe right now?
Better testing becoming available at last
Our ability to advise people about risk of exposure or after possible exposure has been hampered for the past two months because of relative unavailability of specific viral tests for 2019-nCoV, the causative agent of Covid-19. Fortunately, the federal government finally got meaningful numbers of test kits distributed to state departments of public health, so our DPH and local hospitals (such as Newton-Wellesley, or Emerson, or the major teaching hospitals) can do the tests on people who meet the current criteria for exposure.
Those public testing criteria have been restrictive:
- Travel to an endemic area like China or Northern Italy (which no one should be doing), or exposure to or close contact with or coughing from a person with known Covid-19 or one who was shortly after determined to have Covid-19. Asymptomatic passengers on infected cruise ships were all tested so that those who were negative and virus free could be released without a 14-day quarantine.
- Casual contacts are generally of very low risk. For example, contacts of contacts of someone with Covid-19, unless themselves symptomatic, are not worrisome risks. That appears generally true.
- However, the guidelines do not cover every situation, and there are many ambiguous situations in which a person has an uncertain contact/risk and where getting the viral test, especially a negative test, would greatly simply management and reassure everyone involved. We have not so far been able to do any such testing.
Viral test for office use available as of tomorrow
Fortunately, major commercial labs such as Quest, whom we use regularly, have developed reliable Covid-19 tests and are now fielding them. As of tomorrow we will have access, when needed and appropriate, to test our patients for presence of 2019-nCoV. This is done by a nasopharyngeal swap (think long thin Q-tip into a nostril) that is put in special media and then sent to Quest. Results should be available the next day.
Dr. Sobel and I and the staff will work very carefully with any member who has symptoms of concern, whether severe or mild, and chart the correct course, which may be to go to a hospital, but may be to come to the office for carefully monitored and protected exam and obtaining a viral test. Obviously contact us by phone or email if you feel you may have been exposed so we can evaluate and advise.
Always remember basics
Wash your hands with soap and water. Wash your hands. Use hand sanitizer in between (if not available, use soap and water). Wipe down public surfaces with disinfectant wipes (usually available). Try not to touch your face too often. No handshakes. Cover any cough. Wash your hands.
Public websites to keep in mind and monitor
- Comprehensive medical information: CDC website for Covid-19:
- General and technical information, The New York Times Coronavirus section
- Johns Hopkins website that tracks worldwide Covid-19 infections
- Massachusetts Dept of Public Health coronavirus monitoring