As Chief Medical Officer I am asked daily about advice to Caduceus patients about the Coronavirus; now called Covid-19. Wanting to keep the advice timely and factual, it is very difficult to separate the facts from hysteria. But someone has to do it, so here are the recommendations for Caduceus patients from the CMO.
First realize there are FOUR different bugs going around now plus the threat of Covid. Let’s look at each…
1. A bacterial infection is currently on the rise-sore throat, productive cough, fever, maybe sinus symptoms. If you are fit and healthy, it may wear itself out in 3-5 days. If you are very young or very old, frail, or sickly, it may lead to pneumonia or sepsis. An antibiotic is effective, and we may be able to swab for it, or do a blood test or xray to make an accurate diagnosis.
2. A viral syndrome with low grade fever, sneezing, cough, can be difficult to differentiate from a bacterial one at first. Even an experienced provider may need testing to tell the difference. It is usually less serious and runs its course over 2-3 days. Antibiotics do not work for a typical virus. We are seeing a fair number of these cases now, on par with this time of year.
3. NEITHER of these are the “flu”. Influenza is a totally separate animal. High fevers, aches, abdominal distress, dry cough, and feeling like you’ve been run over by a truck are common symptoms. It can be diagnosed via a swab in the office. There are special influenza meds (eg Tamiflu) that help reduce the symptoms and duration. The “Flu” seems to have peaked and even gone in Orange County for 2020. In my personal practice we haven’t had a positive case since Feb 15th. The Health Department confirms we should see very few new flu cases in March.
4. Covid-19 begins as a typical viral illness- sneezing, coughing, low grade fever. But there are serious differences.
Fortunately, we have not had a lot of cases in Southern California–at least not officially diagnosed. But the virus can be spread for two weeks before symptoms appear. In that time, hundreds of people have been put at risk. It is spread by droplets, so simply being near an infected person can spread it if they cough or sneeze. And the 88,000 cases (as of this writing) is misleading since those are CONFIRMED cases. At least 10 times that number have occurred but just not tested for.
There is hope that as a cold weather bug, it will fade away with warmer weather. Yet it is still growing at over 1,000 cases a day being reported world wide; the same number as late January when it first appeared. If more kits were available, you can estimate how many new cases are actually occurring.
To hear an official say “we have this under control” is irresponsible. To hear people on social media say “There were more flu deaths, life goes on” is just idiotic. For one thing, the flu deaths were over an entire season. This pandemic has just begun.For another, would these same people take a vacation to beautiful downtown Baghdad? Stroll thru the streets of Sinaloa Mexico? Of course not because we know that is dangerous. Covid 19 should also be considered dangerous.
What is the difference between an epidemic and a pandemic? An epidemic refers to a condition spreading rapidly. A pandemic is an epidemic spreading throughout the world. We are now in a pandemic. The flu was not a pandemic.
As CMO, I am advising the following measures for our patients at least thru March:
1.If you are sick, don’t travel. In fact don’t leave the house if possible. Of course this is always common sense. But now you run the risk of being quarantined if it is considered possible you harbor Covid 19. Many countries are screening passengers for even low grade fever. Flight attendants are instructed to report anyone they feel is showing signs of infection. If you have a fever you will be detained. and not just sent home, but put in isolation.
2. If you are not sick, but very young, very old, frail, or sickly avoid ALL non-essential travel, or areas where crowds circulate. That means malls, theme parks, churches, even ball games. Going to a school or office may only expose you to dozens of close contacts. But a crowded day at Disney will expose you to THOUSANDS of people who may be incubating Covid.
If you are fit and relatively healthy, use common sense. Avoiding crowds and non essential travel may seem like overkill but it isn’t just about protecting you- its keeping an unknowing carrier from spreading the virus to thousands of uninfected people. We do not advise staying home from work or school, but if you can cancel that trip to Europe or postpone the day to Universal Studios, it will go a long way to stopping the spread and protecting yourself and your family.
3. If you do travel in March, realize there is a high chance of disrupted travel. You may be not allowed to leave your area or be house confined. Bring your own thermometer, your own cold meds, and an extra supply of your prescription meds in case you are stuck somewhere for weeks. Have documentation of your health insurance with you. Realize you may find tourist venues closed, events canceled, and long lines at areas where screening is going on.
4. Common sense dictates frequent hand washing. Remember the rule is to wash singing “Happy Birthday” to allow enough time to wash. If you are using hand sanitizers like Purell, five seconds is sufficient. Avoid touching other people if possible, maybe a thumbs up instead of shaking hands. Prepare your own meals as much as possible. If you must cough or sneeze in public, cover the face or turn away. Normal face masks are insufficient to block Covid–you’ll need to look for N 95 masks. But if your coughing enough to need the mask –STAY HOME! If you are wearing the mask to protect yourself its probably not necessary if you are fit and healthy.
5. If you feel you may have one of those three conditions at the beginning of this blog, DO NOT ignore it. Use Mouse Calls or video visits to talk to your provider. If you feel you must come to the office, alert us so we can swab you or draw your blood in the comfort of your car. If you need to be seen in an exam room, you will be escorted thru the lobby if you alert us in advance. ALL respiratory type infections should be seen and worked up during this crucial time. Covid testing is done at the health dept.
IF World wide screening is effective
IF everyone follows these FIVE simple rules
IF Covid is a cold weather bug only
The pandemic will be history. Otherwise we may witness a pandemic unseen in our lifetimes.
Gregg DeNicola MD
Chief Medical Officer