covid update sign

There’s something happening here…
What it is ain’t exactly clear…

Stephen Stills had it right in the 80’s. We’ve been dealing with Covid for over six months now, and how do we deal with it? Well- it’s not exactly clear.

We will address these issues today:

• The newer trends and what Covid has told us
• Announcing new testing policy at Caduceus
• A call to action to our patients and the public on how to curb the spread

If there is one thing we have learned this year is that we have run out of patience.

At first, we all were united. We saw the horror of China. The devastation of Europe. The ambulances lined up with bodies in New York.

So we quarantined. Locked down. Hunkered.

And the numbers in California dropped from April through late May.

So we reopened. But not smartly. We were ready for returning to some type of normalcy. Going out to restaurants. Memorial Day gatherings. Protests. But Covid plays by ITS rules, not ours and the June, July, and August numbers skyrocketed.

We became divided. Maskers vs. Anti-maskers. Social distancers vs. life as normal. Sadly, it became political. Even Right vs. Left managed to somehow arm wrestle over what should have been a unifying crisis.

Fortunately, as masks and distancing became the “new normal,” the numbers began to fall in the first half of September. So much that in Orange County we were allowed to open back up- restaurants, theatres, gyms, and churches. And at the same time, here came the Labor Day weekend.

We warned our patients about gatherings, parties, and BBQ’s. About frequenting restaurants and hanging out downtown instead of our living rooms.

We’ve all heard Albert Einstein’s famous line, “Insanity is doing the same thing over and over again and expecting different results.”

You guessed it; we are seeing another spike in cases- apparently learning little from our Memorial Day experience.

We shouldn’t be surprised. Covid has now told us exactly how it works.

• It has a two week incubation period where it is spreads even if no symptoms.
• It can spread by micro droplets, far beyond our arbitrary six foot boundary.
• It has a high penetrance rate—i.e. it doesn’t take a lot of Covid to spread; it’s very “catchy.”
• It doesn’t care about the age of its victims.

At Caduceus we have been tenacious on our position.

As CSNY would say,

We, who have a Covid load
Must have a code
That we can live by…

And here is ours….

Know if you’re contagious.
Know if you’re immune.

In Europe, the caseloads are also rising quickly. Where they had been using universal testing with good results and lowering the numbers, they took their eye off the ball when the numbers fell. The European view is shifting toward individual responsibility, and not government action. Instead of locking down and pushing for universal testing, European governments note that many Europeans are tired of the whole thing. Testing, masks, and distancing are less common now, and the rising European numbers are proof that as tired as we all may be, we will not start to see blue skies until we know who is contagious, and who is immune.

Caduceus and PDQ Urgent Care and More are now offering improved PCR swab testing for Covid. At this time, we are no longer using LabCorp or Quest for our testing. (Except on patient request).

This was not punitive or political. We simply could not rely on the results being timely, and our calls to check on the results on behalf of our patients went unanswered.

We have made arrangements with smaller labs that have the same machines, but can meet our needs regarding turnaround time.

We now offer our patients with insurance NO OUT OF POCKET PCR Covid testing with a 2-3 day turnaround.

This allows us to further advise our patients to set up a REGULAR testing schedule without worrying about out of pocket payments.

If you need a 24 hour turnaround,
We can offer you an expedited test for a cash price of $189.

In addition, I recall an old ad campaign for Toyota that said, “You asked for it, you got it.”

If you have no insurance, we can offer you the antigen test with a physician’s order for $66. Results while you wait or we will follow up with you same day if you prefer not to wait curbside.

That’s the deal with swabs for presence of virus. How about immunity?

We continue to use “moderate complexity,” a more sensitive antibody test to help determine if you are immune. We alert you that some insurance plans are not covering antibody testing, so in that case we offer a cash rate of $85 for moderate complexity and $75 for low complexity antibody testing.

One example of how testing may help bring down the numbers…

A family we are caring for wanted to have a family gathering of 10 people over the Labor Day weekend. Of course, I discouraged it, but there were mitigating circumstances that made it essential. The ages ranged from 20 to 80 and many had jobs serving the public.

We ordered PCR testing the day before the gathering. Results were back the next day. All 10 were PCR swab negative. (Antibodies were also negative so no immunity.) They still practiced precautions, but it was reassuring all 10 were Covid free at the same time. It has been over 14 days, and no Covid came from that gathering.

Testing works.

Let’s look at a gathering without testing—

65 people attended an August 7th reception at the Big Moose Inn Cabins in Maine. By August 25th, 53 cases were tied to the wedding. A week later, 147 people who attended the wedding or got the virus second-hand as a result of someone who attended the wedding tested positive for Covid.

Even worse?

Three of those people have died. None of the fatalities had even attended the wedding.

Testing works.

In addition to offering improved testing choices, I also encourage setting up a regular testing schedule for ALL of our patients.

If you serve the public (health care, restaurants, retail workers),
Test every two weeks (Caduceus and PDQ test their staff at least every two weeks.)

If you are usually home or in a small office, but do go out and about,
Test monthly.

If you hunker down at home and rarely go out,
Test quarterly and on demand when you must go to a gathering or meeting.

All patients should consider an antibody test every 1-3 months to detect immunity. If it is negative, take extra precautions.

And as always, all of our testing is done by video from your phone and curbside so you never leave the security of your home or car.

For both swabs and antibody tests, you do not need a physician’s order if you have had a telehealth visit (or office visit) in the previous 12 weeks and were negative.

In summary:
• Learn from this summer… Mask. Distance. Avoid gatherings. Don’t give in to impatience.
• Get tested regularly. If you are contagious, self-quarantine. and if you are not immune, take extra precautions.
• Don’t succumb to peer pressure or your own impatience to socialize unnecessarily or go without a mask. Covid has told us its rules. Listen to them.

If David Crosby could write a song about Covid now, it might go…

Must be because I’m worried I’ll get Covid at Christmas
And I’m not feelin’ up to par
It increases my paranoia
Like not wearing my mask then seein’ a police car
But I’m not givin’ in an inch to fear
‘Cause I promised myself this year
I feel like I owe it to someone
To be tested
Hoping my Covid swab shows none

Gregg DeNicola MD, Chief Medical Officer

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