Half over and just starting

We have reached the mid-point for this year. We are over 100 days into a global pandemic. Our state had started reopening; we had done such an effective job sheltering in place that we flattened the curve. So, we got the green light to go back out in the world: shop, eat out, socialize albeit at a distance. We went back to work. Then things started to shift. So, we started doing more tests. While we do not know how many actual tests are collected and performed each day, the number of positive cases has climbed exponentially. Today, the Governor issued notices that bars had to close – again. Masks are mandated. Hopes of a phase 4 opening are halted. The positive cases are predominantly in asymptomatic, younger people. But, that increases the concerns for super-spreading.

What do you do if you get a positive antigen (PCR viral) test. This is the nasal swab that confirms actual virus in the nose and throat. This means you spread the virus by talking, breathing, coughing, singing or yelling and being close to other people. If you are positive and you do not wear a mask, you shower the virus all over the people and objects around you. And you will remain contagious for 14 or more days. If you are positive on a nasal swab, you must quarantine yourself from your family and the public.

There is NO TREATMENT for this virus unless you end up in the hospital. When do you go to the ER? High fever, shortness of breath, difficulty breathing, diarrhea that you cannot control. But, if you are without symptoms or your symptoms are mild: sore throat, headache, runny nose…..the treatment is the same as for a common cold: Tylenol, Advil, fluids and rest.

Patients have called and asked for hydroxychloroquine (Plaquenil). The evidence now shows that there is NO benefit to taking Plaquenil for COVID. There is very serious risk for heart rhythm disturbances and sudden death. It is not used except in the most extreme ICU, ventilator-dependent patient. The data in these patients is also very poor. It simply does not work. We will not be prescribing hydroxychloroquine to any patients.

Patients have also asked for antiviral pills (remdesivir) and azithromycin (Z-pak). We do not give antiviral in the ambulatory setting. This drug is saved for the ICU, ventilator-dependent patient. The azithromycin is used in the ICU setting in patients with secondary bacterial pneumonia and sepsis. It is given is super high doses via intravenous lines. The Zpak pills do not help COVID in the community setting.

If you get diagnosed with COVID and you have a cough, a terrible headache, high fever, fatigue, body aches and maybe some diarrhea but you are not short of breath or in distress….the treatment is to quarantine and follow supportive measures. You will feel BAD. It will be the sickest you may have ever been. COVID makes the flu look like a walk in the park. You will be sick. Or…you may have very mild symptoms. The most important thing is to monitor yourself and to stay isolated so you do not spread it.

June 2020