March 5, 2020

From the US epicenter of the Covid-19, things remained calmer today, mostly due to the fact that many of my patients cancelled their medical appointments due to concerns of exposure to Covid-19. Also we have set up a separate Respiratory Illness Clinic in a different site and sent patients there that needed evaluation and possible testing for Covid-19. Anyone else with mild respiratory symptoms was advised to stay home. That really decimated my schedule! I did have some intrepid patients, so I had plenty of luxurious time with them. Add to that the near empty streets downtown and the lightest traffic I have seen in years, I realized that our mayor's and health department's advice to do "social distancing" might just work. I personally felt much less exposed to the virus. Avoiding crowds, keeping 3 feet away when talking with people, and washing hands is the old fashioned way of protecting from disease spread, and I hope it works to slow down the spread.

But I also have learned more about the virus and the illness. But first a word about testing, yes-more tests are available and are being done, but due to the back up in King County results will take 2-3 days. We have guidelines for when a test is ordered. Symptoms and/or known exposure risk are used to decide, not just because it is asked for. Obtaining a test from a possible case actually is a risky procedure for the provider. It requires the health care provider to swab the throat and get nasal pharyngeal swabs - the swab goes farther back in your nose than you can even imagine. The patient has to remove their mask, the act of obtaining the swab can induce coughing which can contaminate the healthcare worker. We are expected to be in "Full protective gear": gown, gloves, respirator mask, to be put on and removed in certain order, we are expected to place the specimens in double bags. 

And it is good to know that the test is reliable about positive results- if positive, the disease is confirmed. But if negative, it could be falsely negative and someone still have the disease. The test finds viral genetic material so the timing of the test is important too- get it too early after exposure and especially with no symptoms, the test may miss the virus because there is not enough there. After recovery it may be negative too. So just having a negative test in someone without symptoms may falsely make them complacent. 

As far as the illness goes, it is starts with cough and fatigue, maybe fever, not so much sinus symptoms. But unlike the flu where recovery starts after about 5-7 days. in coronavirus, the people that crash get sicker after 5-7 days. We don't understand why exactly. It is not a bacterial pneumonia, but this is the time when the vulnerable need close follow up. We also know that prednisone makes it worse. Interesting and makes me cautious. We are planning ways to keep close contact with patients at this time.

I expect the numbers of positive cases to go up with testing results in the next few days so don't be surprised. I am glad we will be getting more data and I am glad we are doing the measures in King County to limit the spread. Remember- wash your hands!

PS my notes yesterday about people taking prednisone should not scare people that use inhalers and nasal sprays to control their asthma and allergies. But when it is used in high doses for COPD and other respiratory illnesses it often helps,
but not in Covid 19